Of the 18 HFs, 50% (n=9) of them were from Rakai district, 22% (n=4) from Lwengo district, three HFs (17%) from Kalungu district, and two HFs (11%) were selected from Bukomansimbi district. By facility level; 67% (n=12) were HCIIIs, 28% (n=5) HCIVs, and one hospital. The overall readiness index (RI) was 16.92, (range 10.8 to 26.6, SD 4.19). Of the four districts, Lwengo and Rakai districts had the highest readiness indexes of 17.91(SD 3.15) and 17.63 (SD 4.55) respectively, while Bukomansimbi and Kalungu districts had RIs of 16.51 (SD 7.18) and 13.74 (SD 2.56) respectively. The highest facility level readiness index was at the hospital with a RI of 26.62, while HCIVs had a RI of 20.05 and HCIIIs a RI of 14.80 (Table 1). There was a significant difference in readiness indexes (p= 0.015) across HF levels, with Dunn’s post hoc test showing that the difference (2.39) was between HC IIIs and HC IVs (p=0.025).
WHO building block scores as determinants of overall readiness
Of the six WHO building blocks, the medical commodities, and equipment for geriatric care had the highest score of 46.4, followed by the geriatric care services delivery block (41.7), HMIS for geriatric care (11.8) and human resource for geriatric care (1.7). The leadership and governance, and financing for geriatric care block had a score of zero (Figure 2).
Leadership and governance for geriatric care
All HFs (n=18) scored zero with regard to this building block. They lacked geriatric care policies, national geriatric care management guidelines, had no geriatric focal personnel and did not receive geriatric support visits. Relatedly, old people were not represented on health unit committees, and there were no community networks supporting them (Figure 2).
Financing for geriatric care
Figure 2 shows that the score for this block was zero. This is because all study HFs did not have a work plan that incorporated geriatric care services into their routine care. There were no finances allocated to geriatric care activities, all HFs were not receiving external funding for geriatric activities and old patients did not receive any financial concessions for pay for services.
Human resource for geriatric care
The average block level score across the 18 HFs was 1.7 (Figure 2). Of the 18 HFs, only one HCIII (5.6%) had a geriatric health specialist, while a HCIV (5.6%) had a nurse that had some training in geriatric care. The rest of the health workers (HWs) had never had any geriatric training. Relatedly, all HFs were not receiving mentorship in geriatrics, had no plans to hire a geriatric specialist and had no personnel dedicated to supporting the aged (Table 2).
Geriatric care services delivery
The average score for this block was 41.7 (Figure 2), attributable to all HFs (100%) having a waiting area and 88.9% of them having a reception point accessible by old patients. Sixteen of 18 HFs were well lit and located within 5KM from the communities they serve. At Fifteen health units, their consultation rooms afforded privacy, while 12 HFs had their doors wide enough to allow for wheelchairs and easy to open by old patients.
On the other hand, all HFs lacked audio-visual information on geriatrics. Only one HF was escorting old persons to key points like the laboratory, and two HFs were providing health education (H/E) on ageing, with old people given the opportunity to ask questions. There were only 2 of the 18 HFs that had toilets with grabs for the (Figure 2) and only one health facility had a special room for old patients. Only 4 of the 18 HFs had information written in big reflective colours; easy for old people to read. Other tracer items are shown in Table 3 below.
Availability of diagnostics at visited health facilities
Table 4 shows that microscopy and urinalysis were conducted at 17 of the 18 HFs. Renal and liver function tests were conducted at six of the seven eligible HFs. On the other hand, across all districts, blood cholesterol, serum electrolytes, X-ray services, and ultrasound scan services were conducted at 1 of 6, 3 of 7, 1 of 6 and 4 of 6 eligible HFs respectively.
Medical commodities and equipment for geriatric care
This WHO building block had the highest score of 46.4. All HFs (n=18, 100%) had weighing scales and MUAC tapes, pain killers, anti-hypertensives, eye ointment, and antibiotics. Of the 18 HFs, blood pressure machines were found at 13 (72%), stethoscopes at 15 (83.3%), 11 HFs (61%) had glucometers and 16 HFs (89%) had anti-malarial drugs. On the other hand, all HFs (n=18) lacked hearing screening equipment, hearing aids, memory loss screening cards, and incontinence bags. Eyeglasses, walking clutches, walking aids for the blind and other assistance devices for the blind were found at only one (5.6%) of the 18 HFs. Wheelchairs were only available at four (22%) HFs. Other tracer items are shown in Table 5.
Health management information systems for geriatric care
The overall score for this block was low at 11.8 (Figure 2). All HFs (n=18, 100%) had out-patient department (OPD) registers that segregated data by age at all HFs (n=18, 100%), and 17 of them (94.4%) were reporting on geriatric data through DHIS2. On the other hand, all HFs lacked key tools: the geriatric medical assessment tool, geriatric comprehensive screening tool, geriatric mental state examination tool, memory loss evaluation form, geriatric depression scale, urinary incontinence evaluation form, fall evaluation form, and geriatric daily activity form. At all the 18 HFs, geriatric data was not used to run any improvement projects (Table 6).
WHO building block scores by HF level
The hospital had the highest block level scores; 80.6 for care service delivery and 61.5 for medical equipment and commodities, and 17.6 for HMIS. HCIVs scored 47.8, 59.2, 11.8 and 1.5 for care service delivery, medical commodities and equipment, HMIS, and human resource for geriatric care respectively. Health centers three had the least scores of 35.9, 39.7, 11.3 and 1.9 for care service delivery, medical commodities and equipment, HMIS, and human resource for geriatric care respectively while (Figure. 3).
WHO building block scores by district level
Lwengo district had the highest WHO block level scores: 50, 43.8, 11.8 and 1.92 for medical commodities and equipment, care service delivery, HMIS, and human resource for geriatric care respectively. Rakai district had scores of 47.9, 44.4, 11.8 and 1.71 for medical commodities and equipment, care service delivery, HMIS, and human resource for geriatric care respectively, Bukomansimbi scored: 44.2, 43.1, and 11.8 for medical commodities and equipment, care service delivery and HMIS, while Kalungu had the least scores of 38.5 for commodities and equipment, 29.6 for care service delivery, 11.8 for HMIS, and 2.56 for human resources for geriatrics (Figure 4).