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Uganda health sector needs resuscitation

On November 10, The Observer newspaper ran a story on one Fred Twinomugisha, a five-year-old living with AIDS, ‘rotting’ because of not receiving his ARVs for the last five months due to a stock-out at Lwebitakuli Health Centre III in Sembabule district.

This story comes on the heels of Cecilia Nambozo’s, a teacher at Busamaga Primary School in Mbale, who died at Mbale hospital, eleven hours after reporting to the hospital. It is alleged that the health workers neglected her after she failed to pay Shs 300, 000 for a caesarean operation.

Twinomugisha and Nambozo’s cases aren’t unique. Figures from the ministry of Health show that malaria alone kills 320 Ugandans daily. All these portray a rotting health sector. Indeed, Uganda’s healthcare is one of the worst performing in the world, according to the World Health Organisation rankings.

At Mulago, the national referral hospital, it is the stench, dirt, chaos and overcrowded areas that welcome you. It appears that only the unfortunate and desperate must go there. In the maternity wards, only the lucky expectant mothers are on beds; the rest are on the floor.

Medicine is a luxury, a situation that has been exploited by some private individuals who have set up private clinics around the hospital that the poor Ugandans can resort to.

The situation in our public hospitals is so dire that those with a little more money have shunned them and opted for private health facilities while the poor are left at the mercy of poorly paid and facilitated medical workers, and hospitals with no medicines.

Whereas people go to hospitals and don’t get medicines, the drug expiration rate in the country is shocking. Only between 2005 and 2007, drugs worth Shs 4.8 billion were simply dumped as they had passed their expiry dates.

With 9.8% of the budget allocation (2011/2012) going to health, though far below the 2001 Abuja Declaration’s recommended 15%, some experts say if utilised properly, this could be enough to offer Ugandans the health services they deserve.

While the government has tried to set up facilities countrywide to improve the general health service delivery, a 2009/2010 report, Uganda Local Government Councils Score Card by ACODE, shows that improvements are only in infrastructure, especially in construction of health centres, but the major problems such as understaffing, unavailability of drugs and equipment, absenteeism of health workers, and weak accountability mechanisms remain.

Uganda had scored highly in the fight against HIV/AIDS internationally, but a 2010 MDGs report showed that there was a big reversal in progress. The World Health Organisation observes that Uganda’s doctor-to-patient ratio is low.

This doesn’t agree with the fact that Uganda graduates more doctors every year than any other East African country. Apparently, these immediately relocate to neighbouring countries such as Rwanda and Kenya where the working conditions are better and the pay higher.

So, how do we go about reviving this comatose patient?

The first dose of medicine must be administered against corruption. Large sums of money are simply being stolen from the sector. In 2005, about Shs 150bn from the Global Alliance for Vaccines and Immunisation (GAVI) and the Global Fund disappeared.

Besides, there are reports that ghost health centres are being formed by corrupt district officials who receive their medical supplies from the National Medical Stores. It is quite ironical that genuine health centres always lack supplies.

There is also need to beef up supervision. A 2009 World Bank study titled Fiscal Space for Health in Uganda: Contribution to the 2008 Uganda Public Expenditure Review noted that there are problems of absenteeism where, on a given day, 37% of health workers skip work, costing the government the equivalent of Shs 26bn, not to mention waste and leakage in the pharmaceutical sub-sector through drug theft, expiry, and poor prescription practices.

Supervision could help eliminate quack health workers. Health workers need to be facilitated to prevent brain drain. In 2008 alone, Uganda lost 12 surgeons to Rwanda and South Africa.

While it’s not possible to achieve efficiency in the sector overnight, experts say if corruption is fought, supervision facilitated, drugs availed to the poor, and health workers facilitated, the sector will immensely improve.

The author is a student of Journalism and Communication, Makerere University.

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