Uganda’s Sick Health Sector

By Isaac Imaka

In Uganda, 16 women die every day during childbirth.

Late last year, after failing to raise enough money to pay for his wife’s childbirth at a healthcare facility, an Eastern Ugandan man took her home and cut her belly open. Her contractions, he said, were becoming unbearable, so he opted for what he thought would be quicker and easier. That day she became one of the 16.

This is a typical story coming out of Uganda’s failing health sector, where insurance plans are hard to come by, new health centers often lack adequate doctors or medicine, and the best doctors are frequently found working in unsanitary conditions with outdated equipment. It’s the story of a sector with a doctor-patient ratio of 1-to-24,000.

The plight of the Ugandan health sector was rarely given media coverage until presidential candidates recently began highlighting it on their campaign tours leading up to the country’s 2016 elections. Warren Kizza Besigye, the Forum for Democratic Change candidate, started with a visit to Abim hospital in northern Uganda, while Go Forward Independent candidate John Patrick Amama Mbabazi visited Kabale hospital. During these tours the candidates criticized the public hospitals’ lack of hygiene and medicine and commiserated with ailing patients.

The government reacted by deploying security personnel to surround all public hospitals to prevent further “incidents.” In the case of the Abim hospital, the nurses who allowed Besigye inside were put on probation and forced to plead for their jobs. However, as a result of the visit, the hospital soon underwent major rehabilitation.

Current president Yoweri Kaguta Museveni accused his challengers of dishonesty, saying that they had specifically chosen the worst, most dilapidated national hospitals for their tours, instead of Uganda’s more substantially funded clinics. This response is the epitome of the Ugandan political milieu, in which those who should be ensuring that Ugandans have a sound health system are instead spending their time making accusations and counter-accusations.

What the hospital visits, and the reaction from government and security forces, confirm is that although the government may give the appearance of pushing for a better health sector, the reality is actually quite different.

In Uganda, malaria, according to the 2012-2013 national statistics, still leads among the top 10 causes of morbidity with over 15 million cases per year. People want viable solutions—not only functional and equipped hospitals, but also basic healthcare that is accessible to all citizens. It borders on irresponsibility on the part of the country’s leadership that a mother can lose her life because her husband couldn’t raise less than $100 for her to have a safe delivery.

Uganda lacks paramedics, specialized doctors, and an effective, nation-wide referral network. The country also needs a well-equipped emergency system that includes ambulances stationed at all local health facilities, an air rescue service accessible to every citizen, and a team of paramedics that can respond immediately. Emergency toll-free phone lines should also be established to enable health professionals or patients at home to reach the emergency dispatch center.

Attempts to establish a national insurance program have thus far been unsuccessful. Currently only Ugandans who are employed are able to receive medical insurance, and it often only covers treatment for diseases that are classified as “easily affordable,” such as malaria. Most of the insurance plans don’t provide any dental care.

What’s more problematic, though, is that there is no health insurance program for the local poor. Many don’t even have access to preventive healthcare.

Presidential candidate Amama Mbabazi has proposed implementing a voluntary health insurance scheme. This plan would essentially offer subsidized healthcare to the poorest Ugandans by funneling government and individual resources into a fund for insurance providers who choose to participate. These providers would then offer low-cost standardized medical insurance packages differentiated by patient needs and quality of service.

This is a good initiative, and others like it should be proposed. But again, as the African Health Observatory of the World Health Organization notes, all these initiatives could end up being nothing more than words if there are no corresponding and relevant public policies developed with the input of the Ministry of Finance.

The woman in Eastern Uganda lost her life because she and her husband didn’t have access to the most basic health services. Politicians shouldn’t just talk about her situation on campaign platforms, but should actually act to improve the health sector. No woman should die while giving life.



Isaac Imaka is a Ugandan journalist based in Kampala. He covers Parliament, general politics, and oil and gas for Daily Monitor, Uganda’s leading independent daily. 

[Photo courtesy of Wikimedia Commons]

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