The solution to healing Uganda's sick health sector is through promotion of Good Governance. The unfortunate thing is that many Ugandans wish to reap where they did not sew. In which case, whenever there is opportunity to corruptly benefit, many who would see Good Governance real just ignore and take advantage. A case in point is the Parliament, if these people can only be patriotic and stop believing is benefiting from bribes ad short term benefits, Uganda as a whole will have a future. So, all in all, before we think of changing the country's top leadership, the way to go is to have people love their country so that they are patriotic and chances that decayed sectors like health are bailed out are many.
William Kituuka Kiwanuka
WHO WILL HEAL UGANDA'S SICK HEALTH SECTOR?
By Barbara Among
Posted Saturday, October 1 2011 at 00:00
When his teenage wife went into labour, John Emegu wedged her on a bicycle between himself and his grandmother and pedalled furiously for 11 miles. But on reaching the nearest hospital, his relief quickly turned to despair.
Though healthcare is meant to be free in Uganda, nurses told him to buy a Shs20,000 maternity kit including rubber cloves, saline solution, surgical needle and a plastic ‘delivery’ sheet, which were all out of stock in the hospital. By the time he had done so—and paid another Shs10, 000 to convince an intern doctor to attend to his wife—12 hours had passed. “I don’t know what is happening,” said Emegu, 22, as he waited for news at Soroti regional referral hospital. “I am getting desperate.” His wife and newborn baby survived—unlike his first child who died in the same hospital the year before.
The Emegus’ traumatic experience is not unusual in a country, where the healthcare system is in crisis despite the billions of shillings of mostly donor money flowing in every year. Visits to a dozen health centres across the country revealed a chronic shortage of beds, drugs and medical personnel, confirming a recent verdict by the Anti-Corruption Coalition of Uganda that “service delivery and general care is almost not there”.
The government admits that the situation is dire. “Lack of adequate resources is still limiting hospitals to provide the services expected. In many instances, basic emergency infrastructure, supplies and specilised equipment are inadequate,” reads the latest annual health sector performance report. The dire situation has meant that senior government officials and wealthy Ugandans have long used private hospitals or flown outside the country for treatment, as was the case with some of President Museveni’s daughters, who delivered their children in Germany.
Members of Parliament are registered with private health insurance companies of their choice, paid for by taxpayers. But now even ordinary Ugandans, the intended beneficiaries of the free healthcare system, are increasingly seeking private healthcare. “I don’t see any reason of wasting time; you go to the government hospital yet there are no drugs,” said Joseph Kusemerwa, a resident of Kicucu village, Kabarole District in western Uganda.
So why is it dysfuntional?
Such attitudes are stirring public debate on why the free healthcare system is so dysfunctional. While it is expensive to run, money does not seem to be in short supply. Donors gave more money towards health than any sector of government, amounting to Shs321 billion in 2009/2010.
The government added a further Shs465 billion and this year Shs1.3 trillion went to health. In total, health spending accounts for 9.6 per cent of the budget, significantly higher than the sub-Saharan average of 8 per cent. Local healthcare monitoring groups and government officials say Uganda’s heavy reliance on outside funding is one of the main problems, with a lack of overlap between the government’s priorities and those of donors.
The focus of HIV prevention and treatment is one example. While 1 million Ugandans are estimated to be HIV positive—3.3 per cent of the population—some Shs549 billion went to Aids campaigns in the financial 200/2010, more than half of total healthcare budget. Most of the money came from the US’s Pepfar (President’s Emergency Plan for Aids Relief) and USAID.
‘Unreliable donor funding
Local players in the sector say the unpredictability of the donor funding makes it difficult to plan and when it comes, there is lots of overhead expenditure and what is spent on actual projects is actually less. “The money, which is off budget, has had issues of accountability, which has resulted in delayed release of other funds. Some such as Gavi have been withheld. If we had an organised system of receiving even off budget funds, we should not be seeing such problems,” said the Health Ministry Permanent Secretary, Mr Asuman Lukwago.
The effect of the heavy HIV focus is clearly visible; even in rural areas the voluntary counselling and testing centres are usually well-equipped compared to the general health units. In Kabarole District in Western Uganda, Rose Kayesu, 24, was battling malaria at home. The nearest health centre only had one type of malarial drug, and she was allergic to it. Enock Kibite, her husband, said he sometimes spends more than half of his Shs75,000 monthly earning from carpentry on malaria drugs alone.
According to the Director General of Health Services, Dr Ruth Achieng, the bulk of donor support to the health sector (41 per cent) is off budget and a significant proportion (21 per cent) of government expenditure on health mainly goes to emoluments. Sector players also point to poor coordination among health system players and this has led to fragmentation of services. “Actors have immense interest in M & E (data), at the expense of investment in service delivery. Many actors are measuring the same indices,” said Dr Achieng.
District health directors, many of whom did not want to be named for fear of reprisal, said it was “unacceptable” to run out of drugs, but also unavoidable. “There’s no money,” a director said. Government’s 2009/2010 health sector report shows that only 35 per cent of health centres do not run out of essential drugs. As of August, reports on the ministry website indicate that stocks available at both the National Medical Stores and Joint Medical Stores are generally below recommended minimum central stock level and health centres also registered low stock levels of essential drugs.
The corruption drawbacks
But corruption is a major problem hampering healthcare delivery. The Auditor General’s 2009 report shows that Shs310m meant for drugs went missing that year. “The end users did not also have knowledge of these (missing money, deliveries either). The missing drugs included ARVs, coartem, condoms and oral rehydration salts,” the AG report said.
In November 2010, the National Drug Authority said more than 100 ghost health centres created by corrupt officials had been receiving medical supplies and equipment. By contrast, many genuine health centres lack even basic equipment. So in places like Awcha, Gulu District, the theatre serves as a ward. At Kiyombya Health Centre, Southern Uganda, mothers in the maternity section are expected to pay for parafine for lamps.
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.