ArticleGlobal health action2017
Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda.
Article in Global health action, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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23 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.Human resources for health · 2022Pooled it
- Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial.BMJ global health · 2021Trial
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- Acceptability and barriers to rapid HIV/syphilis testing among pregnant Wayuu women in Colombia: A cross-sectional pragmatic study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Unveiling healthcare disparities in Somalia: the hidden struggles of nomadic communities.International journal for equity in health · 2026Article
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- Evaluating the coverage of sexually transmitted infection prevention and control services in eight districts in Central Uganda: lot quality assurance sampling survey.BMC infectious diseases · 2025Article
- What slows the progress of health systems strengthening at subnational level? A political economy analysis of three districts in Uganda.PLOS global public health · 2025Article
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- Effective coverage of maternal and neonatal healthcare services in low-and middle-income countries: a scoping review.BMC health services research · 2024Article
- Diagnostic pathways of Chagas disease in Spain: a qualitative study.BMC public health · 2023Article
- Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study.Health research policy and systems · 2022Article
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- Evaluating health service coverage in Ghana's Volta Region using a modified Tanahashi model.Global health action · 2020Article
- Impact of Health Systems on the Implementation of Intermittent Preventive Treatment for Malaria in Pregnancy in Sub-Saharan Africa: A Narrative Synthesis.Tropical medicine and infectious disease · 2020Review
- Using bottleneck analysis to examine the implementation of standard precautions in hospitals.American journal of infection control · 2020Article
- Variance estimation for effective coverage measures: A simulation study.Journal of global health · 2020Article
- Decision-making in district health planning in Uganda: does use of district-specific evidence matter?Health research policy and systems · 2019Article
- Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya.International journal for equity in health · 2019Article
- Article
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPoor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system.
methodsA modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study.
resultsEffective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent.
conclusionThe modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.
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