Background: Uganda has hosted an estimated 200 000 refugees in post-emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee-affected districts. The process of integration of health services began in 1999. Objective: To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee-affected districts of Uganda. Methods: Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee-affected districts for 2 years, 2003 and 2004. Results: The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85). The cost per RH intervention is higher in the refugee than in the host health system (US$3.02 vs. US$2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5-100) vs. 53.5% (53.22-53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12-38.48) vs. 15.2% (15.01-15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79-1.25) vs. 0.85% (0.80-0.90); P < 0.05]. Conclusions: Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee-affected settings. © 2007 Blackwell Publishing Ltd.

Reproductive health interventions (antenatal care, vaginal delivery, caesarean section, family planning, sexually transmitted infections) costs Host Coverage Uganda Refugee

Birth Rate rural area Rural Health Services Reproductive Medicine hospitalization Family Planning Services refugee prenatal care Sub-Saharan Africa Pregnancy Complications Refugees health service rural health East Africa Uganda sexually transmitted disease Sexually Transmitted Diseases health care cost Health Care Costs health expenditure Humans female Africa pregnancy Syphilis health services public hospital Article Reproductive Health Health Policy health center Delivery of Health Care Maternal Health Services health care facility Delivery, Obstetric family planning cesarean section health survey