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Item Employee Motivation and Job Performance in Local Governments: A Case Study of Otuke District Local Government(Lira University, 2021) Odur, Denis Oremo; Nsisi, ChristineThe purpose of this study was to examine the effect of employee motivation on job performance in Local Governments focusing on employee of Otuke District Local government as a case study since employees performance was reported to have reduced between the periods of 2017- 2019. Specifically, the study sought to examine the motivation practices in Otuke District Local Government, to assess the level of job performance in Otuke District Local Government, and determine the extent to which motivation affects job performance in Otuke District Local Government. The target population for the study was 137 employees. The study samples comprised of 102 representatives who are employees of Otuke DLG. Data was analyzed using descriptive statistics, correlation analysis and regression analysis. The result for spearman’s rank correlation analysis revealed that all the constructs of motivation were positively correlated with job performance. The findings of the study revealed a positive significant of Job Security on Job performance in Otuke DLG (Coef. 0.413, p < 0.01). Secondly, the results on the effects of Reward system on Job performance in Otuke DLG further revealed a positive significant effect (Coef. 0.558, p < 0.01). Thirdly, the effect of Leadership relation on Job performance in Otuke DLG was found to be negative and insignificant (Coef. -0.106, p > 0.05). Finally, the results of multiple linear regressions yielded an adjusted R Square value of 0.454, which meant that employee motivation contributes about 45.4% to Job performance in Otuke DLG. Based on the above findings, the study recommends that Otuke DLG should put more efforts on Job security by ensuring that staff are recruited following the right channel, through the right qualification and are confirmed timely in their current positions and reward systems must be very transparent with clear scheme in place for staff promotion, the recognition and remuneration. The study also recommends that Otuke DLG should work ways of improving leadership relations in Otuke DLG for a better performance of employees by the district leaders coming up with plans that aim at improving staff welfare and with practices that promote good leadership relations with employees.Item Results-Based Financing, Motivation, And Satisfaction of Health Workers at Lower Level Primary Health Care Facilities in Lira District(Lira University, 2022) Orec, Isaac; Akello, Judith AbalBackground: Globally, Results-Based Financing consists of monetary or non-monetary transfers made to national or subnational governments, managers, providers, or consumers of health services contingent on verified attainment of predefined results within the context of Maternal Child and Newborn Health. In Uganda, monitoring of Results-Based Financing activities at lower level public health facilities in Lira district, involves the use of quality assessment tool to verify performance against predefined health indicators on a quarterly basis. Both quality and quantitiy scores are to determine payment of the health workers. However, no attempt is made towards the assessment of health workers’ motivation and their job satisfaction in realation to results-based financing programs. Overall Objective: To assess the contributions of Results-Based Financing strategy on health workers’ motivation and job satisfaction in Lira District Method: The study design was a descriptive cross-sectional using mixed-method approaches Systematic random sampling technique using lottery method was used to sample the professional health workers where the Kth interval was obtained by dividing the N by the sample size. Purposive sampling technique was used to sample the health administrators as key informants of the study. Data analysis: Data were analyzed using STATA version 17. Every questionnaire was checked for completeness at the end of each interview. Data were scanned for out-of-range and missing values before commencing data analysis. Linear regression analysis was run and then data analyzed as; Univariate analysis to analyze categorical variables and was presented in percentages and frequencies. Bivariate analysis to model the relationship between the independent variables and the dependent variable was also carried out using limear regression. The results were expressed at 95% confidence interval and statistical significance set at a P-value of 0.05. Results: Results of the study indicated that 50.4% of health workers were satisfied with their current job and close to half (49.6%) were dissatisfied. The overall motivation score of health workers in this study was 59.9%. The results show that the predictors of job satisfaction were providing autonomy in decision making at facility level (aOR 4.68, 95% CI: 2.21-7.15; p<0.001) and rapid changes at facility (aOR 2.93, 95% CI: 1.37-4.47; p<0.001) . Further still, the findings indicated that the predictors of motivation were age of the participant (aOR 2.53, 95% CI: 1.26-3.80; p<0.001) and enchaning support supervison (aOR 2.67, 95% CI: 1.42-3.94; p<0.001). Conclusion: The overall level of health professionals’ job satisfaction was 50.4%, suggesting that many health professionals close to half of health workers at lower level primary health care facilities are not satisfied with their current job. The findings from this study provided suggestive evidence that the two autonomy in decision making at facility level and rapid changes at facility became important predictors of health workers’ job satisfaction at the backdrop of lira district’s current health system reform. Age of the respondents was found to be a strong predictor of motivation among health workers additionally, enchaning support supervison was a predictor of motivation among health workers. This suggests that supportive supervision increases health worker motivation, including performance and quality of care. The study recommends that the management of the health care facilities should determine the provide incentives that the health workers are interested in. This would motivate the healthcare workers since they are provided with what they need.Item Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation On Passive Case Finding Strategy in Southwestern Uganda(Lira University, 2022) Odongo, Dickens; Omech, Bernard; Acanga, AlfredBackground: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda. Methods: The study utilized decision-analytic modeling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from National TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P=0.04. The yield among PLHIV Vs. HIV-negative [15.8% Vs.5.3%] P=0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186–294] and 17 [95% CI: 14-22] in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver costs are five times in PCF than HHCI [US$ 26.37 Vs. US$ 5.42]. Under the study baseline assumption, adding HHCI to PCF strategies was not cost-effective at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0-14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCF. Adding HHCI to PCF was not cost-effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low-resource countries like Uganda.Item Factors Associated with IUCD Use Among Women of Reproductive Age Attending Family Planning Clinics at Mbale District.(Lira University, 2022) Ayeko, Jackson; Kumakech, Edward; Acen, JoyBackground Intrauterine Contraceptive Device (IUCD) is among the most effective contraceptive methods in the market with increasing use globally. The use is predominant in few parts of the world, with Sub-Saharan Africa relying on other methods. In Uganda, IUCD utilization remains very low at 1.5% compared to other methods despite several interventions by the government. The objective of this study was to determine the factors associated with IUCD use among women of reproductive age attending family planning clinics in selected public health facilities within Mbale district. Methodology A facility based cross-sectional study was used among randomly selected women who came to obtain different contraceptive methods in the selected public health facilities. Information was obtained face-to-face by trained research assistants using a pre-coded structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward stepwise method. Results. After running multivariable binary logistic regression, IUCD use was associated with Women who were employed (adjusted OR= 14.00, 95% CI; 2.80-70.07), those who wanted to wait for 6 -10 years before having the next pregnancy (Adjusted OR= 12.19, 95% CI; 1.35-110.08), and those who thought IUCD was associated with cancer (Adjusted OR= 0.15, 95% CI; 0.03-0.68). Conclusion In conclusion, the study re-enforced the need to reach out with contraceptive methods especially IUCD to women who have a busy schedule and also points out the need for proper counselling to ensure that women who plan to stay for long should be counselled to also consider IUCD use which has a longer duration of action. Further, Proper health education is needed through different channels to address the issues of myths and misconceptions which hinders utilization of IUCD.