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Musculoskeletal conditions0 ZAccount for much long-term pain/disability Have received far less public health attention (ZZ,<Successful management of childhood and communicable diseasesr Has shifted the burden of disease to musculoskeletal and non-communicable conditions WHO Scientific Group 2003 DV!V$&9 Increase in life expectancy along with increase in Road Traffic Accidents Challenges already depleted health systems Mock et al 2004 PuZ%ZZu0( By definition: rural, remote, disadvantaged populations have overall less healthcare Access Availability Less  Health Schlenker et al 2002nVZZ!Z%ZV$$(  x  Orthopaedic Outreach Programme$  With recognition of significant service delivery inequality The Dept of Orthopaedics at Mulago instituted the Orthopaedic Outreach Programme in 1991  provide specialized quality orthopaedic sevice to upcountry patients in their community ZbH   %* Recent Cochrane Review:  Specialist Outreach Clinics in Primary Care and Rural Hospital Settings bb  RGruen concludes: Need for further studies in rural/disadvantaged  where outreach interventions may offer the most benefit to access, better health outcomes, and greater impact Gruen 2004.!$  Need for StudyVery few Southern studies Mutyaba presented ASEA 2003 OOP to Fort Portal Found cost-effectiveness Cost per referral patients (US $35) Cost per Outreach patient (US $8)&6r6r  MethodologyLiterature/Document Review Quantitative methods Qualitative Key Informant Interviews(NGOs/IPH/MOH/Mulago) Semi-structured Interviews&<I<Ib  Visited 4 Regional Hospitals2Mbale Arua Masaka Fort Portal (surgical camp 2004)!  Limitations of StudyAll interviews conducted/coded/analyzed by one ortho surgeon Lack of overall burden of musculoskeletal disease in Uganda Poor follow-up on outreach results No beneficiary interviews,/"P Observations and ResultsjBetween 1991-2002: 50 missions with MOH support Between 1999-2004: 67 missions with partnership with USDC  Obsevations and Results  Quantitative output Decentralization of orthopaedic services and decongestion of Mulago Hospital by: 6,653 patients 1,071 surgeriesHQ!Q  ,( , Capacity Building Objective1New Orthopaedic surgeons at: Mbarara Mbale Masaka.$$,  Qualitative Assessment6!41 interviews conducted July 2004""( InterviewsBarriers to Access Harms of OOPBenefits of OOP to SystemBenefits to Patients/Family 0What  Works for Uganda?Overall-  more benefit than harm But-  single disease approach Need for systematic, integrated surgical services delivery That is part of a comprehensive, prioritized health care delivery system&|I|IConclusions and RecommendationsMusculoskeletal conditions pose an increasing BOD to Uganda Surgery is increasingly seen as cost effective and possibly part of the essential package of clinical care Despite decentralization, rural/disadvantaged/ poorest of the poor lack accessZ%Conclusions and Recommendations cont.Specialty Orthopaedic Outreach provides short-medium term solution to equity and access issues OOP  works for Uganda but Needs improved organization Needs integrated surgical services and PHC Needs follow-up, data systems, regular monitoring and evaluation&zz RecommendationsObtain baseline studies to quantify need and priority interventions Strengthen and further develop community-based rehab network Garner greater involvement from grassroots level Bottom-up planning/implementation/evaluation*Z-Z-Recommendations cont.Work toward attainment of ortho surgeons at all regional referral hospitals Create partnerships of all actors MOH/Public/Private NFP Hosp/OOP PH/CBR/Civil Society(NGOs, Service Org, Prof. Societies Greater emphasis on teaching/training/capacity building Sustainable funding nZYZLZZZZZnYL   ` MMM̙Cff3` fГ̳t` ` f` Ǫff3^` 3f7SFFx` ̙c`` TOI.%s>?" dd@,?" dd@   K " d@ `$ n?" dd@   @@``PP   @ ` ` p>> V(    H&7 ?"J 7 T Click to edit Master title style! !$  0)7 "Ii 7 RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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