Of the 18 HFs, 50% (n=9) of them were from Rakai district, 22% (n=4) from Lwengo district, three HFs (17%) from Kalungu district, and two HFs (11%) were selected from Bukomansimbi district. By facility level; 67% (n=12) were HCIIIs, 28% (n=5) HCIVs, and one hospital. The overall readiness index (RI) was 16.92 (range 10.8 to 26.6, SD 4.19). Of the four districts, Lwengo and Rakai districts had the highest readiness indexes of 17.91(SD 3.15) and 17.63 (SD 4.55) respectively, while Bukomansimbi and Kalungu districts had RIs of 16.51 (SD 7.18) and 13.74 (SD 2.56) respectively. The highest facility-level readiness index was at the hospital with a RI of 26.62, while HCIVs had a RI of 20.05 and HCIIIs a RI of 14.80 (Table 1). There was a significant difference in readiness indexes (p= 0.015) across HF levels, with Dunn’s post hoc test showing that the difference (2.39) was between HC IIIs and HC IVs (p=0.025).
Table 1: Readiness index scores by district and health facility levels
Characteristics
|
Number of health units
n (%)
|
Readiness indexes
|
Std. Dev. (±)
|
Overall RI
|
18 (100)
|
16.92
|
4.19
|
District
|
|
|
|
Rakai
|
9(50)
|
17.63
|
4.55
|
Bukomansimbi
|
2(11)
|
16.51
|
7.18
|
Kalungu
|
3(17)
|
13.74
|
2.56
|
Lwengo
|
4(22)
|
17.91
|
3.15
|
Health facility level
|
|
|
|
|
Health center III
|
12(67)
|
14.80
|
2.34
|
Health center IV
|
5(28)
|
20.05
|
3.22
|
Hospital
|
1(5)
|
26.62
|
|
WHO building block scores as determinants of overall readiness
Of the six WHO building blocks, the medical commodities, and equipment for geriatric care block had the highest score of 46.4, followed by the geriatric care services delivery block (41.7), HMIS for geriatric care (11.8), and human resource for geriatric care (1.7). The leadership and governance, and financing for geriatric care blocks had a score of zero (Figure 2).
Leadership and governance for geriatric care
All HFs (n=18) scored zero concerning this building block. They lacked geriatric care policies, national geriatric care management guidelines, had no geriatric focal personnel, and did not receive geriatric support visits. Relatedly, older adults were not represented on health unit committees and had no community networks to support them (Figure 2).
Financing for geriatric care
Figure 2 shows that the score for this block was zero, attributable to all study HFs not having a work plan that incorporated geriatric care services into their routine care. Furthermore, there were no finances allocated to geriatric care activities, no HFs were receiving external funding for geriatric activities, and older adults did not receive any financial concessions for pay for services.
Human resource for geriatric care
The average block-level score was 1.7 (Figure 2). Of the 18 HFs, only one HCIII (5.6%) had a geriatric health specialist, while a HCIV (5.6%) had a nurse that had some training in geriatric care. The rest of the health workers (HWs) had never had any geriatric training. Relatedly, no HFs were receiving mentorship in geriatrics, had plans to hire a geriatric specialist, or had personnel dedicated to supporting older adults (Table 2).
