The ills that plague our health sec­tor to­day and pos­si­ble so­lu­tions

By: Winnie Watera

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

Pe­ti­tion­ing Par­lia­ment

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 [1]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.




[1] 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.