Introduction: During 1986-2009, an estimated 1.6 million persons were internally displaced from northern and eastern regions of Uganda due to civil war. We investigated accessibility to and availability of health care services for the internally displaced persons in Kitgum and Pader districts, northern Uganda. Methods: This was a cross-sectional study conducted in Kitgum and Pader districts, northern Uganda. We interviewed a total of 1383 respondents comprising 968 (70%) adults and 415 (30%) adolescents; 60% were females and 40% males, randomly selected from 35 of 67 (52.2%) internally displaced persons (IDP) camps. We held 27 key informant interviews and 52 focus group discussions. Data were entered in EPI data version 3.02 and analysed using SPSS version 12.00 statistical packages. Findings: Two thirds of the respondents 67.5% lived within 5 km distance of a health facility. The majority 62.9% of respondents mentioned that health related information was readily provided. 43.5% of health providers were always available in a health facility. A quarter 25.1% of health facilities always had drugs available, while 56.9% of the drugs prescribed were always available. Two thirds of the respondents 65.9% were satisfied with the health care services provided. The main reasons for the choice of a health facility were proximity 29.6%, provision of free treatment 24.7% and availability of drugs 17.2%. Main barriers to health care access were due to the lack of financial resources, trained personnel, and inadequate drugs and supplies in the health facilities. Conclusions and Recommendations: The majority of IDPs lived in close proximity to health facilities and obtained health care services from public health facilities. Access to health care was determined mainly by proximity and availability of free services and drugs. Although geographic accessibility to health services was high, lack of finances, information and decision power hindered access to health care services.
Over two decades of a protracted civil war between the Lord’s Resistance Army (LRA) rebels and the government armed forces, led to the displacement of an estimated 1.6 million persons from northern and eastern regions of Uganda during 1986-2009 [
In 2005, the vast majority 95% or 279,000 and 93% or 267,000 of the populations of Pader and Kitgum districts respectively were displaced into squalid internally displaced persons camps. A total of 64 internally displaced persons camps were established, 30 in Kitgum and 34 in Pader districts respectively [
During the peak period of displacement in 2005-2006, the health indices in the Acholi sub-region were poor with high crude and under five mortality rates, estimated at 1.54 and 3.18 per 10,000/day respectively. The crude mortality rate (CMR) and the under five mortality rate (U5MR) in Gulu district IDP camps were high, estimated at 1.22 and 2.31 per 10,000/day respectively. These mortality rates were both above the emergency thresholds of 1/10,000/day and 2/10,000/day respectively and the national estimates of 0.46/10,000/day and 0.98/10,000/day respectively [
During emergencies, displaced populations especially women and children are extremely vulnerable to ill health owing to a variety of socio-cultural, economic and physiologic reasons [4,5]. Several factors including insecurity, poverty, poor nutrition, inadequate water and sanitation, and lack of adequate health services predispose displaced populations to high levels of morbidity and mortality [
In situations of emergencies the health system is heavily burdened, and the problems of the quality of services and inadvertent discrimination may arise, yet it should ensure respect for human rights and the attainment of the highest standard of health [
Since 2007, the phenomenon of displacement has gradually evolved into return home (resettlement) and the camp population shifted into decongestion settlements in northern Uganda. Today the majority, over 90%, of the population in the Acholi sub-region has returned home. The objective of this study was to examine accessibility to and availability of health care services to internally displaced persons (IDPs) in Kitgum and Pader war affected districts, northern Uganda.
The study was carried out in Kitgum and Pader districts in northern Uganda. In 2007, there were an estimated 629,617 internally displaced persons i.e. 310,111 IDPs in Kitgum and 319,506 in Pader districts respectively [
We carried a cross-sectional study comprising internally displaced community members including adults and adolescents, service providers at the central and local district levels (including Ministry of Health and local district health services providers and humanitarian relief i.e. UN agencies, international NGOs and community based organisations (CBOs).
We sampled 15 of 24 IDP camps (62.5%) in Kitgum district and 20 of 43 (46.5%) camps in Pader using both purposive and random sampling techniques. The camps were stratified by parishes, population size, and security considerations and randomly selected into the study.
Administratively, a camp is sub-divided into blocks and zones. A block constituted a study cluster. We selected households based on the modified WHO Expanded Programme of Immunization cluster sampling technique [
In a household, either a male or female adult head of household was interviewed. We selected male or female respondents in the proportion of 40% to 60% respectively. However, after every third household, an adolescent aged between 14 and 19 years was identified and interviewed. A total of 51 respondents (adult/adolescent) were interviewed per cluster in Kitgum and 40 in Pader district. In total 1383 individuals comprising 720 (52%) of respondents in Pader and 663 (48%) in Kitgum district were interviewed.
We held 27 in-depth interviews and conducted 52 focus group discussions. The key informants included camp commandants, and Local Council I, II and III Chairpersons, in charge of health units including health centre II and III. In addition, leaders of community-based organisations (CBOs) were interviewed. At the district level, civic authorities including local council (LC V) chairpersons, resident district commissioners, chief administrative officers; and in the health sector, the district health team members such as the district health officer (DHO), medical superintendent, medical officers, the person in charge of the nurse training school (the matron), district health visitor, and personnel responsible for health centre IV were interviewed. Finally, we interviewed various
humanitarian relief workers from agencies including United Nations High Commission for Human Rights (UNHCHR), United Nations Children’s Fund (UNICEF), World Health Organization (WHO), and Non-Governmental Organisations as shown (in
We held 27 in-depth key informant interviews with 14 staff from international and local humanitarian agencies (UN/NGO/CBOs), 8 with district health staff, and 5 with community and district civic leaders.
We conducted a total of 52 focus group discussions (FGDs) (
More than half of the FGDs (28 of 52, or 52.8%), were carried out with adults (men and women), 16 of 52 (30.8%) with adolescents (males and females), and 7 of 52 (13.5%) with community leaders.
Data collectors (research assistants) were trained for three days. The study instruments comprising (questionnaire, focus group, and key informant guides) were translated into the local language-Luo/Acholi and back into English. The data collection tools were pre-tested. Quantitative data were captured, cleaned, and edited. The completed questionnaires were checked by the principal investigator daily for accuracy, completeness and consis-
tency before the data collectors left the IDP study sites/ camps. Quantitative data were checked for completeness, sorted, coded and captured using EPI data version 3.02 packages. The data were entered in Epidata version 3.1 and analyzed using SPSS version 12.00 software package. Qualitative data were analyzed manually. Content analysis was based on condensation and abstraction of main themes.
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