Table 2. Summary scores for select human resource for health tracer items at 18 HFs
Tracer item
|
Availability
|
HC III
|
HC IV
|
Hospital
|
Total
|
Freq. (Col %)
|
Freq. (Col %)
|
Freq. (Col %)
|
HF has geriatric care specialist#
|
Yes
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
No
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
|
|
|
|
|
|
Doctor had geriatric care training
|
No
|
0(0)
|
5(100)
|
1(100)
|
6(100)
|
NA
|
12(0)*
|
0(0)
|
0(0)
|
|
|
|
|
|
|
|
Clinical officer had geriatric training
|
Yes
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
No
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
|
|
|
|
|
|
Nurses had geriatric training
|
Yes
|
0(0)
|
1(20)
|
0(0)
|
1(5.6)
|
No
|
12(100)
|
4(80)
|
1(100)
|
17(94.4)
|
|
|
|
|
|
|
Midwives had geriatric training
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
The pharmacist had geriatric care training
|
No
|
1(100)
|
5(100)
|
1(100)
|
7(100)
|
NA
|
11(0)*
|
0(0)
|
0(0)
|
|
|
|
|
|
|
|
Other health workers had geriatric training
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
The facility has a health worker to help older adults
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
The HF has support staff to help older adults
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Health workers had geriatric training in the last two years
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Staff receive CME in geriatric services
|
Yes
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
No
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
*NA indicates not applicable for that level of HF and is not included in the analysis
# Indicates someone who had a geriatric-specific training that lasted one year or more
Geriatric care services delivery
The average score for this block was 41.7 (Figure 2), attributable to all HFs (100%) having a waiting area, and 88.9% of them having a reception point accessible by older adults. Sixteen of 18 HFs were well lit and located within 5KM from the communities they serve. At Fifteen health units, their consultation rooms afforded privacy, while 12 HFs had their doors wide enough to allow for wheelchairs, and easy to open by older adults.
On the other hand, all HFs lacked audio-visual information on geriatrics, only one HF was escorting old persons to points like the laboratory, and two HFs were providing health education (H/E) on ageing, with older adults allowed to ask questions. Only 2 HFs had toilets with grab rails (Figure 3A), and only one HF had a special room for older adults. Only 4 HFs had information written in big reflective colours; easy for older adults to read. For other tracer items, see Table 3.
Table 3. Summary of scores for select geriatric care services delivery tracer items at 18 HFs
Tracer item
|
Availability
|
HC III
n=12
|
HC IV
n=5
|
Hospital
n=1
|
Total
n=18
|
|
Freq. (Col %)
|
Freq. (Col %)
|
Freq. (Col %)
|
|
|
|
|
|
|
|
|
Pathways at the HF are well paved with handrails and grabs
|
Yes
|
5(41.70)
|
0(0)
|
1(100)
|
6(35.29)
|
|
No
|
7(58.30)
|
5(100)
|
0(0)
|
12(66.67)
|
|
|
|
|
|
|
|
|
|
|
HF markings readable by older adults
|
Yes
|
6(50)
|
3(60)
|
1(100)
|
10(55.6)
|
|
No
|
6(50)
|
2(40)
|
0(0)
|
8(44.4)
|
|
|
|
|
|
|
|
|
Floors are rough to prevent falls
|
Yes
|
7(58.3)
|
1(20)
|
1(100)
|
9(50)
|
|
No
|
5(41.7)
|
4(80)
|
0(0)
|
9(50)
|
|
|
|
|
|
|
|
|
Floor steps are simple for the old persons to climb
|
Yes
|
5(62.5)
|
2(66.67)
|
1(100)
|
8(66.67)
|
|
No
|
3(37.5)
|
1(33.33)
|
0(0)
|
4(33.33)
|
|
NA*
|
4(0)
|
2(0)
|
0(0)
|
|
|
|
|
|
|
|
|
|
Public transport readily available at the HF
|
Yes
|
8(66.7)
|
5(100)
|
1(100)
|
14(77.8)
|
No
|
4(33.3)
|
0(0)
|
0(0)
|
4(22.2)
|
|
|
|
|
|
|
The HF gives priority to older adults
|
Yes
|
5(41.7)
|
3(60)
|
1(100)
|
9(50)
|
No
|
7(58.3)
|
2(40)
|
0(0)
|
9(50)
|
|
|
|
|
|
|
Older adults are directed to key points
|
Yes
|
8(66.7)
|
4(80)
|
0(0)
|
12(66.7)
|
No
|
4(33.3)
|
1(20)
|
1(100)
|
6(33.3)
|
|
|
|
|
|
|
|
|
|
|
|
HF has an equipped emergency resuscitation kit
|
Yes
|
0(0)
|
5(100)
|
1(100)
|
6(33.3)
|
No
|
12(100)
|
0(0)
|
0(0)
|
12(66.7)
|
|
|
|
|
|
|
HF has an ambulance for referring patients
|
Yes
|
0(0)
|
4(80)
|
1(100)
|
5(8350)
|
No
|
0(0)
|
1(20)
|
0(0)
|
1(17)
|
NA**
|
12(0)
|
0(0)
|
0(0)
|
|
*NA indicates HF was constructed with no need for steps
**NA means not applicable for that level of HF and is not included in the analysis
|
Availability of diagnostics at visited health facilities
Table 4 shows that microscopy and urinalysis were conducted at 17 of the 18 HFs, and renal and liver function tests were conducted at six of the seven eligible HFs. On the other hand, across all districts, blood cholesterol, serum electrolytes, X-ray services, and ultrasound scan services were conducted at 1 of 6, 3 of 7, 1 of 6 and 4 of 6 eligible HFs respectively.
