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Here’s how we can revolutionize the ailing Ugandan health sector

In sub-Saharan Africa, only 34 per cent of hospitals have reliable electricity access yet access to electricity is critical to health care delivery.

In the wake of the chronic raw sewage leakage at two of Mulago national referral satellite hospitals at Kiruddu and Kawempe, it is imperative to comprehensively optimize alternative energy from the perspective of health financing.

For our national referral hospitals to be leaking raw sewage barely three years after their construction, is absolutely preposterous and raises a major concern as to whether hospital wastewater in Uganda is being treated prior to being released to sewers and the aquatic environment.

Hospital wastewater contains hazardous pharmaceuticals, toxic contaminants, micro pollutants and substances that contribute more than 50 per cent of the total load of contaminants carried to regional wastewater treatment plants and hence can cause serious infectious diseases.

Ministry of Health officials have suggested connecting Kawempe hospital to the main sewerage line, a toxic idea in itself. Although sewage water can be centrally treated, conventional wastewater treatment plants are not able to eliminate all pharmaceutical residues efficiently, hence ending up in surface water.

A comprehensive review of the national healthcare waste management plan from 2009 to 2012 showed significant gaps. There are neither national healthcare waste management regulations nor specific hospital healthcare waste regulations.

In Uganda, the scope of drugs available on the essential medicines and health supplies list of 2016 is quite extensive. It reveals that quite a number of pharmaceutical derivatives, antibiotics, pain-relievers and other drugs are potentially found in raw hospital wastewater.

To break it down in plain terms, hospital wastewater contains x-ray derivatives, anti-hypertensives, pain-relievers, antibiotics, psycho-active drugs, and anti-epileptics, to mention but a few.

To make matters worse, with the emergence of antibiotic resistant bacteria, sites that are at disposal points of hospital wastewater have been demonstrated to have higher degrees of resistance with a significant rise of multidrug-resistant bacteria in hospital wastewater.

This, in simple terms, means that over the last couple of years, a good number of citizens have been ingesting water containing a host of multidrug-resistant bacteria and drug residues!

Revolutionizing the way hospital wastewater is treated is, therefore, timely and a viable initiative. It is unfortunate that the existing legal framework makes it difficult for medical institutions to set up their own facilities for treatment of hazardous harmful wastewater generated by these very facilities.

Wastewater management framework 

From Waste to Wealth: Sustainable wastewater management in Uganda - 2014; a study by United Nations University and McGill University, among others, indicates that pre-treatment approaches for instance the anaerobic digestion approach has been found to be a successful pre-treatment for high-strength wastewater.

For every 1,000-person population base at an institution, a minimum of 5.5 KW of biogas would be created. That means that for health centre IIIs that serve a minimum of 20,000 people, the amount of electricity offset would result in annual savings of a minimum of $200,000 or roughly Shs 720m.

The remaining residue (bio-slurry), when dried and assembled, would result in providing an alternative source of charcoal/firewood, resulting in additional annual savings to the health centre/hospital of $45,000 (about Shs 162m).

In this case, as the biogas and briquettes are used directly within the health centre/hospital, they would directly offset the use of electricity/charcoal of a health centre III by a minimum of $245,000 annually (about Shs 880m).

In regional referral hospitals and national referral hospitals that serve a minimum of two million people, this would translate into electricity/charcoal offsets of a minimum of $26,000,000 annually or Shs 93 billion.

To augment hospital operations, solar energy provides an unprecedented opportunity to reduce utility bills with huge returns on investment and even greater savings. 

A combination of hospital wastewater treatment, biogas production and solar energy production facilities would supply side finance incentives that would culminate into cleaner, less-contaminated water, increased annual savings for hospital expansions and extensions, insulation of the health sector from price fluctuations in global energy markets, procurement of advanced medical equipment, mitigate the impact of climate change, salary augmentations and ultimately advance multiple sustainable development goals.

The writer is a senior health expert.


0 #1 Phalanch 2018-06-05 18:07
Thanks for effort and time but without a government in place no solution or idea can ever yield a good harvest .

As it is Uganda's foundation doesn't have a single brick in it.

Like it is said, No help can give a jerry fish a backbone
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0 #2 Akot 2018-06-05 19:11
Only good governance with National Education & help to modernise Agriculture in Uganda, will ensure tax money is used for public sevices, development of the country, for the good of Ugandans!

For the last 32 years, Uganda tax money is personal property of Museveni & this will be so as long as he is in power!

Without UNITY against the god, tribes with natural resources can go for Independent Tribal States then manage their land riches for the good of their people, while those who still want/need Museveni will have him!

Ugandans must by now know they have no future as long as Museveni is dictator-chief tribal leader who will do as he pleases in a country that is his property!
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0 #3 Jet Balamba 2018-06-05 22:20
"Here’s how we can revolutionize the ailing Ugandan health sector".....Import CUBANS to do all the work for us as the president demanded.

Any other health care solution/ "revolution" however sound it is, may force him back to the bushes, remember people he warned us of that possibility.

We don't want to anger our beloved fountain of honor or go against his wishes lest we be branded "ideologically disoriented" with imperialist tendencies.

Lets do the "right" thing. IMPORT CUBANS NOW pay them more than what their Ugandan counterparts earn & be done with it. Now that is revolutionary. We need to make Sabalwanyi happy at all costs.
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