{UAH} The sick-est healthcare system

Patients in Kitagata Hospital ward unattended to by the staff resorted to moving around[/caption]   Monitoring activities were carried out in Mulago Hospital – Kamuli District,  Namwendwa Health Centre (HC) IV, Kinawampere HC II, Kinu HC II, Bubago HC II, Nabilama HC II, Balawoli HC IV, Kasolwe HC II, Namaira HC II and Kibuye HC II. These health facilities had something in common which was lack of essential drugs retarding them to deliver optimally to the people. [caption id="attachment_22430" align="alignnone" width="2896"]A dilapidated and broken Hospital cabin in the patients' ward where they keep their food.[/caption] In Mulago Hospital, Kamuli Town Council The hospital receives an average number of 400 patients per day from Monday to Friday. However, the delayed delivery of drugs to the hospital makes it hard to have services delivered adequately. The Anti-Retroviral Treatment Department has not received drugs since February although the Department is supposed to receive drugs every quarter. For instance 70 patients who were previously receiving "daption", a drug that is given to those who are allergic to Septrin have become frustrated and no longer check whether the drug was received by the hospital for distribution apart from about 15 patients who constantly check. [caption id="attachment_22432" align="alignnone" width="1024"]Mbale Hospital Kitchen Abandoned.[/caption] Instead the hospital has stocked more malaria drugs yet HIV/Aids prevalence is high in the district. HIV/Aids patients are therefore at risk of developing resistance to ARVs when the drugs are not taken regularly. This worsens their medical condition and response to further treatment.  In Balawoli HC IV in Balawoli Sub County there poor storage of drugs is on the rise. The drug store is too small creating high chances of drugs getting contaminated and turning them poisonous to patients. [caption id="attachment_22434" align="alignnone" width="720"]Men' Urinals, Kitagata Hospital.[/caption] In Namaira HC II, there has been delayed delivery of drugs too. The HC has not received HIV /Aids prevention drugs, testing kits and other essential drugs like quinine since February 2013. The lack of operational materials/drugs could cause death of patients. It should be noted that inadequate or lack of essential drugs in Health Centres, has eventual consequences one of them being death and constant negligence of medical staff to deliver on their duties. Some health workers are reluctant and yet patients need their quick attention. [caption id="attachment_22437" align="alignnone" width="745"]The Hospital medical ambulance that has for long been parked in the compound.[/caption] A young lady of 19yrs (Nakirya Halima) from Butansi Sub County, Naluwoli Parish who had given birth to twins in April 2013 was not attended to and yet she was in a very critical condition. This happened even after Money, Jik and OMO which the medical staff asked for was provided by the care taker (mother – Nabirye). [caption id="attachment_22438" align="alignnone" width="745"]Patients waiting for medicine at Mukono Health Centre IV.[/caption] The mother of this lady was advised by other patients in the ward to use a local herb which she applied to save the life of her daughter. After 3days, they left the hospital without proper medical attention. Negligence by medical staff due to lack of drugs can lead to the death of a patient if not discouraged. It's the duty of the Districts in question to advocate for timely delivery of drugs by the Ministry of Health to the Health Centres. The district leadership together with the hospital administration should take this as a matter of urgency and set penalties for medical staff who neglect patients at all costs and there should be a reporting mechanism that can be shared with the Ministry of Health to ensure sufficient services are accessible and easily delivered to the intended beneficiaries.   The Government too through Ministry of Health should ensure that there is timely delivery of essential drugs to Health Centres and Hospitals to reduce on the dangers that can come up as a result of insufficient drugs like death, especially in hard to reach areas. Through this, Government will be able to achieve its target for this financial year 2013/14 which focuses on reducing morbidity and mortality.   Poor Infrastructure and inadequate facilities in health centers deter service delivery By Mbabazi Peninah.  Over the years the proportion of health facilities have been few and distanced in far areas making it a challenge in achieving effective service delivery which todate is still failing to scale up to other developed countries because of the poor infrastructure and inadequate facilities. Infrastructure and facilities such as wards, laboratory, transport, energy sources, surgical beds, and staff houses are needed to ensure that all health facilities are functional, utilize the resources already invested and reduce patient overload in referral health facilities. [caption id="attachment_19373" align="alignnone" width="559"] A dilapidated toilet bahind the Marternity ward at Arua hospital.