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Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

“Helping my neighbour is like giving a loan” –the role of social relations in chronic illness in rural Uganda

Authors: Jovita Amurwon, Flora Hajdu, Dominic Bukenya Yiga, Janet Seeley

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Understanding individuals’ experience of accessing care and tending to various other needs during chronic illness in a rural context is important for health systems aiming to increase access to healthcare and protect poor populations from unreasonable financial hardship. This study explored the impact on households of access to free healthcare and how they managed to meet needs during chronic illness.

Methods

Rich data from the life stories of individuals from 22 households in rural south-western Uganda collected in 2009 were analysed.

Results

The data revealed that individuals and households depend heavily on their social relations in order to meet their needs during illness, including accessing the free healthcare and maintaining vital livelihood activities. The life stories illustrated ways in which households draw upon social relations to achieve the broader social protection necessary to prevent expenses becoming catastrophic, but also demonstrated the uncertainty in relying solely on informal relations.

Conclusion

Improving access to healthcare in a rural context greatly depends on broader social protection. Thus, the informal social protection that already exists in the form of strong reciprocal social relations must be acknowledged, supported and included in health policy planning.
Literature
1.
go back to reference Nixon SA, H-H J, Whiteside A, Barnett T. The increasing chronicity of HIV in sub-Saharan Africa: re-thinking “HIV as a long-wave event” in the era of widespread access to ART. Glob Health. 2011;7(1):41.CrossRef Nixon SA, H-H J, Whiteside A, Barnett T. The increasing chronicity of HIV in sub-Saharan Africa: re-thinking “HIV as a long-wave event” in the era of widespread access to ART. Glob Health. 2011;7(1):41.CrossRef
2.
go back to reference World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: WHO; 2002. World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: WHO; 2002.
3.
go back to reference World Health Organization. Global status report on noncommunicable diseases 2014. 2014. World Health Organization. Global status report on noncommunicable diseases 2014. 2014.
4.
go back to reference Maher D, Waswa L, Baisley K, Karabarinde A, Unwin N. Epidemiology of hypertension in low-income countries: a cross-sectional population-based survey in rural Uganda. J Hypertens. 2011;29(6):1061–8.CrossRefPubMed Maher D, Waswa L, Baisley K, Karabarinde A, Unwin N. Epidemiology of hypertension in low-income countries: a cross-sectional population-based survey in rural Uganda. J Hypertens. 2011;29(6):1061–8.CrossRefPubMed
5.
go back to reference Kipp W, Kamugisha J, Jacobs P, Burnham G, Rubaale T. User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ. 2001;79(11):1032–7.PubMedPubMedCentral Kipp W, Kamugisha J, Jacobs P, Burnham G, Rubaale T. User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ. 2001;79(11):1032–7.PubMedPubMedCentral
6.
go back to reference Barennes H, Frichittavong A, Gripenberg M, Koffi P. Evidence of high out of pocket spending for HIV care leading to catastrophic expenditure for affected patients in Lao People's Democratic Republic. PLoS One. 2015;10(9):e0136664.CrossRefPubMedPubMedCentral Barennes H, Frichittavong A, Gripenberg M, Koffi P. Evidence of high out of pocket spending for HIV care leading to catastrophic expenditure for affected patients in Lao People's Democratic Republic. PLoS One. 2015;10(9):e0136664.CrossRefPubMedPubMedCentral
7.
