Practices, motivation, perceived benefits and barriers to outsourcing by hospitals in Uganda

Abstract

This study investigated practices, motivations, perceived benefits and barriers to outsourcing of support services by general hospitals in Uganda. The aim was to contribute to the evidence base to increase adoption and effectiveness of outsourcing by hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data was collected from hospital managers in 32 randomly selected hospitals using a self-administered questionnaire. Qualitative data was collected through in-depth interviews from 8 purposively selected hospital managers using an interview guide. Quantitative data was statistical analysed (frequencies, contingency tables and Wilcoxon-Mann-Whitney tests) using SAS 9.3. Qualitative data was managed using ATLAS ti 7, coded manually and content analysis conducted to identify emerging themes, subthemes and categories. A cost benefit analysis was conducted for outsourcing cleaning services in a selected hospital using financial data provided by the managers. Quantitative findings indicate that many (72%) hospitals were outsourcing some of their support services; many were satisfied with their outsourcing (>60%). The key motivation for outsourcing was to gain access to quality service (68%). Most hospitals have a system for monitoring outsourcing (71%). Managers perceive improved productivity and better services as the main benefit from outsourcing (90%). The main barrier to outsourcing is limited financing. A key challenge encountered during outsourcing was limited number of service providers (57%). Managers perceive regulatory violations as a key risk during outsourcing (87%). Hospital location is a determinant of outsourcing (p=0.0033). Managers’ perceptions towards outsourcing have no impact on outsourcing (p>0.05). These findings were confirmed and explained by the qualitative data. Qualitative findings reveal masquerading, impersonation and extortion of patients by outsourced staff as an outsourcing risk. They reveal a concern that outsourcing may lead to job loss for community members. The cost benefit analysis indicates that outsourcing in the studied hospital for the year considered was cheaper than insourcing by UGX 669,575.00. The savings increase to UGX 48,753,689.94 when adjusted for quality differences between insourced and outsourced services. Sensitivity analysis shows that the assumptions used in the analysis were robust. Recommendations, interventions and guidelines are proposed for increasing outsourcing and its effectiveness.