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PLoS One. 2018 Feb 8;13(2):e0192332. doi: 10.1371/journal.pone.0192332. eCollection 2018.

Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment.

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Epidemiology of Microbial Diseases Department, Yale School of Public Health, New Haven, Connecticut, United States of America.
Arnhold Institute for Global Health, Mt. Sinai School of Medicine, New York, New York, United States of America.
Quality Assurance Department, Uganda Ministry of Health, Kampala, Uganda.
Programme for Prevention and Control of Non-Communicable Diseases, Uganda Ministry of Health, Kampala, Uganda.
Uganda Initiative for Integrated Management of Non-Communicable Disease, Kampala, Uganda.
Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America.



Although the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD).


We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables.


In multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities' EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048).


We identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.

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