'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda

Research output: Contribution to journalArticle


Introduction Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. Methods A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. Results Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. Conclusion As in Uganda's public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.


  • Katherine Albutt
  • Gustaf Drevin
  • Rachel R. Yorlets
  • Emma Svensson
  • Didacus B. Namanya
  • Mark G. Shrime
  • Peter Kayima
External organisations
  • Massachusetts General Hospital
  • Harvard University
  • Karolinska Institutet
  • Boston Children's Hospital
  • Massachusetts Eye and Ear Infirmary
  • Mbarara University of Science and Technology
  • St. Mary's Hospital Lacor
  • Uganda Martyrs University
  • Ministry of Health, Uganda
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Health Care Service and Management, Health Policy and Services and Health Economy
Original languageEnglish
Article numbere0224215
JournalPLoS ONE
Issue number10
Publication statusPublished - 2019
Publication categoryResearch