Orthopaedic Outreach Program in Uganda: A Strategy to Improve Inequality in Service Delivery between Rural and Urban Communities

Abstract

Background: Musculoskeletal diseases are on the increase worldwide. Greater than 80% of Ugandans live in rural areas, facing formidable barriers to specialized care. In 1991 the Orthopedics Outreach Program (OOP) was initiated as a plausible solution to the inequity of orthopedic care between the urban and rural disadvantaged populations. This investigation was conducted to evaluate the output, effectiveness, and barriers to access, of the OOP over 13 years.

Methods: This was a retrospective analysis to quantify surgical output and effectiveness of the OOP using the outreach record and a cross sectional analysis to assess access and efficacy of the program. Semi-structured and key informant interviews targeted to key actors involved in the OOP were conducted to provide a qualitative assessment of the program.

Results: Sixty seven outreach visits were completed, 6,653 patients seen, and 1,071 surgeries performed, at a total cost of US$12,701.00. The cost per patient seen was US$1.91 and US$11.86 per surgery performed. Poverty was uniformly cited as barrier to access, others were, transportation, and lack of awareness. There was unanimous opinion on the worthiness and effectiveness of the OOP, but many operational issues and constraints were cited.

Conclusion: The OOP may provide a short and medium term solution to equity and access for orthopedic care in Uganda. There is need to quantify the burden of specific orthopedics conditions. A follow-up analysis assessing operational efficacy and output from 2004 to date, under the African Medical and Research Foundation (AMREF) and Ministry of Health funding is recommended.