{UAH} AND THIS IS WHAT IDDI AMIN NEVER ALLOWED TO HAPPEN IN UGANDA YET HERE WE SO ARE TODAY

Who will save Uganda’s limping health system?

One of the houses in the medical staff quarters in Moroto. 

By FREDERIC MUSISI

Posted  Saturday, April 4  2015 at  01:00

In Summary

Insensitive? As government plans to send at least 263 specialised medical personnel to the Caribbean island of Trinidad and Tobago, what is the health situation back home?

On a good day at a rural government health facility, when doctors are present and nurses are not shouting, drugs will be out of stock. On a bad one when drugs have been stocked, health attendants will be out of sight. It was such undoing, typical of majority health centres around the country, that Joyce Ategeka, a resident of Nyawaiga village on the shores of Lake Albert in Buliisa District, was left a widow at 35. Her husband succumbed to acute malaria and diarrhea, leaving her the burden of raising 10 children alone.

A nurse at a health centre III in the neighbouring village, Sebagoro, where the deceased had been admitted four days before his death, revealed that there was a high chance of saving him.

Problem was, there were neither drugs nor a qualified doctor so he could not be helped further. Admitting that the centre has a staff and drug shortage, the best the nurse, who spoke on condition of anonymity, says they all they could do was give him painkillers - Panadol. The doctor at the health centre had been transferred three months earlier.

The health centre in Sebagoro is a 20 by 40-feet container that moonlights for patient examination, emergencies, labour ward, antenatal and clerking, name it. The unit is shared by seven villages, with a daily patient influx of between 30 to 40 and a staff of seven.
Four hundred kilometers South West in Nyakashaka, Burere Sub-county in Buhweju District, the situation is perhaps slightly but not any better.

Regional referral hospitals
At the 14 regional referral hospitals in the country, the status quo is barely better.
According to the ministry’s Annual Health Sector Performance Report for the FY2013/14 issued in October last year, seven out of the 14 regional referral hospitals have a staffing level below the average. These include Moroto (41%), Mubende (55%), Naguru (67%), Kabale (70 %), Soroti (74%) and Hoima (74 %). Having to serve five neighbouring districts of Nakapiripirit, Abim, Kaabong, Moroto and Kotido, Moroto Regional Referral Hospital has had to up its 115 bed capacity by 70, despite its laughable staff numbers.

Patient numbers, however, are quite low except for the maternity ward due to factors ranging from the bad roads, drought, famine, absence of specialised facilities and medical attendants and lack of electricity. With limited access to clean water, the hospital is forced to rely on the hard water available, which frequently breaks down the equipment.

The hospital’s chief medical supretendant, Dr Filbert Nyeko, says they have to refer patients to as far as Soroti to access specialised services.

Nonetheless, health centres continue to face other challenges, including poor working conditions, excessive workloads, low salaries and poor remuneration, obsolete diagnostic equipment, medical workers stealing drugs, and drug shortages.

Yet in the face of all such challenges, government is making plans to send at least 263 specialised medical personnel to the Caribbean Island of Trinidad and Tobago, a deal which officials from both Health and Foreign Affairs ministries, say is intended at “accelerating diplomatic relations” between the two countries.

Uganda is number 149th in rankings of healthcare around the world. Trinidad on the other hand, is in the 67th position and in third position is the Americas after United States and Canada. With a population of 1.3 million people, Trinidad has 12 times as many doctors per capita than Uganda.

According to the shortlist, the personnel set to go include , 15 of the 28 orthopedics Uganda has, four of the six urologists, 15 of of 91 Internal medicine specialists, 15 of 92 paediatrics, four of the 25 ophthalmologists, four of the 11 registered psychiatrists and 20 of the 28 radiologists.

Others include 20 Radiologists, 15 of the 126 gynaecologists in Uganda, four of the 15 pathologists, 15 paediatrics, four Ophthalmologists, 15 general surgeons, among others.

But Dr Asuman Lukwago, the Permanent Secretary in the Health ministry, says the decision to offer Trinidad a helping hand has nothing to do with Uganda’s health sector being afflicted.

“The sector has some human resource challenges, but this is not because of availability on the front line. There are some frontiers where we even have excess and the question that begs is what should we do for such people without work?” he asks.

Dr Lukwago argues that the challenges plaguing the health sector are bigger than the ministry, and a solution, if any, requires multi-pronged approaches. “There is a lot of progress but the problems keep growing everyday,” he said in an interview last month. “And where we are now, we just need to think through some of our policies and approaches again. Otherwise, that is why sometimes even when money is allocated, challenges remain the same.”