Table 4: Summary of scores for the availability of diagnostics at the 18 HFs
Sub-block item
|
Availability
|
HC III
n=12
|
HC IV
n=5
|
Hospital
n=1
|
Total
n=18
|
|
|
Freq. (Col %)
|
Freq. (Col %)
|
Freq. (Col %)
|
|
|
|
|
|
|
|
Microscopy
|
Yes
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
No
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
|
|
|
|
|
|
Urinalysis
|
Yes
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
No
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
|
|
|
|
|
|
Prostate surface antigen and tumour markers
|
No
|
0(0)
|
5(100)
|
1(100)
|
6(100)
|
NA*
|
12(0)
|
0(0)
|
0(0)
|
|
|
|
|
|
|
|
Blood glucose or any other screening test for diabetes
|
Yes
|
5(41.7)
|
5(100)
|
1(100)
|
11(61.1)
|
No
|
7(58.3)
|
0(0)
|
0(0)
|
7(38.9)
|
|
|
|
|
|
|
Visual acuity done at the HF
|
Yes
|
2(16.7)
|
1(20)
|
1(100)
|
4(22.2)
|
No
|
10(83.3)
|
4(80)
|
0(0)
|
14(77.8)
|
*NA indicates not applicable for that level of HF and is not included in the analysis
Medical commodities and equipment for geriatric care
This WHO building block had the highest score of 46.4. All HFs (n=18, 100%) had weighing scales and MUAC tapes, pain killers, anti-hypertensives, eye ointment, and antibiotics. Of the 18 HFs, blood pressure machines were available at 13 (72%), stethoscopes at 15 (83.3%), 11 HFs (61%) had glucometers, and 16 HFs (89%) had anti-malarial drugs. On the other hand, all HFs (n=18) lacked hearing loss screening equipment, hearing aids, memory loss screening cards, and incontinence bags. Eyeglasses, walking crutches, white canes for the blind and other assistance devices for the blind were found at only one (5.6%) of the 18 HFs. Wheelchairs were only available at four (22%) HFs. For other tracer items, see Table 5.
Table 5: Summary of scores for select medical commodities and equipment tracer items at the 18 HFs
Tracer item
|
Availability
|
HC III
|
HC IV
|
Hospital
|
Total
|
Freq. (Col %)
|
Freq. (Col %)
|
Freq. (Col %)
|
|
|
|
|
|
|
Thermometer
|
Yes
|
4(33.3)
|
5(100)
|
0(0)
|
9(50)
|
No
|
8(66.7)
|
0(0)
|
1(100)
|
9(50)
|
|
|
|
|
|
|
Visual acuity screening chart
|
Yes
|
2(16.7)
|
1(20)
|
1(100)
|
4(22.2)
|
No
|
10(83.3)
|
4(80)
|
0(0)
|
14(77.8)
|
|
|
|
|
|
|
Wheel chairs
|
Yes
|
0(0)
|
3(60)
|
1(100)
|
4(22.2)
|
No
|
12(100)
|
2(40)
|
0(0)
|
14(77.8)
|
|
|
|
|
|
|
Anti-diabetic drugs
|
Yes
|
0(0)
|
5(100)
|
1(100)
|
6(33.3)
|
No
|
12(100)
|
0(0)
|
0(0)
|
12(66.7)
|
|
|
|
|
|
|
Nutrition supplements
|
Yes
|
3(25)
|
1(20)
|
1(100)
|
5(27.8)
|
No
|
9(75)
|
4(80)
|
0(0)
|
13(72.2)
|
|
|
|
|
|
|
Antidepressants
|
Yes
|
10(83.3)
|
4(80)
|
1(100)
|
15(83.3)
|
No
|
2(16.7)
|
1(20)
|
0(0)
|
3(16.7)
|
|
|
|
|
|
|
Anticholinergic drugs for incontinence
|
Yes
|
1(8.3)
|
2(40)
|
0(0)
|
3(16.7)
|
No
|
11(91.7)
|
3(60)
|
1(100)
|
15(83.3)
|
|
|
|
|
|
|
Benzodiazepines for insomnia
|
Yes
|
10(83.3)
|
5(100)
|
1(100)
|
16(88.9)
|
No
|
2(16.7)
|
0(0)
|
0(0)
|
2(11.1)
|
|
|
|
|
|
|
Oxygen cylinders
|
Yes
|
0(0)
|
4(80)
|
1(100)
|
5(27.8)
|
No
|
12(100)
|
1(20)
|
0(0)
|
13(72.2)
|
Health management information systems for geriatric care
