Access to Health Care by Urban Refugees and Surrounding Host Population in Uganda

Abstract

Uganda hosts an estimated 34,200 urban refugees who are living within the peri-urban areas among nationals in Kampala city. The study assessed factors that affect access to health services by the urban refugees and host communities. A cross-sectional study was conducted between July 2011 and June 2012 employing qualitative and quantitative techniques of data collection. Using structured questionnaires and guides, 944 heads of households interviews who were randomly selected using cluster sampling, 6 key informant interviews and 2 focus group discussions were conducted. SPSS, STATA and manifest-content analysis was used for analysis. The factors found to promote access to health services for refugees and host communities were availability of health facilities, (91.2%, 229/246) for refugees compared to (97.8%, 220/224) for nationals (OR = 2.61; 95%CI 1.36-5.03; p<0.05); and geographical accessibility to health facilities within a 5 km distance, (75.6%, 291/384) for refugees compared to (95.5%, 340/356) for nationals (OR=1.64; 95%1.25-2.16; p=0.000). Access was hindered by affordability of health services, refugees (44.9%, 173/385) compared to nationals (80.9%, 288/356) (OR = 4.68; 95%CI 3.33-6.59; p<0.05) and temporal accessibility of health services, refugees (23.5%, 53/226) compared to nationals (67.4%, 203/301) (OR = 2.61; 95%CI 1.36-5.03; p<0.05). Nationals (55.7%, 234/420) compared to refugees (21.3%, 76/356) (OR=0.41; 95%CI 0.23-0.73; p=0.003) perceived health services provided by the public facilities as good. Access to health care by urban refugees is enhanced by availability of and the proximity to health facilities while it is hindered by cost of health care, long-waiting time and low acceptability of the services. Refugees have a poorer perception towards the quality of health services compared to nationals. There is need to invest in the availability of comprehensive health services, demand creation initiatives, refugee skills trainings and income generating activities, establishment of a refugee buddy-system to facilitate communication and institutionalization of a refugee-based village health system.