While before Uganda’s Parliamentary Health Committee, Dr Diana Atwine, head of medicines and health service delivery monitoring unit, explained Uganda’s state of public hospitals, maintaining that 60 % of health centres IVs are not functional, and the referral system at Mulago broke down long time ago.
Whereas such inefficiencies are attributable to doctor absenteeism, the head of Mulago hospital, Dr Baterana Byarugaba, blames it on underfunding. It must be appreciated that, Uganda Shs100bn has not been released to procure medicines and Shs2bn for laboratory services, $4.5m for imaging equipment, Shs5bn for utilities, among others for mulago. More so the only x-ray machine in Butabika hospital broke down, Shs400m which was applied for to have it replaced any yet has not been released.
The Uganda Cancer institute administration failed to prepare for replacing the radiotherapy machine until it was reported broken down. Now we hear that there is a legal process perquisite for its replacement which is at scrap value, it is very dangerous bearing cancer causing agents until returned to manufacturer, yet officials reported to police stolen items and yet to be found related to the machine.
Health sector issues became political capital to presidential hopefuls for the 2016- 2021 electioneering after notably the Abim Besigye Hospital visit. In the President’s Response to Dr Kizza Besigye’s Abim hospital visit, HE, Museveni, said: ‘That is why I set up a Health Monitoring Unit, headed by Dr. Atwiine, in my office. This unit has made 227 arrests of health staff engaged in malpractices that include criminal negligence, including death of patients, stealing of drugs, etc. The unit, however, is being frustrated by the Judiciary that continues to release the culprits. I have complained to the Principal Judge and the Chief Justice about this.’ This failed prosecution success in implicating abusers of health goods and services sent to Public health facilities demoralises funders of the health sector.
Funding less to15% the Health sector of the national budget denies tools of work to health workers, thence violating economic rights in article 40 of the constitution functionalised by the Employment Act of 2006. This compromises not only their professional ethics but also fails ability to innovatively practise medicine translating to brain drain of specialised health work force.
Breakdown, delayed replacement and inferior to quality health equipment, expired and drug stock outs too, violate patient rights to life and protection of life espoused in article 22 of the constitution. As a upshot, government’s slow role in functionalising maternal functions fails when attracted mothers to deliver in Hospitals instead find it a death trap contrary to saving life as is the proviso in article 33(3) of the constitution where government pledges to have enabling infrastructure for the same. This was the case last year blamed on, Buhinga and Kabale regional referral hospitals maternal deaths. Delays for essential/ tracer drugs’ replenishment for health facilities in mountainous or island arears, poor waste management at hospitals, dirty toilets run without water, need the intervention of the community monitors and the health unit managements or local leaders to correct.
“Who will heal Uganda’s sick health sector?” Barbara Among wrote in the Daily Monitor online publication of October 1st 2011 thus: Large sums of money are simply stolen. In 2005, nearly Shs150b from the Global Alliance for Vaccines and Immunisation (Gavi) and the Global Fund to fight Aids, tuberculosis and malaria was unaccounted for. “The healthcare system is very sick but the one who is supposed to heal it is very corrupt,” said the Anti-Corruption Coalition Uganda in its report. The referral hospital is all but a dilapidated structure that has been condemned for human use, though plans are underway for a new modern hospital. Also, some sections have been refurbished. The maternity ward, children’s ward and medical ward have given some hope to visiting patients—if only service delivery was equalled.
Specialist care remains a hurdle, as it is concentrated in urban areas with electricity, good schools, banking sector, recreation centres and decent housing befitting of their academic qualifications, places lacking the same can never attract and retain the same save to have Daily Missing Officers (DMOs). It must be recognised that this kind trends in all public service delivery departments thus calling for the entire infrastructural improvement or operationalising decentralisation policy that works.
Ugandans deserve a health sector that is accountable and relevant to them all. To that end, health sector financing should go beyond government and donor led contributions, fast track the alternative health insurance schemes with stringent accountability mechanisms, is a must follow. Invite more entrepreneurs to venture into the health sector to create competition where the consumers can access health goods and service that are affordable yet of quality. Constitutionalise the right to health so as to create an enabling policy, legal and institutional framework that allows rights’ based programing for government sectors which punishes persons the most responsible for failures in the sector.
It appears, therefore, that whereas the doctors may not be doing their job, they seem to be discouraged by the lack of tools to work with in order to do a good job. Their employer cum Government(central or local government) needs to facilitate the health sector so as to redeem the health profession’s welfare challenges; however that is not excuse for violating patient’s rights or mismanaging public resources with impunity even when there has not been as much success from the courts of judicature. In one of the community support visits conducted by Uganda National Health User’s/ Consumers Organisation (UNHCO) on the 2nd of May 2016, the in charge Nagoje Sub County Health Centre thanked the community that prepares free food for their lunch. This community show of support is commendable as it cuts the spending budget of health work force.
Against this back drop UNHCO is implementing a project which seeks to strengthen access to social justice through strengthening administrative and judicial redress mechanisms for health rights violations, against marginalised groups in two Ugandan districts of Dokolo and Mukono.
I pray that this does not have to be the proverbial elephant fight but one that has lasting solutions to the ill funded health sector owed by other departments that do not pay for services enjoyed. Whereas the health sector may carry the blame for continued abuse of finances allocated by both government and donors, funding what is asked or must not be lost in the blame game because the citizens deserve a fully functioning health sector.