On June 10, 2010, the then Minister for Finance, Planning and Economic Development, Ms Syda Bbumba, presented to Parliament the Budget for the financial year 2010/2011.
In the budget, the government reaffirmed its commitment to the rehabilitation of the country’s regional referral hospitals and a whole range of Health Centre IVs, which are an integral part of the national referral system.
“In the FY 2010/11, Government will mainly focus on development of health infrastructure through rehabilitation of Regional Referral Hospitals…. Government will further undertake the rehabilitation of the Mulago National Referral Hospital” she said.
Besides Mulago Hospital, other hospitals that the government lined up for renovation included Arua, Fort Portal, Hoima, Gulu, Jinja, Mbale, Soroti, Mbarara, Mubende and Moroto.
At the same time, the Minister promised that the government would expand health facilities and provide accommodation for health workers at Kiryandongo, Kawolo, Kitagata and Nakaseke hospitals.
Shortly after Ms Bbumba’s budget speech, the then Permanent Secretary in the Ministry of Health, Dr Asuman Lukwago, announced that another batch of hospitals would be renovated under the Uganda Health System Strengthening Project (UHSSP) with funding from the World Bank.
The $130million project was to improve infrastructure of two regional referral hospitals, 17 general hospitals and 27 health center IVs; to improve development and management of the health work force. It would also strengthen management, leadership and accountability for health service delivery and improve access to and quality of maternal health, new born care and family planning services.
The two regional referral hospitals were Mubende and Moroto, while the 17 General Hospitals were Anaka, Nebbi, Moyo, Kiryandongo, Masindi, Apac, Mityana, Nakaseke, Iganga, Bugiri, Entebbe, Itojo, Bukwo, Buwenge, Kawolo, Pallisa and Kitgum.
The Health Centers that were lined up for renovation were Kasanda, Kiganda, Ngoma, Mwera, Kyantungo, Kikamulo, Kabuyanda, Mwizi, Kitwe, Rubare, Aboke, Aduku, Bwijanga, Bullisa, Padibe, Atiak, Obongi, Pakwach, Buvuma, Budondo, Ntenjeru-Kojja, Buyinja, Nankoma, Bugono, Kiyunga, Kibuku and Budaka.
At the time Ms Bbumba and Mr Lukwago came out with news of the planned renovations, most of the country’s hospitals were in a serious state of disrepair.
The buildings, many of which had been constructed by either the colonial government or during the early days of independence, needed major sprucing up, while others, that is if the architecture is anything to go by, had to be demolished to give way for new ones.
It was a tale of lack in all hospitals across the country. As of December 2013 a facility like Jinja hospital, which was elevated to regional referral status in 1994, was touted as the biggest government-owned facility in Eastern Uganda, yet it had only 11 wards and a private wing, both of which had a bed capacity of 600.
The facility often admitted more than its capacity, which would compel some patients to sleep on the floor while infants admitted in the pediatrics sections were often forced to share beds.
The facility also had only 20 medical doctors, 16 consultants and 185 nurses serving a population of about five million strewn across Busoga region and parts of neighboring Buganda.
The state of other facilities like Abim hospital, where there were neither houses for medical staff, no running water, no resident doctor or toilet or latrine facilities soon became a subject of the political ping pong between President Museveni and his opponent Dr Kizza Besigye ahead of the 2016 general elections.
“My brother Amuriat (Patrick Oboi) told you about the condition of Abim hospital since it was built in the 1960s. We have not even put a coat of paint. It is no longer a hospital but a mortuary where you go to die. NRM has turned our hospitals into mortuaries,” Dr Besigye told supporters at a rally in Morulem, Abim, in December 2015.
Renovation work was carried out on seven other hospitals, namely Moyo, Nebbi Entebbe, Mityana, Nakaseke, Kiryadongo, Anaka, Moyo, Nebbi and Iganga. The work, which was carried out under a World Bank funded programme, kicked off in December 2013 and was completed in November 2015.
Fifteen other general hospitals including, among others, Kaberamaido, Ntungamo, Bundibugyo, Kiboga, Bugiri, Ambi, Adjumani, Abim, Kitgum, Kabarole, Pallisa, Masindi, Kumi, Apac, Sheema (Kitagata Hospital) and Kapchorwa were renovated.
Rehabilitation and redesign work on Mulago National Referral Hospital which was launched by President Museveni on October 18, 2014 is ongoing. The US$85million works are expected to be completed during the course of this year.
Work and equipping of Mulago is expected to save the country valuable foreign exchange expended on payment for specialized services outside the country, which the facility is not providing mainly due to lack of equipment.
