Thursday December 14 2017

Are health centres remembered only during campaigns?

Antenatal services. Expectant mothers wait to

Antenatal services. Expectant mothers wait to be attended to at Kawaala Health Centre IV in October. PHOTO BY RACHEL MABALA 


The promise: In the run up to the March 2016 General Elections, the ruling National Resistance Movement (NRM) released a campaign manifesto in which the party committed itself to presiding over a gradual increment in the number of workers in health facilities countrywide.
“In order to improve the human resource in the health sector, the NRM will undertake…to recruit health workers to 100 per cent staffing level by 2018,” the manifesto reads in part.

By the time the manifesto was put in the public domain the Uganda Bureau of Statistics (UBOS) had just released a statistical abstract, which revealed a deficit in staffing levels for the 2,998 health centres in the mostly rural parts of the country.

The report, which skipped mentioning the deficits in staffing levels in major hospitals and urban centres revealed that only 40,375 out of the approved 58,000 posts had been filled, leaving a gap of 18,316, about 31 per cent of approved posts vacant.

Going into specific areas, the 2015/2016 annual Health sector performance review revealed that Uganda has a staffing gap of 73 per cent anesthetic officers, 60 per cent pharmacists, 51 per cent, and 25 per cent midwives.

Very worrying! Right? Yes, but it was actually an improvement. The situation had been worse prior to 2011/2012.
If the Health Sector Development Plan (2015/16-2019/20), which was published in September 2015, is anything to go by, the manpower deficit in Uganda’s health facilities had with donor support been decreased from about 44 per cent in about 2000 to between 30 and 31 per cent in the financial year 2013/2014.

The same document states that staffing levels had been maintained at 70 per cent in the financial year 2015/2016.
According to the 2016 manifesto, the idea was to circumvent the rigorous recruitment regime which entails going through the public, health and district service commissions.

“To avoid delays in the recruitment, health workers will be posted by the Ministry of Health immediately after completion of registration to fill gaps within the ceiling of staff needs in the sector. The Health Service Commission and the District Service Commissions will only be required to validate their appointments,” the manifesto read in parts.
Poor health service delivery in government health facilities across the country has been a major issue since the NRM came to power in January 1986.
The issue, however, assumed more prominence in the last one-and-a-half decades and became a major campaign issue in the 2011 General Elections.

As the then FDC Presidential candidate, Col Dr Kizza Besigye, traversed the country in the run up to the February 18, 2011 elections, he was quick to latch on the challenges in the public health system and sought to use the NRM campaign slogan of “NRM Pakalast” to his own advantage.

“I hear some of our friends in the NRM saying that NRM Paka last, but the only thing that they are saying is that poverty paka last; poor education standards in our schools paka last; lack of health workers and drugs in our health centers paka last. Yes. That is what they are saying,” he repeatedly said. On his part, Mr Museveni preferred to blame drug stock-outs and the inadequate number of health workers and warned that they would “pay with their backs”.

Despite the sustained pressure from the Opposition nothing was done in 2011.
Now with 2018 by which the recruitment and filling of approved posts was meant to have been done which is a couple of weeks away, only the development and launch of the Health Service Commission was fulfilled and the Ministry of Health launched an Electronic Recruitment system (ERS).

In what appears to have been a move designed to meet the wish listed in the manifesto, the ERS allows for health workers to be recruited without going through traditional recruitment processes that entail the tedious journeys to Kampala for either interviews or registering official complaints.

The chairperson of the HSC, DR Pius Okong, said ERS had been developed to help the body improve on, among others, data sharing and transparency, and also provide HSC with an opportunity to conduct online assessments of candidates.
It is still early days to establish how far the innovation has gone in achieving those objectives especially in light of the high levels of computer and Information Communication Technology (ICT) illiteracy among existing and potential health workers countrywide.

The doctor to patient ratio has remained pathetically high at 1:24,000 which is way above the World Health Organisation’s (WHOs) recommended ratio of 1:1,000. WHO has since projected that the ratio should be coming down to 1:600 by 2020 if doctors if patients are to have effective medical attention in the facilities.
Uganda is one of the 49 countries that the World Bank categorised as low income economies, which cannot meet the minimum threshold of 23 medical doctors, nurses and midwives per 10,000 people, a figure that WHO set as a necessary in the quest to deliver essential maternal and child health services.

The sum total of this situation is that government health facilities are perpetually overcrowded and available medical workers are stretched to the limit. This therefore means that fewer people get to access the kind of care and attention that they would have loved to get at the hands of the country’s medical workers.

The staff shortages have contributed to the poor working conditions in the hospitals in government health facilities, which was one of the reasons advanced when medical doctors under the Uganda Medical Union (UMU) advanced when they downed their tools early in November to protest among other things the poor pay and end to harassment of medical workers by the State House based Health Monitoring Unit (HMU).

The HMU was established by President Museveni in the first half of the first decade of the millennium “to monitor and work out solutions to problems in the health sector”.

Monitor’s Position

If the contents of the third Health Sector Barometer on “Seeking a new Consensus on Health Services” which was delivered by the Uganda Medical Association to President Museveni at State House Entebbe on October 31 is anything to go by, the health system needs more than recruitment of staff for it to function properly.

Medical workers are not well facilitated, they are poorly motivated and have no work equipment.
Drug stock-outs are constant. Patients have to buy drugs and sundries such as cotton wool and gloves from private clinics before they can attended to.

Unfortunately, some overzealous Resident District Commissioners (RDCs) and members of the State House based Medical and Health Services Delivery Monitoring Unit have been pouncing on medical workers and subjecting them to arrests, other forms of torture and harassment basing on rumour. Blaming the failings of the health system on medical workers is not helpful. The challenges of the health sector have to be addressed in a holistic manner.

We agree that medical workers have to be better paid and we do appreciate government’s announcement that it is going to improve their salaries come July 2018, but health centers need to be fully equipped.

Official position

It was not possible to talk to the Permanent Secretary in the Ministry of Health, Dr Diane Atwiine, but in an earlier interview with Daily Monitor, she had indicated that the Health Service Commission was addressing itself to the recruitment of Staff beginning with those required for more specialised sections such as Intensive Care Units (ICUs). “Right now (before the reading of the budget for the financial year 2017/2018) the Health Service Commission is in the process of recruiting medical workers for most of the ICUs across the country,” she said.

There is however no evidence that staff for the ICUs have been recruited.
The policy statement of the Ministry of Health for the financial year 2017/2018 indicates that the health sector is still dogged by “inadequate staffing at all levels”. It adds that “Current staffing (levels stand) at 70% though staffing norms (are) below the service delivery needs”.

Sections of the local media quoted the Under Secretary in charge of Administration and Finance in the Ministry of Health, Mr Ronald Ssegawa Gyagenda, saying that the planned recruitments will be happening as soon as January this year.

Mr Ssegawa was however not available for a comment on how the processis to be implemented.