Health System Capacity for Epilepsy Care in Uganda: A Survey of Health Facilities In Western Uganda

Background

Epilepsy is a chronic neurological disorder characterized by recurrent seizure activity caused by abnormal electrical activity in the brain. Over 80% of all cases globally occur in Low- and Middle-Income countries. A high treatment gap exists in LMICs, including Uganda, with 80% of people with epilepsy never receiving treatment. Studies have shown that even with existing medical services, a lack of skilled workforce, medication stock-outs, and long distances to health facilities contribute to the high treatment gap. This study describes the capacity, distribution of health facilities, and referral patterns between facilities that care for epilepsy patients in Uganda.

Methods

We conducted a cross-sectional survey adapted from the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. It was modified to include WHO Mental Health Gap Action Program (mhGAP) resources for epilepsy and the Tool for Situational Analysis to Assess Epilepsy Care. Data collection occurred between July and August 2022. Our sample included all regional and general hospitals and a sample of randomly selected Health Centers in Southwestern Uganda. We used probability proportional to size sampling to determine which Health Centers to include in our sample. We had only public health facilities in our sample. Data were collected through in-person interviews conducted by trained research assistants. A three-tiered categorical score (full, intermediate, and low capacity) was used to describe epilepsy capacity. For scoring, hospitals were stratified into three groups/facility levels: tertiary care (regional referral hospitals), secondary care (district hospitals/health center IVs), and primary care (health center IIIs), as we hypothesized that available resources would differ between the groups. We did geospatial mapping to show the distribution of facilities.

Ethical approval was obtained from the Makerere School of Public Health Research Ethics Committee (Protocol 1104), the Uganda National Council of Science and Technology (Protocol HS2344ES), and Duke University’s Institutional Review Board (Protocol 00110747).

Results63 facilities were surveyed, with 100% completion in all facilities. 63 (100%) facilities provide care for epilepsy patients. None of the facilities surveyed had full capacity to treat epilepsy patients. Most of our sampled facilities had a low capacity to treat epilepsy: 100% of tertiary care facilities, 77.3% of secondary care facilities, and 83.8% of primary care facilities. Overall capacity was weakest in medication, equipment, and human resources and highest in infrastructure and guidelines. Conclusion While epilepsy services are present in Uganda’s southwestern region, a lack of vital medicines, staff shortages, and technology can limit service delivery. Task shifting and sharing have been widely implemented to address workforce shortages. The findings of this study can help inform policy to improve service delivery for epilepsy patients.