One policy discord that has led to the near collapse of the health system, Dr Lukwago points out, is decentralization, which he said is challenging when it comes to maintaining health facilities, staffing them, remunerating thee staff, and equipping facilities with drugs.

“Health centres bring basic serves to the majority of Ugandans but as a ministry, we have little input on how they are run or organised. [The ministry of] Local government has the bigger say on them but on their inefficiencies, it is us that have to explain.”

However, Mr Justinian Kateera, the executive director of The Institute of Public Policy Research Uganda (IPPR), says the challenges existed even before decentralisation came into force. “But even in the current environment, it is easier for a district Chief Administrative Officer (CAO) to supervise a rural health centre than an officer seated at the [Health] ministry’s headquarters.”

“We would be persuaded if the challenges at Mulago hospital, which is across the road (from health ministry offices), were resolved before imposing the burden of far-flung health centres. I think what is lacking is coordination. It is not a binary choice but an integrated approach. I do not think recentralisation will resolve the problem.”

Critics of the government point to the limited budgetary allocation to the sector, coupled with mismanagement and misuse of public resources.
Ingrid Turinawe, the chairperson of the Forum for Democratic Change Women’s league, says health is the first priority of any human being but what government gives is not enough.

“Who doesn’t know that 19 women die everyday while giving birth out of negligence of attendants who are paid poorly?” The party recently launched a health campaign dubbed “Shs6200” and are distributing mama kits to upcountry health units. However, such initiatives are still not a long term solution.

Budgetary allocation to the health docket has been improving steadily during the last three financial years. In FY 2013/14, the ministry received a boost of 7.2 per cent - Shs940b, up from Shs852b in 2012/13. In the FY 2014/2015, Shs1 trillion was allocated to the sector, notably to address the above.

Recently appointed junior minister in charge of General Duties Dr Chris Baryomunsi says whatever the approaches to the problem are, the focus now should be on creating a condusive environment to retain health workers in the country, which requires more funding to the sector.
Currently, government is on a nationwide drive to renovate all the 14 regional hospitals, but who will work in them?
Dr Lukwago is of the same thought but avers that the solution should start with fixing gaps in both the old and new policies.

But as the saying goes, that money makes the world go around, any solution would require government to revise upwards the Health budget.
Uganda is signatory to the 2001 Abuja Declaration, which requires African countries to contribute about 15 per cent of their annual on health. Unfortunately, according to the next FY 2015/2016 draft budget paper, government is instead proposing budget cut for health.

World health organisation recommendations Vs Uganda’s state

World Health Organisation (WHO) recommends a ratio of one doctor per 1,000 people. But the UN body’s recent research findings indicate Uganda’s ratio of doctors to patients is 1: 24,725 in urban areas and 1:100,000 in rural areas.

Malaria remains the leading cause of mortality in hospitals with 12.8 per cent, followed by Tuberculosis.

“Mulago hospital’s major problems are, overwhelming patient numbers, old infrastructures, understaffing and low pay for staff,” the report observed. “Forty-two per cent of all health centre IIs have a staffing below 40 per cent, compared to nine per cent of all health centre IIIs, and nine per cent of all health centre IVs.

On the other hand, 91 per cent of all health centre IVs have at least only 50 per cent of the established key positions filled by workers. The staffing levels are closely linked to the observed service gaps at different levels of care,” reads part of the report.

About 300 doctors graduate from medical schools every year in Uganda.

 

A 2011 research conducted by Canadian scientists, led by Dr Edward Mills, indicated that countries including Zimbabwe, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda and Zambia have the highest HIV/Aids prevalence in Sub-Saharan Africa and suffer the worst economic losses due to doctors emigrating.

 

The Institute of Public Policy Research Uganda (IPPR), a local think-tank, last year dragged government to court in the landmark medical brain drain case of exporting medics to Trinidad, calling the decision “illegal, irrational, unethical and contrary to government health policy.” Judgment on the case is pending.

IPPR’s executive director, Justinian Katera, says the recent Ebola outbreak in West Africa revealed the vulnerability of African health systems and the risk that medical brain-drain poses to national and global public health.

“Uganda does not graduate sufficient medical workers to meet the health needs of 37 million people, with a growth rate of 1.5 million annually,” he argues. “Of a graduating medical class, 70 per cent leave the country, 20 per cent opt for research and administrative roles and only 10 per cent remain to perform clinical services. Consequently, Uganda loses more than 100,000 children to malaria and 7,000 women to labour complications.”

musisif@ug.nationmedia.com

 

EM

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