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Private healthcare unaffordable, but free healthcare not free.

Private healthcare unaffordable, but free healthcare not free.

When one of my close relatives became critically ill in Kampala last week, he was taken to a neighbourhood clinic where preliminary tests revealed the most likely cause.  His family took him to Najjera Hospital in Kiwatule, where Dr. Patson Ndyakira Makobore promptly evaluated him, and initiated appropriate treatment and stabilization. Dr. Makobore quickly determined that the patient needed to be in an intensive care unit (ICU) and arranged transfer to Ruby Hospital on Lugogo Bypass. 


By all accounts, the status of the patient on arrival at Ruby Hospital was extremely worrying. The ICU team at Ruby, including Dr. Fred Nsereko, Dr. Moses Ssenyonjo, Dr. Bruno Serunkuma, and Dr. Gerald Tumwebaze, treated and monitored the patient with a high level of professionalism and competence. I was kept informed of the patient’s progress by my relatives, and they had nothing but high praise for Dr. Makobore, and for the health care team at Ruby. As I write, the patient is out of the ICU and is continuing to recover under the watchful eye of the team in a regular care unit. However, he is going to need ongoing inpatient care for a while, then as an outpatient, all under the direction of specialist and subspecialist doctors. 


None of this should be newsworthy.  The management of a critically ill patient has been so refined and standardised that it should not matter whether one is in Kampala, Kigali, Nairobi, Gaborone, Dakar, Santiago, Mumbai, Sydney, Helsinki, London, New York, or Toronto. Indeed, this story, and the experience of two of my relatives who received care at Nakasero Hospital last year, illustrate that excellent health care is available in Kampala. God forbid, but should I ever need medical help while in Kampala, I am confident that I will be in very safe hands. However, there is one catch.  


The cost of health care in Uganda is simply unaffordable for most citizens. While I have not done a comparative cost analysis, I hazard a guess that, relative to Uganda’s per capita income, health care costs in Uganda are astronomical, probably, relatively speaking, in the league of a country like the United States of America.  Looking at the fees already paid by my relative after a few days in hospitals left me wondering what his fate would have been had he not had the means to meet the cost. 


Not that the hospitals overcharged the patient. Not at all. Quite the opposite in fact, considering the state-of-the-art care he received. Provision of good medical care is a very expensive undertaking. In most hospitals, the fees charged cover numerous costs, leaving a smaller profit margin than people imagine it to be. So, as I have stated before, Ugandan doctors, nurses, other healthcare professionals, and private hospitals themselves deserve better remuneration than they receive today. 


The answer cannot be increasing fees that patients pay out of pocket. Indeed, patients already pay way too much for their healthcare, even in government hospitals. It is a small fraction of the population that can afford to pay for very good healthcare such as that offered at Nakasero, Najjera and Ruby Hospitals in Kampala. My concern is what happens to the urban peasants, who are most of Kampala’s residents, and other hardworking professionals whose salaries can barely pay for their rent and other necessities?


What happens to the thousands who present daily with critical illnesses to the accident and emergency departments of government hospitals in towns like Arua, Kitgum, Soroti, Mbale, Kampala, Hoima, Kayunga, or Kabaare? What services are available to them, and at what cost? How easily and quickly do they receive those services? How about those who present to smaller, rural health centres in places like Mparo, Ntungamo, Nakasongola, Zombo or Bugiri?  


At the risk of sounding like a broken record, let me say this again: health care should be a well-funded public priority program that provides easy access to state of the art care for all citizens. Free healthcare is a human right, and should apply to every Tondo, Draru, and Hamujuni, regardless of their socio-economic station or their geographical location in the land. I speak with confidence, not based on opinion, but on many studies in the USA that have consistently shown that private, “for-profit care is nearly always more expensive and often of lower quality.” I speak as one who knows the ins and outs of the Canadian provincial health care systems that offer free state-of-the-art services to all legal residents and refugees in this country, without distinguishing between the rulers and the ruled, the rich and the poor, the titled and the so-called ordinary citizens. 


Like elsewhere, free healthcare in Uganda is an expensive proposition that must be paid for by somebody. That “somebody” is us – all citizens – who must shift our priorities to adequate funding for three critical determinants of health. These are (1) education, (2) public and preventive health care, and (3) timely state-of-the-art emergency and inpatient treatment. No doubt, spending on the infrastructure like roads, water, power, telecommunications, and such is very important. However, an uneducated and sick population is the perfect recipe for economic stagnation, regression, and state failure. 


If free health care is neither free nor cheap, where does the money to fund it come from? The money we spend on politics, patronage, and pomp could easily provide modern, well-staffed ICUs in at least all the old capitals of the districts that we had fifty years ago, namely, Arua, Gulu, Moroto, Lira, Soroti, Tororo, Kapchorwa, Mbale, Jinja, Mengo, Mityana, Masaka, Mbarara, Kabaare, Fort Port, and Hoima. 


The expensive cost of the lifestyles of the ruling classes, and the money spent on flying a select few to receive health care abroad can fund state of the art accident and emergency departments in every one of these towns. There are money-losing projects that need reassessment and, in my opinion, decanting. Shift those funds to trustworthy health care professionals and we shall reclaim our once admirable health services. Supplemented with a graduated healthcare tax on all adult citizens, these redirected funds would provide a foundation for equitable access to modern healthcare. This would mean scrapping all publicly funded health care benefits that are enjoyed by politicians and other public servants. I insist that an MP’s healthcare needs are not more important than those of his poverty-burdened constituent. Yes, Old Man Musoke’s healthcare in Mbirizi should be as important as that of Museveni in Rwakitura. Both lives are precious, and equal.


A healthcare tax causes great discomfort, but it is necessary to meet the exorbitant cost of healthcare. It is an achievable goal in a society that chooses its priorities carefully and invests in the long-term, not in immediate gratification exemplified by our obsession with luxury, conferences, self-congratulatory celebrations, glamorous weddings and funerals, and addiction to partying and daily consumption of illness-inducing foods and beverages.  Priorities, priorities! We can do it. We must do it! 


© Muniini K. Mulera

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