Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: a Poisson analysis using the Service Availability and Readiness Assessment
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Abstract
Objective Although the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD). Methods We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables. Findings In multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities’ EM-NCD counts were 98% higher than public facilities (p<.001). General hospitals and referral health centers had 98% (p=.004) and 105% (p=.002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p=0.015; p=0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p=0.006). Offering HIV counseling and testing was associated with 57% higher counts (p=0.048). Conclusion We identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.
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2017. Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: a Poisson analysis using the Service Availability and Readiness Assessment. PeerJ Preprints 5:e3197v1 https://doi.org/10.7287/peerj.preprints.3197v1Author comment
This is a preprint submission to PeerJ Preprints that is currently under external peer review.
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Competing Interests
The authors declare that they have no competing interests.
Author Contributions
Mari Armstrong-Hough conceived and designed the experiments, performed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.
Sandeep Kishore conceived and designed the experiments, analyzed the data, wrote the paper, reviewed drafts of the paper.
Sarah Byakika reviewed drafts of the paper.
Gerald Mutungi reviewed drafts of the paper.
Marcella Nunez-Smith reviewed drafts of the paper.
Jeremy Schwartz conceived and designed the experiments, analyzed the data, wrote the paper, reviewed drafts of the paper.
Data Deposition
The following information was supplied regarding data availability:
The raw data is owned by a third-party (Uganda Ministry of Health) which has not given permission to publish it as part of this manuscript.
Funding
This work was supported by the Yale Global Health Leadership Institute Hecht-Albert Pilot Innovation Award for Junior Faculty. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.