By Hon Kyagulanyi Ssentamu Robert
In Today’s Daily Monitor Monitor, at Page 14 on the state of Uganda’s healthcare system
Reflecting upon the events and controversies surrounding the death of the Rt. Hon. Speaker of Parliament, Jacob Oulanyah.
The late Rt. Hon. Jacob Oulanyah’s death has re-ignited the debate about the state of Uganda’s public healthcare, more than 36 years since the NRA seized power – with lack of funding remaining the single biggest barrier to health service delivery. To worsen matters, the few resources allocated to the sector tend to be misused, lost to corruption and patronage, or ‘invested’ in ill-advised infrastructure projects such as the Lubowa Hospital saga. Recently, funds for Covid vaccine development have been added to those for which there is neither accountability nor visible outcomes.
As a result of maladministration, there are too few public health facilities in place. 38% of the population lives over 5Km away from a public health facility (and 21% over 5km away from any health facility). Given the condition of most rural roads, and the absence of a public transport system, that is an unacceptable burden for over ten million people.
Health facilities lack basic drugs, medical equipment and staff. The staff are overworked in generally unsafe conditions, but underpaid. Their demands for better conditions are usually met with threats of collective dismissal.
For close to four decades, the NRA regime has not established a public health insurance scheme to lift the burden of medical expenses off the majority of the population which is already struggling with hunger. 11% of Ugandans subsist on one meal a day. Only 37% have three meals a day!
It is public knowledge that in his final days, the late Speaker was flown abroad for treatment on a chartered flight that cost the tax-payer Shs. 1,700,000,000/=. This sum is sufficient to build more than one health facility or to buy numerous ambulances. It would be sufficient for a CT scan, or 100-plus dialysis machines. Both services are currently only available to a very small section of the population.
This past week, public debate has centered on whether the tax payer should spend 2.5 billion shillings on the Speaker’s burial, at a time when prices of basic commodities for citizens are skyrocketing and the regime is making no effort to cushion them! The biggest irony came in with the announcement by Jane Ruth Achieng, the health minister, that there is no money to continue paying the COVID19 support staff.
The average Ugandan citizen covers 37% of their healthcare costs. Donors cover about 45%, while government covers only 15%. Whereas on paper it is government policy that all surgical care in public hospitals is to be provided free of charge, in reality patients are usually compelled to meet the greater part of their surgical bills. Statistics show that 75% of Uganda’s population would be bankrupted if they had to pay for surgery- the cost is impoverishing and catastrophic.
Private health insurance is unaffordable by most, and concentrated in urban areas. It covers less than 1% of the total national population. The vast majority of Ugandans, 75% of whom stay in rural areas, are on their own — abandoned to their fate.
In a nutshell, the regime has completely failed to make effective health care accessible to all citizens. Rather than the economically disempowered, it is the wealthy or ‘connected’ that benefit from the shoe-string health budget.
Still, I wish to assure you countrymen and women, that with sheer political will as the starting point, these barriers to healthcare can be overcome. Let us refuse to be distracted by political opportunists who have tried to hide the healthcare crisis by creating a North-South divide. There is no such divide. What we have is the divide between a few political elites and the vast majority of poor and desperate people in all regions of Uganda.
The late Speaker organized a significant donation from Parliament of equipment to Lalogi Health Centre, Omoro’s first Health Centre IV. Let our national tribute to him be to unite in working towards better governance and healthcare.
We have enough resources to run and fully stock a public health facility in every sub-county, eliminate the prohibitive cost of accessing treatment in public facilities, while at the same time paying health workers what they should earn.
We must appoint technocrats on merit to manage our healthcare system, and then let them do their job with minimal political interference or patronage. There should be credible mechanisms to hold accountable those of them who misuse the funds entrusted to them.
Effecting these and more interventions would improve the quality of our public healthcare services, and restore public trust in our facilities. There should come such a time when it is foreigners that fly to Uganda for treatment.