CHALLENGES OF HEALTH SERVCE DELIVERY IN RURAL AREA OF UGANDA; ACASE STUDY OF SUBCOUNTY, MUBENDE DISTRICT.
Health is an issue of concern worldwide. There are various definition of health, some formal and informal. Most people define it as merely absence of disease. However in 1948, two year after its formation, the world Health Organization obtained a much broader explanation to the meaning of the Health to include aspects beyond mere absence of disease for example welfare of an individual. It defined health as; A state of complete physical, metal, and emotional wellbeing of an individual and not merely absence of disease and infirmity. Poor health is a threat to both survival and productivity society. This has drawn concern of how adequate health care systems can be developed, maintained, and sustained. Measurement of health is done basing on three major indicator; mortality, mobidity and Disability Mortality measures the number of deaths per unit time usually per one thousand individuals per year, Mortality measures the levels of incidence and prevalence of a disease in a population while Disability measures the level of hand cap or any other forms of limitations in normal functioning of an individual. There more the mortality, morbidity and disability, the healthy a population is.
In a bid to contain these indicators, five forms of health services to treat signs and,symptioms of ill health, Rehabilitative service to restore victims of individuals and significant others and provide services to build coping ability. In 1995, the constitution of Uganda provided for the decentralization of service delivery to governments with an aim of bringing services closer to people. In the health sector, a notional structure was built in referral form from grass root to national level. Health centre one was set up comprising of semi trained persons (village health team) meant to link community members to health services at village level, Health centre two at parish level,Genenal hospitals at sub county level, Health four at county level (health sub-district). General hospitals at district level, Regional referral hospitals at regional level and National referral hospitals at national level. A national health policy was established (1999) to guide health service delivery It emphasized implementation of the National Minimum Health care package, a set of interventions that address common causes of diseases. It aimed at control of communicable diseases, management of childhood illnesses, sexual productive health. , Essential clinic care, Strengthening metal health facilities and other public interventions. However, chronic illnesses like cancer high blood pressure and heart diseases, which are on the rise locally, were not catered for. Mubende district has overtime partnered with Non-Governmental Organizations and the private sector at large to deliver health services to people. The three year development plan (2009/10, 2010/11, 2011, 12) stipulates targets to be achieved regarding the health sector including equitable, efficient and effective and effective health services delivery. Health infrastructure was built and trained persons deployed to health centers Kiyuni sub-county in particular has a health centre iii Facility with personnel and equipment although about more is still desired. However even with this complex and ambitious investment in health by the Uganda government, the rates of morbidity, Mortality and disability are still frustrating rural areas. It is not exacting clear why rural eras of Uganda have not benefited from this rather’’ Buffy ‘health system as urban areas. It is therefore upon this background that the research wishes to undertake a study to explore the challenges that have impaired health service delivery in kiyuni Sub County, Mubende district in order to draw knowledge on how health care can be provided more equally and effectively to rural areas of Uganda.
The goal of the state in the health sector is to attain a good standard of health in order to promote productive life (National Health policy 1999), In this regard, a national health service diver structure was drawn from from grass root to national level. Priority was put on implementation of the National Minimum Health care package equally, equitably, efficiently, effectively and sustainably to all citizens of Uganda. This has fetched many achievements especially in urban areas. On the centrally, rural areas seem not to have benefited as much from this health system. Prior research indicates very low level access to health centres. Forexample, 51% of the population are in over 5km distance from a facility ( Mubende district development plan 2009/10-2011/12).Few facitities exist in rural areas where they exist, they are in sory state. They are under staffed,poory equuired and have inadequate or no physical infrastructure like water and electricity. In liyuni sub county, the rates of infant mortality, martenal mortality child mortorlity and general crude death is worring.People still die of preventable illnesses like; Malaria olds and diarrhea stunited, underweight and generally mulnutrished children are common. The level of sanitation is very low indicated by low toilent coverage and sale water is a mystery. The impact of HIV/AIDs is very evident despile the high levels of awareness about the epidemic.