go back to reference World Health Organization. The elimination of user fees in Uganda: impact on utilization and catastrophic health expenditures. 2005. World Health Organization. The elimination of user fees in Uganda: impact on utilization and catastrophic health expenditures. 2005.
8.
go back to reference Orem JN, Mugisha F, Kirunga C, Macq J, Criel B. Abolition of user fees: the Uganda paradox. Health Policy Plan. 2011;26(suppl 2):ii41–51. Orem JN, Mugisha F, Kirunga C, Macq J, Criel B. Abolition of user fees: the Uganda paradox. Health Policy Plan. 2011;26(suppl 2):ii41–51.
9.
go back to reference Kansiime C, Rutebemberwa E, Mugisha A, Mugisha S, Asiimwe BB, Rwego IB, et al. Determinants of Patients' choice of provider in accessing brucellosis care among pastoral communities adjacent to Lake Mburo National Park in Kiruhura District, Uganda. PLoS One. 2014;9(8):e105276.CrossRefPubMedPubMedCentral Kansiime C, Rutebemberwa E, Mugisha A, Mugisha S, Asiimwe BB, Rwego IB, et al. Determinants of Patients' choice of provider in accessing brucellosis care among pastoral communities adjacent to Lake Mburo National Park in Kiruhura District, Uganda. PLoS One. 2014;9(8):e105276.CrossRefPubMedPubMedCentral
10.
go back to reference Ayé M, Champagne F, Contandriopoulos A-P. Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. Soc Sci Med. 2002;55(11):1929–46.CrossRefPubMed Ayé M, Champagne F, Contandriopoulos A-P. Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. Soc Sci Med. 2002;55(11):1929–46.CrossRefPubMed
11.
go back to reference Manderson L, Block E, Mkhwanazi N. Fragility, fluidity, and resilience: caregiving configurations three decades into AIDS. AIDS Care. 2016;28(sup4):1–7.CrossRefPubMed Manderson L, Block E, Mkhwanazi N. Fragility, fluidity, and resilience: caregiving configurations three decades into AIDS. AIDS Care. 2016;28(sup4):1–7.CrossRefPubMed
12.
go back to reference Manderson L, Block E. Relatedness and care in southern Africa and beyond. Soc Dyn. 2016;42(2):205–17.CrossRef Manderson L, Block E. Relatedness and care in southern Africa and beyond. Soc Dyn. 2016;42(2):205–17.CrossRef
13.
go back to reference Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.CrossRefPubMed Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.CrossRefPubMed
15.
go back to reference Putnam RD. Bowling alone: the collapse and revival of American community: Simon and Schuster; 2000. Putnam RD. Bowling alone: the collapse and revival of American community: Simon and Schuster; 2000.
16.
go back to reference Sahlins MD. Stone age economics. Chicago & New York: Aldine-Atherton Inc.; 1972. Sahlins MD. Stone age economics. Chicago & New York: Aldine-Atherton Inc.; 1972.
17.
go back to reference Hart K. Kinship, contract, and trust: the economic organization of migrants in an African city slum. Trust: Making and breaking cooperative relations. 2000:176–93. Hart K. Kinship, contract, and trust: the economic organization of migrants in an African city slum. Trust: Making and breaking cooperative relations. 2000:176–93.
18.
go back to reference Seeley J, Kajura E, Bachengana C, Okongo M, Wagner U, Mulder D. The extended family and support for people with AIDS in a rural population in south west Uganda: a safety net with holes? AIDS Care. 1993;5(1):117–22.CrossRefPubMed Seeley J, Kajura E, Bachengana C, Okongo M, Wagner U, Mulder D. The extended family and support for people with AIDS in a rural population in south west Uganda: a safety net with holes? AIDS Care. 1993;5(1):117–22.CrossRefPubMed
19.
go back to reference Ekoru K, Bukenya D, Lutalo T, Pain A, Seeley J. The longitudinal impact of HIV and AIDS on rural livelihoods in East Africa,(MRC/UVRI and RHSP Uganda component). A report for the food and agriculture organisation of the United Nations. 2010. Ekoru K, Bukenya D, Lutalo T, Pain A, Seeley J. The longitudinal impact of HIV and AIDS on rural livelihoods in East Africa,(MRC/UVRI and RHSP Uganda component). A report for the food and agriculture organisation of the United Nations. 2010.
