The demand and supply of child health services in Uganda in the context of the integrated management of childhood illnesses strategy

Background. The purpose of this study was to analyze the market for child health services in Uganda in the context of the Integrated Management of Childhood Illnesses (IMCI) strategy.;Methods. Basic logistic, multinomial logistic, and conditional logistic regression were used to estimate the effect of household socio-economic status (SES) and the price of services on demand for child health services. On the supply side, the cost of quality improvements due to IMCI, and the marginal costs of changes in quality and utilization for health facility care were analyzed with ordinary least squares regression.;Results. Household SES was not associated with the likelihood of child sickness, utilization of care, or type of provider chosen. The conditional logit results showed that households in the highest wealth quintile were more than twice as likely (OR = 2.11 p < 0.05) to choose a provider with an additional hour of travel time as compared to households in the poorest wealth quintile and households with education at the secondary level or above were less than half as likely (OR = 0.46, p < 0.10) to choose a provider with an additional hour of travel time compared to those with no education. This model also showed that providers with associated access costs less than or equal to 500 Ugandan Shillings (USh) were 2.4 (p < 0.01) times more likely to be chosen than providers with costs greater than 500 USh.;With an elasticity of 0.35, facility costs increase 3.5% for each 10% increase in number of sick child visits. With an elasticity of 0.31, costs increase 3.1% for each 10% increase in quality. Facilities with IMCI-trained health workers have 13.5% higher average facility costs than those facilities without IMCI-trained staff.;Conclusions. While the richer households are more likely to travel an extra hour to see a provider, the more educated are more discriminating of their time. The low cost elasticity of quality and utilization is likely due to the high fixed costs and the fact that clinics are not operating at full capacity; as such, there is great potential to further improve the health facility quality and see more patients in government and NGO clinics.