The ills that plague our health sector today and possible solutions
A percentage of the Ugandan population has been code named the “alcohol, salt, sugar and soap” population, because that is all legislators need to give in exchange for a vote and when elected they almost forget those who put them into power. This population has been duped into believing that “no change” is the only way to go despite the unrealistic policies that are in place. The notion that 55% of the Ugandan population does not get angry when government is not accountable to them baffles a multitude of people. The health sector continues to lag behind, below are a few reason why.
Export of medical Workers
In 2014 there was a government proposal to export over 250 medical workers to Trinidad and Tobago on three year contracts in order to strengthen bilateral relations between the countries. 13 Ugandan doctors with specialties were chosen by the government for relocation, along with another 270 physicians, nurses and midwives. Recently this prompted an outcry from people but the reaction expected from the people who can barely afford healthcare, whose hospitals lack electricity and who move more two kilometers seeking medical attention was zero to none.
According to a 2013 government report, 42 % of Uganda’s health positions were still vacant, with only one doctor for every 24,725 people. This is itself a reason for us to be up in arms against the decision. This is when the flow of information becomes an important aspect in promoting accountability; do we expect the grass root folk to know what’s happening at the center? Clearly, decentralization has not been able to yield the expected results.
This is 2015 and most people here in Uganda are still dying of curable diseases such as typhoid, dysentery and malaria but we can afford to even think of exporting medical labor.
Meager budget allocation
The Budget Frame Work Paper of 2015/16 laid in parliament indicates that there will be no significant change in the budget allocation for the health sector. Last financial year, 9% was dedicated to the health sector, this year it’s a mere 7% with only Ugx 333 billion allocated to wages. This is definitely the very reason why our medical workers to seek employment elsewhere . Neighboring Kenya pays its health workers 7 times more than Uganda. The budget for reproductive health items remains low despite having challenging reproductive health issues. For example contraceptive prevalence rates are at 28% and needs of family planning services at 34%. And these days donor aid isn’t coming though as often as it used to. We are below the Abuja declaration of 2001 which requires a country to dedicate at least 15 % of its national budget to the health sector. With the 2015/16 health budget at 6.7% -what does this say about Uganda?
Are there any solutions one may ask: well, there are a few
The Coalition of the Civil Societies Organizations presented a petition on 8th April 2015 on the export of health workers. They however did not address the politicians who always promise better health facilities, access roads to hospitals and even delivered ambulances for the sick to be transported to health facilities plagued with lack of health workers. However, given parliament’s history in dealing with petitions, this is likely to be another battle on the side of the petitioners and the public that is waiting for a decision to be reached soon. Normally a petition is supposed to take 45 days in a committee; research confirms 80% of petitions at committee stage take more than 90 days before Parliament receives a report. In the meantime – we have limited staff working in our health centers like we have only eight (8) oncologists in Mulago Hospital, the national referral hospital. A petition could help but it will take time.
Political leaders taking action
The other obvious solution is to our plight is our politicians, the 375 that will deliberate on the budget, those most influential in the eyes of the 55%. First they need to increase the allocation to the health and social sector, specifically the recurrent budgets to tackle the human resource problem. The capacity gap should also be addressed as well. However, believe it or not, most votes [offices] in the health sector that report that they have not received funds have not handed over accountability that Ministry of Finance needs before it disburses money, and last but not least there’s need for the citizens of Uganda especially those at the grass root to be involved in the process of budgeting.
The issues that plague the health sector are many – but there are also solutions. All these need to be taken into account as we ask for this sector to be revamped.
 According to the Public Finance Management Act 2015, a vote is an entity for which an appropriation is made by an appropriation act or supplementary appropriation act eg Cancer Institute could be 002.