The overall score for this block was 11.8 (Figure 2). All HFs (n=18, 100%) had out-patient department (OPD) registers that segregated data by age at all HFs (n=18, 100%), and 17 of them (94.4%) were reporting on geriatric data through DHIS2. On the other hand, all HFs lacked vital tools: the geriatric medical assessment tool, geriatric comprehensive screening tool, geriatric mental state examination tool, memory loss evaluation form, geriatric depression scale, urinary incontinence evaluation form, fall evaluation form, and geriatric daily activity form. No HF was using geriatric data to improve service delivery (Table 6).
Table 6: Showing a summary of scores for HMIS tracer items at the 18 HFs
Tracer item
|
Availability
|
HC III
n=12
|
HC IV
n=5
|
Hospital
n=1
|
Total
|
Freq. (Col %)
|
Freq. (Col %)
|
Freq. (Col %)
|
OPD registers with age disaggregation
|
Yes
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Inpatient registers with age disaggregation
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
HIV registers with age disaggregation
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Laboratory registers with age disaggregation
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Other registers with age disaggregation
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Geriatric daily activity form
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
HF collects geriatric care data
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
|
|
|
|
|
|
Data at facility is segregated by age
|
Yes
|
0(0)
|
0(0)
|
1(100)
|
1(5.6)
|
No
|
12(100)
|
5(100)
|
0(0)
|
17(94.4)
|
|
|
|
|
|
|
HF reports geriatric data through DHIS2
|
Yes
|
11(91.7)
|
5(100)
|
1(100)
|
17(94.4)
|
No
|
1(8.3)
|
0(0)
|
0(0)
|
1(5.6)
|
|
|
|
|
|
|
HF running any geriatric-focused project for which data is utilised
|
No
|
12(100)
|
5(100)
|
1(100)
|
18(100)
|
WHO building block scores by HF level
The hospital had the highest block-level ratings: 80.6 for care service delivery, and 61.5 for medical commodities and equipment, and 17.6 for HMIS. HCIVs scored 47.8, 59.2, 11.8 and 1.5 for care service delivery, medical commodities and equipment, HMIS, and human resource for geriatric care respectively. HCIIIs had the least scores of: 35.9, 39.7, 11.3, and 1.9 for care service delivery, medical commodities and equipment, HMIS, and human resource for geriatric care respectively (Figure 4).
WHO building block scores by district
Lwengo district had the highest WHO block-level scores: 50, 43.8, 11.8 and 1.92 for medical commodities and equipment, care service delivery, HMIS, and human resource for geriatric care respectively. Rakai district had scores of 47.9, 44.4, 11.8 and 1.71 for medical commodities and equipment, care service delivery, HMIS, and human resource for geriatric care respectively, Bukomansimbi scored: 44.2, 43.1, and 11.8 for medical commodities and equipment, care service delivery and HMIS respectively, while Kalungu had the least scores of 38.5 for commodities and equipment, 29.6 for care service delivery, 11.8 for HMIS, and 2.56 for human resources for geriatrics (Figure 5).