Effectiveness of Training Health Unit Management Committees on Performance of Health Centres, in East Central, Uganda
Gangu, Muwanguzi David
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There has been poor performance of health sector in East Central Uganda leading to the Districts in East Central Uganda perpetually being at the tail end of the Uganda National District Performance League Table. Performance of the health sector is the sum total of the performance of individual health centres. Uganda embraced decentralization and Primary Health Care Concept that provide responsibility for managing performance of health centres at lower administrative levels. The performance driven management of health centres is completed by having in place competent and knowledgeable management committees. This study investigated the effectiveness of training of Health Unit Management Committees (HUMC) on performance of health centres in East Central Uganda. Specifically, the study assessed how the socio-demographic characteristics of members of the management committees were affecting performance of health centres. The study ascertained the performance levels of health centres and assessed the effect of training members of Health Unit Management Committees on performance of the health centres. The study was interventional employing the design of a randomised community trial. The study was done in East Central Uganda in 24 health centres. These were randomly selected into two study arms as intervention and control arms each arm with 12 health centres. Out of expected 288 members, only 280 members of Health Unit management Committees participated in the study. Data from monthly reports provided the records for assessment of individual health centre performance. The dependent variable was the performance of the health centres. The independent variables were the factors that influence performance of health centres including the social demographics of the HUMC members. The intervention was training of the Health Unit Management Committees. The study used both qualitative and quantitative data collection techniques. Data was analysed using Chi-Squares for the bi-variate analysis and pearson‘s correlations. Logistic regression was then employed for the multivariate analysis on factors that drive performance of health centres in view of training of HUMC members. The results showed that Good performance of health centres was dependent on ages of members of HUMCs (P-Value 0.005), occupation of HUMCs p-value 0.006, economic level p-value 0.05 and education level of these members (P-Value-0.003). The performance of individual health centres in East Central Uganda had been poor prior to training of Health Unit Management Committees. After training of members of health unit management committees in the intervention arm, performance improved and was better than those health centres in the control arm. The t-test statistic showed that training of HUMC improved performance of HC (p value 0.000), and this had the strongest association with improved performance with odds ratio of 164.22, age had odds ratio 38.56, education level had odds ratio 59.43, profession of member of HUMC odds ratio 26.16 and economic level at odds ratio 1.41. It was concluded that performance of health centres in East Central Uganda depended on social demographic characteristics, was poor prior to training of HUMCs and training of members of health unit management committees greatly improved performance of health centres. It was recommended that average aged members that are trainable be appointed members of HUMCs, Ministry of Health of Uganda increase resources to enhance performance of HCs and enforce HUMC involvement and participation in running HCs, and all members of HUMCs be trained by policy from the Ministry of Health.