INTRODUCING QUALITY MANAGEMENT INTO PRIMARY HEALTH-CARE SERVICES IN UGANDA

In 1994, a national quality assurance programme was established in Uga nda to strengthen district-level management of primary health care ser vices. Within 18 months both objective and subjective improvements in the quality of services had been observed In the examples documented h ere, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting time s and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyo nd these quantitative improvements, increased morale of district healt h team members, improved satisfaction among patients, and greater invo lvement of local government in the decisions of district health commit tees have been observed. At the central level, the increased coordinat ion of activities has led to new guidelines for financial management a nd the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health head quarters have led to a greater understanding by central staff of the i ssues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control pr ogrammes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to prov ide appropriate support At the district level, some health teams tackl ed problems over which they had little control or which were overly co mplex; others lacked the management capacity for problem solving.