It is also expected that the upgrade of Kawempe and Kiruddu Health Centers to general hospital status, giving each of them 170 bed capacities, with 40 beds going to the maternity wings and five operating rooms, coupled with the services that are being offered by Naguru General Hospital will help decongest Mulago.
However, while the National Advisory Committee on Medical Equipment, headed by Dr E. K. Naddumba had in 2003 released guidelines on standard equipment for health centres, district and regional referral hospitals, government seems to be finding it difficult to implement the recommendations.
The report, for example, recommends the installation of power backup, perhaps a standby generator, and refrigeration facilities for the mortuary. But hospitals like Kawolo, Jinja and Iganga neither have the recommended facilities nor the capacity to maintain them.
Kawolo and Jinja hospitals do not have refrigeration facilities. Refrigerators in Iganga and Kawolo collapsed more than five years ago, while facilities in Jinja have been dysfunctional for more than two years now.
Those who for one reason or other must keep their dead for a couple of days before the interment can take place must make do with moving them to facilities in Kampala.
Despite most of the renovation work having come with a component for provision of equipment, in some cases, such equipment has not been provided. Where it has been provided, members of staff have not been equipped to deal with the modern machines.
A case in point is Jinja Regional Referral Hospital. The hospital’s former director, Dr Michael Osinde, says that whereas the facility has a 20 bed Intensive Care Unit, which was constructed with joint funding from the government and the Rotary Clubs of Jinja and Oregon, it remains underutilised.
“Its equipment lies idle since there is no specialised staff to operate and maintain it while the Health ministry has never arranged to train personnel in intensive care management,” he said.
The Permanent Secretary in the Ministry of Health, Dr Diana Atwine, says the Ministry has started addressing itself to the lack of specialised staff.
“Right now the Health Service Commission is in the process of recruiting medical workers for most of the ICUs across the country,”
Dr Atwine also acknowledges that provision of equipment has not matched the pace of renovations, but hastenes to blame the situation on a small resource envelope.
“We are trying to address challenges around lack of equipment, but we are constrained by limited resources. Nevertheless, we equip as we get the resources. It (equipping the hospitals) is a process. It is not an event,” she says.
Where some work has been done, the quality is left wanting, but for us in Masaka, we have been neglected. We were abandoned. We don’t have a district hospital, which puts a lot of pressure on services at Masaka Regional Referral hospital. We don’t know why this has been done. We don’t know whether it is intentional or not.
Ms Florence Namayanja, MP Kalungu County East, Masaka
“Basing the Healthcare at the sub-county and the county (HC IIIs and HC IVs) has caused a Revolution in Uganda. Infant mortality has declined from 122 to 44 per 1000 live births, life expectancy has risen from 43 years to 58.7 years in spite of the AIDs epidemic. The immunization takes place.
President Yoweri Museveni, in a statement issued in December 2015 following Dr Kizza Besigye’s visit to Abim hospital
“The (2016/2017) budget was long passed. We are now in the implementation phase and it’s a little difficult to increase the salaries of the workers. This work (negotiations on salaries) is in progress. We all know the importance of the health workers, the amount of work they do, and we are still committed to increasing their salaries across the board which hopefully will be done in the next financial year”
State Minister for Health, Ms Sarah Opendi, in a July 20, 2016 Statement to Parliament
Daily Monitor position
The decision by government to source funds for the renovation of health facilities is commendable. The dilapidated state in which most of them had been would never inspire confidence among patients whose psychological state of mind plays a major role in the healing process.
However, now that the renovations are done with, it is important that issues of lack of equipment and personnel are addressed.
In January last year, the then Permanent Secretary for Ministry of Health, Dr Asuman Lukwago, announced that thanks to a donation from China, the government had under the National Minimum Health Care Package moved to provide health centers across the country with 7,000 beds and mattresses. Each hospital received 100 mattresses, while each health center IV received 24 mattresses.
“With the new addition, the government will be able to meet 100 percent mattress needs for general hospitals and Health Center IVs. Every patient who reports to a health facility will therefore have access to a mattress once admitted,” he declared.
But equipment goes beyond beds and mattresses. It should go on to providing equipment such as X-ray machines, Ultra Sound machines, Delivery beds and a host of others.
The government should also move to address poor staffing levels in our health facilities.
The doctor-to-patient ratio was as of 2013 estimated at 1:24,724, while the nurse-to-patient ratio was at 1:11,000. This is far below the World Health Organization’s recommended health worker to population ratio of 1:439.
To fix this, the government could start by addressing longstanding concerns about remuneration for health workers, who are the lowest paid in the East African region, with nurses earning an average of Shs600,000 and doctors about Shs1m.
On the other hand nurses in Tanzania and Kenya earn an average of Shs 804,255 and Shs1.4 m, while Doctors in the two countries earn an average of Shs1.6m and Shs4.4m respectively.