Responding to chronic illness

This thesis explores the individual and household-level factors that determine households’ responses to and ability to cope with chronic illness of adults, as well as with the stresses from the wider environment, in a rural Ugandan context. Over a period of one year, in 2009/2010, monthly visits were made to 22 households that were part of a cohort that accessed free healthcare from the Medical Research Council of Uganda. Data was collected through in-depth interviews including life histories and observations. The material was continuously analysed and data collection refined over the course of the year, and later the three most important themes arising from the material were developed into papers. The three major findings were; 1) the lifecycle-stage of a household influenced response strategies and outcomes during chronic illness, and households headed by the elderly (those with household heads over the age of 60) were an especially vulnerable group, 2) Social relations and broader social protection is key for minimising financial hardships in households with chronically ill individuals, even with free healthcare, as locally prevailing factors such as poor transportation services, food shortages and droughts still cause economic loss during ill health, and 3) the elderly are in an especially vulnerable situation due to their shrinking asset base as well as due to trends in the wider environment, such as increased schooling of children and out-migration of young people, which means they risk being left in rural areas with inadequate access to care and support. Addressing the needs of individuals and households with chronic conditions requires health systems to focus on both medical factors and the broader context-specific social determinants of health. The unique case of a population accessing free healthcare made it possible to observe the factors that could still hinder access to the available care, and the needs, aside from purely medical concerns, that had to be met in order to cope with illness. The highlights from the thesis help to fill gaps in knowledge on how health systems could improve and maintain health outcomes during chronic illness in similar low-income settings. It must also be acknowledged that households are all different, and that solutions that are successful at one point might prove less suitable in a changing context that demands continuous attention and flexible policies