If you’re a health worker in Uganda, what do you need in order to provide the best possible care for your patients – people who could be suffering from anything from HIV to broken limbs? You need a range of medicines and other medical supplies, like stethoscopes or blood pressure cuffs. And of course enough medical personnel.
But perhaps most fundamentally, you also need the basic infrastructure to provide patient services. This means regular electricity, running water, and access to transportation. The physical infrastructure of health facilities can have an enormous and basic impact on how services are delivered – but we often don’t think about infrastructure’s important role until health systems start to fall apart.
In the case of the Ebola crisis in West Africa, the role of physical infrastructure was clear. Facilities were overwhelmed. Without functioning water, electricity, or waste disposal systems, many facilities could not practice good infection control – a potential driver of continued disease transmission. Patients resorted to using cabs or public transportation, increasing risk of exposure to Ebola, when facilities couldn’t provide transportation. Together, these deficiencies made it extraordinarily difficult to not only contain the disease, but also to successfully respond to Ebola’s rampage of West Africa.
When news coverage primarily focuses on health system failures, it often overlooks the places where health care infrastructure improvements are occurring, such as Uganda. Through an ongoing study focused on assessing health system performance, researchers at the Infectious Diseases Research Collaboration (IDRC) and the Institute for Health Metrics and Evaluation (IHME) found that Uganda greatly improved its health facility infrastructure across the board.
Below is a graphic that shows the availability of functional electricity and piped water, two key indicators of improved infrastructure in Uganda. (The data are from IDRC and IHME’s recent report on health service provision in Uganda.)
Availability of improved facility infrastructure in Uganda, 2012. Source: IHME, 2014
All surveyed hospitals had functional electricity in 2012, a substantial gain given that 14% lacked electricity in a 2011 survey. Functional electricity was also available at the vast majority of Uganda’s main facilities for primary care (health center IVs and health center IIIs). This is also a huge improvement, given that a 2007 study found that less than 20% of Uganda’s primary care facilities had reliable electricity.
IDRC and IHME’s study also showed that nearly 100% of hospitals and 67% of health centers had piped water. (In 2000, fewer than 10% of health centers had piped water, largely relying on boreholes or springs for water.) With these gains in water availability, health workers are better positioned to reduce the spread of infections and ensure that their medical equipment is clean.
So what did Uganda do to improve its health system infrastructure? In 2005, Uganda’s Ministry of Health explicitly set ambitious infrastructure goals for existing health facilities. These targets were developed after the Ministry found that access to health services improving since 2000, a time when Uganda started building many new health facilities, without accompanying gains in health service quality. The country’s Ministry of Health then mapped out a facility rehabilitation plan, hospital by hospital, health center by health center.
Two years later, the national government pledged to improve physical infrastructure for health as part of Uganda Vision 2040. With some financial support from China, large investments have been made to improve telecommunications, water, electricity, and transport. The World Bank also awarded Uganda substantial funds for health system strengthening, specifically to enhance existing health facilities’ infrastructure.
Room for improvement remains, especially for the country’s smallest facilities that operate at the community level. As Uganda achieves great progress throughout its health system, the country’s investments in its health system infrastructure will likely translate into even greater health gains in the future.