20.
go back to reference Ntozi JP, Nakayiwa S. AIDS in Uganda: how has the household coped with the epidemic. In: Orubuloye IO, John CC, James PMN, editors. The continuing HIV/AIDS epidemic in Africa: responses and coping strategies. Canberra, Australia: Health Transition Center, Australian National University; 1999. p. 155–80. Ntozi JP, Nakayiwa S. AIDS in Uganda: how has the household coped with the epidemic. In: Orubuloye IO, John CC, James PMN, editors. The continuing HIV/AIDS epidemic in Africa: responses and coping strategies. Canberra, Australia: Health Transition Center, Australian National University; 1999. p. 155–80.
21.
go back to reference Barnett T, Blaikie P. AIDS in Africa: its present and future impact. London: Belhaven Press; 1992. Barnett T, Blaikie P. AIDS in Africa: its present and future impact. London: Belhaven Press; 1992.
22.
go back to reference World Bank. Fiscal space for health in Uganda. 2010. World Bank. Fiscal space for health in Uganda. 2010.
23.
go back to reference Kwesiga B, Zikusooka CM, Ataguba JE. Assessing catastrophic and impoverishing effects of health care payments in Uganda. BMC Health Serv Res. 2015;15:30.CrossRefPubMedPubMedCentral Kwesiga B, Zikusooka CM, Ataguba JE. Assessing catastrophic and impoverishing effects of health care payments in Uganda. BMC Health Serv Res. 2015;15:30.CrossRefPubMedPubMedCentral
24.
go back to reference Musoke D, Boynton P, Butler C, Musoke MB. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda. Afr Health Sci. 2014;14(4):1046–55.CrossRefPubMedPubMedCentral Musoke D, Boynton P, Butler C, Musoke MB. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda. Afr Health Sci. 2014;14(4):1046–55.CrossRefPubMedPubMedCentral
25.
go back to reference Whiteford P. How much redistribution do governments achieve? The role of cash transfers and household taxes. Growing unequal? Paris: OECD; 2008. Whiteford P. How much redistribution do governments achieve? The role of cash transfers and household taxes. Growing unequal? Paris: OECD; 2008.
26.
go back to reference Asiki G, Murphy G, Nakiyingi-Miiro J, Seeley J, Nsubuga RN, Karabarinde A, et al. The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies. Int J Epidemiol. 2013;42(1):129–41.CrossRefPubMedPubMedCentral Asiki G, Murphy G, Nakiyingi-Miiro J, Seeley J, Nsubuga RN, Karabarinde A, et al. The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies. Int J Epidemiol. 2013;42(1):129–41.CrossRefPubMedPubMedCentral
27.
go back to reference Bukenya D, Wringe A, Moshabela M, Skovdal M, Ssekubugu R, Paparini S, et al. Where are we now? A multi country qualitative study on access to pre-ART care services, a precursor for ART initiation. Sex Transm Infect. 2017; Bukenya D, Wringe A, Moshabela M, Skovdal M, Ssekubugu R, Paparini S, et al. Where are we now? A multi country qualitative study on access to pre-ART care services, a precursor for ART initiation. Sex Transm Infect. 2017;
28.
go back to reference Ojermark A. Presenting life histories: a literature review and annotated bibliography. SSRN eLibrary. 2007. Ojermark A. Presenting life histories: a literature review and annotated bibliography. SSRN eLibrary. 2007.
29.
go back to reference Krause D. The research act - a theoretical introduction to sociological methods, 3rd edition - Denzin,Nk. Teach Sociol. 1989;17(4):500–1.CrossRef Krause D. The research act - a theoretical introduction to sociological methods, 3rd edition - Denzin,Nk. Teach Sociol. 1989;17(4):500–1.CrossRef
30.
go back to reference Mills M, Huberman M. Qualitative data analysis: An expanded sourcebook (2nd Edition). Thousand oaks: Sage Publications, Inc.; 1994. Mills M, Huberman M. Qualitative data analysis: An expanded sourcebook (2nd Edition). Thousand oaks: Sage Publications, Inc.; 1994.
