Health sec­tor : We are still not us­ing the lit­tle re­sources al­lo­cated prop­erly

By: REA­GAN WA­MA­JJI

In Africa, par­tic­u­larly sub-Sa­ha­ran Africa, poor health of the pop­u­la­tion is gen­er­ally a known re­al­ity and Uganda is no ex­cep­tion. The health­care de­liv­ery sys­tems re­main too in­ad­e­quate to meet the needs of the ever-grow­ing pop­u­la­tion. This has raised con­cerns by pol­icy mak­ers and plan­ners on whether health ser­vices are be­ing de­liv­ered ef­fi­ciently by hos­pi­tals.[1]

The health sec­tor in Uganda is al­ready con­stricted by a num­ber of chal­lenges; fund­ing gaps amid an ever grow­ing pop­u­la­tion, hu­man re­source gaps, short­age of health fa­cil­i­ties, fi­nan­cial im­pro­pri­ety, cor­rup­tion and mis­man­age­ment of funds among oth­ers. While the health bud­get is still be­low the 15% of the na­tional bud­get as per the Abuja de­c­la­ra­tion, the biggest im­ped­i­ment be­dev­il­ing our health sys­tem has been poor uti­liza­tion and man­age­ment of the mea­gre re­sources made avail­able to health cen­ters.

In 2014 the Au­di­tor Gen­eral car­ried out a value for money au­dit on the Uganda Health Sys­tems Strength­en­ing Pro­ject (UHSSP) pro­ject, ad­min­is­tered un­der the Min­istry of Health (MoH). UHSSP was es­tab­lished as an en­abler to achiev­ing the Uganda Na­tional Min­i­mum Health Care Pack­age (UN­MHCP) with a fo­cus on ma­ter­nal health, new born care and fam­ily plan­ning, through im­prov­ing hu­man re­source for health; phys­i­cal health in­fra­struc­ture; and man­age­ment, lead­er­ship and ac­count­abil­ity, for health ser­vice de­liv­ery. UHSSP, is a five year pro­ject, which was es­tab­lished in 2010, com­menced op­er­a­tions in Feb­ru­ary 2011 and ended on on 31st July 2015. The pro­ject was worth $130M over a 5 year pe­riod.

It was dis­cov­ered that med­ical sup­plies de­liv­ered were ly­ing unutilised in some health cen­tres, there were no safety and space re­quire­ment prior to sup­ply, pro­cure­ment de­lays, equip­ment in some cases were not de­liv­ered as per con­tract terms and there was no user train­ing in some cases. A proper needs as­sess­ment prior to the pur­chase of equip­ment was not un­der­taken to de­ter­mine the ac­tual user needs so as to cre­ate greater im­pact; this, in some cases, re­sulted in sup­ply of non-pri­or­ity equip­ment. A lot of money worth of equip­ment was lost.

This was one of many cases of poor uti­liza­tion of re­sources af­fect­ing the health sec­tor. Worse still, the 2013/​14 Au­di­tor Gen­er­al’s re­port also high­lighted gross fi­nan­cial im­pro­pri­ety in the health sec­tor where 2.4 bil­lion shilling was un­ac­counted for, of which 2.2 bil­lion alone re­lates to re­gional re­fer­ral hos­pi­tals; 5.1 bil­lion shillings was dis­charged and spent on ac­tiv­i­ties other than those bud­geted for. In some cases funds were un-uti­lized with the min­istry of health – Ugx 112m, Global fund HSS -Ugx 1.1bn, Global fund for malaria -Ugx 119m, Butabika hos­pi­tal Ugx 323 M, Uganda Can­cer In­sti­tute 13M, China –Uganda friend­ship hos­pi­tal 1.5Bn. Waste­ful ex­pen­di­ture in the Min­istry of health alone was 2.1 Bn.

The de­clin­ing qual­ity of health ser­vices in the coun­try is mainly at­trib­uted to the lack of drugs/ stock outs, short­age of health work­ers, de­lays in ac­cess­ing health­care ser­vices in every re­fer­ral hos­pi­tal, mis­man­age­ment of hos­pi­tal in­fra­struc­ture, over­crowd­ing of hos­pi­tal fa­cil­i­ties, among oth­ers; with dire con­se­quences, in­clud­ing avoid­able deaths of pa­tients. There has been grow­ing con­cern as to whether these hos­pi­tals are op­er­at­ing ef­fi­ciently with the re­sources availed to them.

The re­sults of the ef­fi­ciency study of the op­er­a­tions of Re­gional re­fer­ral hos­pi­tals also in­di­cate that 50% of the hos­pi­tals were rel­a­tively ef­fi­cient in util­i­sa­tion of re­sources. Ap­pro­pri­ate in­ter­ven­tions need to be made to ad­dress the slacks in the uti­liza­tion of the key in­puts such as med­i­cines, in­fra­struc­ture / equip­ment and hu­man re­source.

While ap­pear­ing be­fore the Par­lia­men­tary Pub­lic Ac­counts Com­mit­tee on 27th Au­gust 2015, the Per­ma­nent Sec­re­tary Min­istry of Health, Luk­wago Asuman con­curred with the Com­mit­tee mem­bers that a lot the pop­u­la­tion is los­ing out on cru­cial and life sav­ing ser­vices on ac­count of this mis­man­age­ment. “We ac­knowl­edge the risks and the losses in­curred…..We apol­o­gise to the coun­try,” He said.

Trans­form­ing the health sys­tem in Uganda to meet the grow­ing needs of the pop­u­la­tion would re­quire pru­dent fi­nan­cial man­age­ment, ef­fec­tive and ef­fi­cient man­age­ment of the mea­gre re­sources. There is need for gov­ern­ment to act on the is­sues raised in the var­i­ous Au­di­tors Gen­er­al’s re­ports; com­bat cor­rup­tion as well as re-eval­u­ate the poli­cies and in­ter­ven­tions in or­der to im­prove the health de­liv­ery sys­tems.

[1] Au­di­tor Gen­er­al’s Value for money re­port, 2014