Residents waiting on eight-year promise to upgrade health centre

Healthy living. Namulonge Health Centre III meant to serve not less than 10,000 people as well as to provide both out-patients and in-patients services. Photos by Joseph Kiggundu

What you need to know:

  • Mr Museveni, who was in the area to promote the fight against poverty by improving household incomes, was forced to make the promise following demands from residents of the area. The constituency had since 2001 been showing signs of gravitating from the ruling party NRM to the Opposition.
  • Health Centre IIIs, such as the one in Namulonge, are meant to service at least 10,000 people and provide both outpatients’ and inpatients services. The facilities, which are usually run by clinical officers, also conduct simple diagnosis and provide maternity services.

KAMPALA. In 2008, President Museveni, while addressing a public rally at the Namulonge playground in Wakiso District, promised to upgrade Namulonge Health Centre III to Health Center IV status.
Mr Museveni, who was in the area to promote the fight against poverty by improving household incomes, was forced to make the promise following demands from residents of the area. The constituency had since 2001 been showing signs of gravitating from the ruling party NRM to the Opposition.

Nangabo Sub-county is within proximity of the Kasangati home of Col Dr Kizza Besigye, the founder President of the opposition Forum for Democratic Change (FDC) and four time Presidential Candidate.
Formerly, the area was part of Kyadondo North constituency, which had over the years been voting for the ruling NRM, but the Opposition had been making inroads partly due to the increasing influence of the opposition in the neighbouring Kyadondo South, where the Opposition had previously voted for the late Sam Kalega Njuba and later Mr Ibrahim Ssemujju Nganda, his successor.

The opposition Democratic Party (DP) finally took the constituency during last year’s general elections after the boundaries had been altered to create Nansana Municipality.
The government-funded health facilities include the national and regional referral hospitals and the Health Centre IIs, Health Center IIIs and Health Centre IVs at the district level.

The Health Centtre IIs are basically out-patients’ facilities run by nurses and meant to serve not more than 5,000 people. But since the last half of 2015, there have been indications that the facilities are to be scaled down and ultimately phased out to free resources which the government says will be redirected to better equip and staff the bigger health units.

Health Centre IIIs, such as the one in Namulonge, are meant to service at least 10,000 people and provide both outpatients’ and inpatients services. The facilities, which are usually run by clinical officers, also conduct simple diagnosis and provide maternity services.
But the population of Nangabo Sub-county where the facility is located having grown to 56,230, partly due to the location of both the National Crop Research Institute and the Namulonge Agronometry Station, which are the main employers here, only made sense that it be elevated to Health Centre IV level so it would not only be run by a medical doctor, but also get to provide a whole range of other services including surgery, emergency obstetric care and blood transfusion services.

Status
More than 8 years since the President first made the promise, nothing has been done to realise the promise.
According to a copy of the Uganda Hospitals and Health Centre IV Census Survey carried out in 2014 by the Ministry of Health with funding from both the World Health Organisation (WHO) and the African Development Bank (AfDB), Health Centre IVs are meant to have provisions for an operating theatre, inpatient and laboratory services and a referral facility for 20 to 30 people, but there is nothing on the ground to suggest that the said facility is being prepared to get all the said facilities in place.

Official position
The Minister for the Presidency, Ms Esther Mbulakubuza Mbayo, said the pledge which is part of the latest list of outstanding pledges, which was compiled by the Parliamentary Committee on Government Assurances under the leadership of Mr Latif Ssebagala Sengendo, the Vice Chairperson of the committee and also , Kawempe North legislator, must have been passed on the Ministry of Health for implementation.
Indeed the list from Parliament indicates that it is to be implemented by the Ministry of Health, but there are contradictions too.
The Wakiso District Health Officer, Dr Robert Kagwire, insists that upgrading the facility is not be possible as it will amount to a contraventions of existing health policies.
“Uganda’s Health Policy doesn’t allow a municipality to have more than one Health Center IV. Nansana Municipality already has Kasangati Health Centre IV. That is why I am saying it will not happen. If you upgrade Namulonge to Health Centre IV, Nansana will have two Health Center IVs, which is a contravention of the Health Policy,” Dr Kagwire argues.
Besides the conflict with the policy, the Under Secretary in Charge of Administration and Finance, Mr Ronald Ssegawa Gyagenda, says the Ministry is yet to receive any information to that effect.
“There is no official communication to my knowledge. We have to find out whether the President made the promise or not and where he made it from. Sometimes people come from public rallies and claim the president or a minister has promised something when the person actually hasn’t done so. We cannot act on rumours,” Mr Ssegawa said.
Impact
Failure to improve the Health facility means there has been a general decline in the provision of healthcare services, including access to services that could have either helped checked preventive diseases by detecting early warning signs or symptoms or treat before they develop into diseases.
It has also meant that the health facility does not have a medical doctor and that the few health workers available are overstretched and cannot provide services in a timely manner. Those who need the services of a Doctor or a measure of specialised treatment have to make do with either a visit to a private health facility, which might not be pocket friendly or any of the five Health Centre IVs at Kasangati, Buwambo, Namayumba, Ndejje, Wagagayi and Wakiso, which might not be within easy reach.
While the World Health Organization (WHO) recommends a ratio of one doctor for every 1,000 people, the same organisation had by 2013 estimated that the doctor to patients’ ratio in Uganda stands at one doctor for every 24,725 people and a ratio of one nurse for every 11,000 people.
The sum total of it all is that more pressure has been brought to bear on the National Referral Hospital, Mulago, which is also plagued by shortages of beds, health workers and equipment.
Monitor’s Position
Why did Mr Museveni make the promise to upgrade the facility well knowing that it was in conflict with existing health policy?
While it might be true that Mr Museveni could have been under pressure in 2008 when he made the commitment, it would have been important to first take into consideration the existing policy and the national resource envelope before making such commitments. Short of that, many of the pledges that Mr Museveni makes risk being treated as a roadside pronouncement.

Voices

“I know that this Health Centre needs to be rehabilitated and have new buildings, but a few things need to first get worked on. Top on the list is the issue of land. The land on which it is located belongs the National Agricultural Research Organization (NARO). We can’t put up buildings unless we have a land title. All new developments will begin after we have the title in our custody, but it will not be upgraded to Health Centre IV level,
Dr Robert Kagwire, Wakiso District Health Officer.

If President Museveni promised to upgrade the facility to Health Centre IV level, he should do it. After all, he has the budget to do it. People here sometimes get complications and are often referred to other health centres and hospitals. Most of us find it not only inconvenient on account of the long distances that we often have to travel, but also very expensive,”
Benjamin Kavuma, Resident of Namulonge Sub County

“We receive between 160 and 200 patients. We do our best to treat them, but also give referrals to so many of them because of our status. That is why most of the people here want this health centre to be upgraded to allow them access certain medical services that we are not qualified to provide. The centre needs to be upgraded to Health Centre IV level”
Betty Namata, Nursing Officer at Namulonge Health Centre III

“You can see right now am working from the corridor and if there is anyway of constructing a lab here that will help me and the patients to have space and a conducive working environment. Otherwise, if we continue operating from within the corridors we might easily be infected by some of the diseases that we are actually meant to be preventing or curing,”
Lawrence Anyu, Laboratory Technician at Namulonge Health Centre III

5000

The Health Centre IIs are basically out-patients’ facilities run by nurses and meant to serve not more than this number of people.