31.
go back to reference Merriam SB. Qualitative research: A guide to design and implementation: 3rd ed, San Francisco: Jossey-Bass; 2009. Merriam SB. Qualitative research: A guide to design and implementation: 3rd ed, San Francisco: Jossey-Bass; 2009.
32.
go back to reference Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications; 1985. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications; 1985.
33.
34.
go back to reference Schneider H, Lehmann U. From community health workers to community health systems: time to widen the horizon? Health Systems & Reform. 2016;2(2):112–8.CrossRef Schneider H, Lehmann U. From community health workers to community health systems: time to widen the horizon? Health Systems & Reform. 2016;2(2):112–8.CrossRef
35.
go back to reference Leon N, Sanders D, Van Damme W, Besada D, Daviaud E, Oliphant NP, et al. The role of ‘hidden’ community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa. Glob Health Action. 2015;8 https://doi.org/10.3402/gha.v8.27214. Leon N, Sanders D, Van Damme W, Besada D, Daviaud E, Oliphant NP, et al. The role of ‘hidden’ community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa. Glob Health Action. 2015;8 https://​doi.​org/​10.​3402/​gha.​v8.​27214.
36.
go back to reference Drinkwater M, McEwan M, Samuels F. The effects of HIV/AIDS on agricultural production Systems in Zambia: a restudy 1993–2005. IFPRI RENEWAL report. 2006. Drinkwater M, McEwan M, Samuels F. The effects of HIV/AIDS on agricultural production Systems in Zambia: a restudy 1993–2005. IFPRI RENEWAL report. 2006.
37.
go back to reference Hosegood V. The demographic impact of HIV and AIDS across the family and household life-cycle: implications for efforts to strengthen families in sub-Saharan Africa. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/HIV. 2009;21(SUPPL. 1):13–21.CrossRef Hosegood V. The demographic impact of HIV and AIDS across the family and household life-cycle: implications for efforts to strengthen families in sub-Saharan Africa. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/HIV. 2009;21(SUPPL. 1):13–21.CrossRef
38.
go back to reference United Nations. Community Realities & Responses to HIV/AIDS in Sub-Saharan Africa. United Nations, New York: United Nations Office of the Special Adviser on Africa; 2003. United Nations. Community Realities & Responses to HIV/AIDS in Sub-Saharan Africa. United Nations, New York: United Nations Office of the Special Adviser on Africa; 2003.
39.
go back to reference Kasedde S, Doyle AM, Seeley JA, Ross DA. They are not always a burden: older people and child fostering in Uganda during the HIV epidemic. Soc Sci Med. 2014;113:161–8.CrossRefPubMedPubMedCentral Kasedde S, Doyle AM, Seeley JA, Ross DA. They are not always a burden: older people and child fostering in Uganda during the HIV epidemic. Soc Sci Med. 2014;113:161–8.CrossRefPubMedPubMedCentral
40.
go back to reference Rutakumwa R, Zalwango F, Richards E, Seeley J. Exploring the care relationship between grandparents/older Carers and children infected with HIV in south-western Uganda: implications for Care for both the children and their older Carers. Int J Environ Res Public Health. 2015;12(2):2120–34.CrossRefPubMedPubMedCentral Rutakumwa R, Zalwango F, Richards E, Seeley J. Exploring the care relationship between grandparents/older Carers and children infected with HIV in south-western Uganda: implications for Care for both the children and their older Carers. Int J Environ Res Public Health. 2015;12(2):2120–34.CrossRefPubMedPubMedCentral
Metadata
Title
“Helping my neighbour is like giving a loan…” –the role of social relations in chronic illness in rural Uganda
Authors
Jovita Amurwon
Flora Hajdu
Dominic Bukenya Yiga
Janet Seeley
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2666-5

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