[/caption] Health workers are disgruntled on the poor conditions they work under making it hard for them to be able to fulfill the demands from the high number of patients that fill the health centers. In some health centers a number of patients have had to resort to sleeping on the floors simply due to the lack of beds and enough room in the wards. [caption id="attachment_19374" align="alignnone" width="595"] A malnourished child sleeping on the floor of a surgical ward using a mat at Arua hospital[/caption] Transport to move patients from one hospital to another is far more alarming due to the fact that some of these health centers especially those that are far away lack ambulances while those that have ambulances have been abandoned due to the inadequate funds to carry out maintenance. It's also been noticed that patients are asked for fuel for the ambulance even in cases of emergencies. In a project conducted by Results for Development Institute Inc (R4D) under the Transparency and accountability programme on " Assessment of the Extent to which Resources Allocated to the Health Facilities Affect Access to Essential Medicines in Uganda" a study in Bushenyi and Lira District was carried out intended to improve accountability for health expenditures and health service delivery. The Quantitative Service Delivery Survey (QSDS) which focused on the service provider perspective and Citizen Report Card had key findings indicating that infrastructure for health service delivery is not available at lower levels while in higher level health facilities is inadequate due to high patient loads. New health facilities such as HC IIs and IVs are not put to use immediately because of lack of staff and equipment. There are inadequate storage facilities for medicines and acute lack of lighting in the facilities; less than ¾ of the facilities were connected to electricity and most of them have been disconnected. Health financing still remains low in all districts with affecting service delivery. [caption id="attachment_19375" align="alignnone" width="400"] A plastic chair improvised in a wheelchair at Kitagata hospital[/caption] The Uganda Health System Strengthening Project (UHSSP), a government initiative set out to assist the country achieve the Uganda National Minimum Health Care Package (UNMHCP) with a focus on maternal health, new born care and family planning which was implemented by the Ministry of Health was to undertake a number of cost effective intervention and places emphasis on expanding coverage and improving the quality of maternal health, new born care and family planning. This among others is to achieve and improve human resources for health; physical health infrastructure; and management, leadership and accountability for health service delivery. [caption id="attachment_19376" align="alignnone" width="467"] District officials visits a ward with pregnant women sitting on the floor waiting to deliver at Okole Health Centre II in Kole district[/caption] With a number of components in the Uganda Health System Strengthening Project (UHSSP) one being the need to improve infrastructure of existing health facilities of the selected existing health facilities which will be done through renovation of selected health facilities; provision of medical supplies; improve capacity for operations and maintenance and strengthen the referral system, the health sector needs to be monitored closely and for the Ministry of Health to provide leadership for the health sector: taking a leading role and responsibility in the delivery of curative, preventive, promotive, palliative and rehabilitative services to the people of Uganda.   [caption id="attachment_19377" align="alignnone" width="533"] Expectant mothers rest on the floor as they wait to deliver at Alebtong Health Centre IV hospital[/caption] Budgetary allocation to the health sector is still less that what can be used to improve the sector. In the FY 2011/2012, donor funding totaled to UGX 206,097,000,000/=, in this FY 2012/13, donor funding is UGX 221,430,553,000/=. Following the withdrawal of funds by donors in the FY 2012/13 the health sector which received an estimated Shs930.5 billion—representing 8 per cent of the national cake was highly affected, consequences twinkling down to the common man. It was highlighted that 6,172 health workers have been recruited and the salaries of medical officers at the health centre IV level had been increased to Shs2.5 million per month. The health sector budget priority for the current financial year is to focus on strengthening health systems, equipping and stocking health facilities with essential medicines and health supplies, expanding disease prevention cover and ensuring safety of pregnant and lactating mothers. We can only hope that these health workers will meet the demands of the patients to be attended to and in the long run for Government to take key interest in the rehabilitation and renovation of these health facilities. [caption id="attachment_19378" align="alignnone" width="400"]

Unrepaired stretchers and benches abandoned in a ward at Mbale Referral hospital[/caption] There is the need to enhance sustainable and an enriched population by having health sector needs prioritized and more Government funding to the sector. It's inevitable for a country to achieve development unless we have a healthy population. The poor infrastructure and inadequate facilities is just the tip of the iceberg that Government ought to put emphasis on enhancing the standard of living with a healthy population.      

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