Availability of health care for older persons in primary care facilities in Uganda

Background. This thesis evaluated the health care available and delivered to older persons (≥50years) at primary care facilities in Uganda in order to identify gaps and weaknesses and to suggest potential solutions for improving the quality of their care. Methods. The study was conducted in 48 primary care facilities across Uganda. It involved structured interviews with the persons in-charge of the facilities to determine what health care was provided at their facility; analysis of the numbers of outpatients attending the clinics to determine the absolute and relative caseloads due to older persons; structured interviews with health workers to determine their knowledge, attitudes and practices regarding the care of older persons; and structured exit interviews with older persons and younger adults (35-49 years) to determine their perceptions of the services they had received from the facility. Study participants were selected through a multistage stratified random sampling method designed to give a representative sample of Ugandan government primary care clinics and outpatients. Data were analysed using methods for complex multistage surveys. Findings. Availability of services: The study found important gaps and weaknesses in the availability of services, equipment and amenities that were considered to be particularly important for the care of older persons and that were enquired about in the study. Availability was particularly low for non-communicable diseases and at lower level (levels II and III) primary care facilities. Caseload: A total of 11,847 out of 140,338 total visits (8%) were made by older persons. Infectious illnesses (63%), as opposed to chronic non-communicable diseases (32%), were the most commonly diagnosed illnesses among the older persons. Knowledge, attitudes and practices of health workers: In total, 145 health workers (92% of target) were interviewed. Using predefined criteria, 32% of them were classified as having poor knowledge of geriatrics and 68% as having at least satisfactory knowledge. Most of them (97%) were classified as having neutral attitudes towards older persons. Although hardly any of them (0.6%) was classified as having bad practices overall; a substantial proportion reported not giving older persons and younger adults autonomy (46-49%), health education (15-35%), prompt attention (19-30%), and or screening for diseases that are common in older persons (14-17%). Perceptions of older persons and younger adults of the services they had received: In total, 244 older persons (96% of target) and 96 younger adults (100% of target) were interviewed. Although only 16-17% were classified as having received poor treatment overall, a substantial proportion reported not being screened for common diseases found in older persons (65-70%), receiving prompt attention (66-76%), having autonomy (70-80%), or receiving health education (30-39%). Only 1-2% perceived they had received poor service from the primary care facilities. Generally, older persons were not treated differently from younger adults (p=0.52) and their perceptions of the services were similar (p=0.21). Conclusion. There were important gaps and weaknesses in services important for the care of older persons, and in the knowledge, attitudes and practices of the health workers. The Ministry of Health should therefore investigate how they might improve services for older persons at all levels of primary care facilities.