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Low morale undermining health sector

The state of the nation’s health is bad.

Don’t believe the statistics pro-government politicians spew out. We are not complaining about the shortage of brick and mortar. There are many health centres scattered all over the country, but these buildings are ill-equipped and ill-manned.

It is the poor pay and acute shortage of health personnel which appalls us. At last our MPs agree with us. That is why they are threatening to block the NRM government’s budget.

The minister of Health also agrees. “The shortage of health workers in Uganda presents a crisis,” she said recently. Some say the problem is money. We disagree. The real problem is a lack of political will to uplift the health services in Uganda.

The Abuja Declaration, which our blessed republic is a signatory to, requires governments to spend at least 15% on health. Uganda’s budget stands at Shs 859bn. Of this, despite Uganda’s alleged commitment to decentralization, about 50% remains in Kampala.

The districts get slightly above 50% of the money, yet they are in charge of more than 70% of the responsibilities. This is criminal neglect of one of the core principles of decentralization. You cannot decentralise work without decentralizing the money needed to get it done.

Government contribution to the health of the nation is the lowest. Households pay 50% of the total cost of health. This goes to user fees charged by the health facilities, purchase of drugs and under-the-counter fees (call it bribes) at public facilities. Donors contribute 35%. The government comes in with 15%!

The 6% cut in the health budget is unjustified. Any nation that seeks development cannot neglect the health of its people. Out of the current total budget of about $3.6bn, health gets about $307.5m. That is 7% of the pie.

But the government never tires of setting new ambitious health targets. Last December, the government vowed to eliminate mother-to-child HIV transmission by 2015! KCCA also vowed to double the number of HIV patients on [ARV] treatment this financial year.

In case you are not sufficiently outraged, let me tell you that the HIV prevalence rate has increased from 6.4% to 7.3 as of 2011. According to the 2010/11 - 2014/15 Health Sector Strategic Investment Plan, Uganda will not achieve the MDGs.

This is, therefore, not the time to slash the health budget. It is an unwise and ill-timed decision and should be resisted. The health budget may appear big to novices but the truth is that the public per capita expenditure on health is a paltry $10 - an amount equivalent to a crate of soda in a village kiosk.

In Kampala’s posh hotels, one would only manage to secure 10 bottles with that kind of money! The MPs are right to demand that money be provided for the recruitment of 5,000 new health workers.

This would cost Shs 260bn (about $103m). What would that money do? It would fill 50% of vacancies for doctors, nurses and midwives in government hospitals. It would raise staffing levels from the current 56% to 65%.

Currently, every 1,000 Ugandans are served by two health workers. By World Health Organization (WHO) standards this is a crisis. Recruitment and retention of health workers should be a priority.

Parliament’s social services committee should be saluted for standing up and threatening to block the entire budget in protest at government’s refusal to increase the health budget. The MPs want $27.5m to be reallocated to the health sector, but President Museveni has flatly refused.

The question remains whether we can afford the required increase in the health budget. The answer is yes. Other countries have done it. Zambia and Uganda have similar GDP but Uganda is lagging behind Zambia in health service delivery.

MPs have offered some items that the country can do without, or at any rate, have less of. These include workshops, adverts, PR, welfare, fuel and lubricants, hire of venues, entertainment, printing, photocopying, travel and motor vehicle maintenance.

But knowing how intransigent Museveni is, he will not change his mind. As a matter of fact, as mothers die in childbirth and health facilities turn into ghosts, Museveni is planning to spend about $1bn on more Russian fighter jets.

In short, it is business as usual. But what can the MPs do? If you cannot change the policy of the government, then the only option is to change the government itself. I expect to hear more MPs denouncing the government for its uncaring attitude and calling for a change of government.

The author is the President of the Democratic Party and former MP for Gulu Municipality and former Chairman of Gulu District.

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