Hospitals get facelift, but far from better service delivery

Shortage of doctors, nurses, midwives, pharmacists and related support staff have become a common characteristic of the country’s healthcare system.

Palma Mindraa, an enrolled midwife, found attending to about 40 expectant mothers alone at Kiryandongo Hospital, says although the hospital structures look better after refurbishment, the challenge of inadequate staffing has remained a major impediment to health service delivery to Ugandans.

Kiryandongo General Hospital, one of the nine hospitals which have received a facelift through a $52m loan provided to government by the World Bank in 2011, shares the human resource problem with Iganga hospital, Anaka Hospital in Nwoya District and Moroto Regional Referral Hospital.

“We are dying of work. I have been here alone since 8.30am and I will push on until 8.30pm because my colleague is sick. I am expected to come back here tomorrow at the same time,” says Mindraa.
Despite working beyond her normal working hours, Mindraa says she does not get any overtime allowance as a token of appreciation for her extra effort.

“I have to attend to mothers in the labour suite, antenatal and post-natal wards at the same time since I am the only midwife on the ward,” Mindraa says as she walks to the labour suite where a mother is impatiently waiting to deliver.
Sam Tumwesige Mutiti, the Senior Hospital administrator at Kiryandongo hospital, admits that the human resource constraint largely affects the facility which is already overwhelmed by high patient numbers due the population influx of refugees, highway accident victims and resettled populations in the area. The hospital receives patients from as far as Nakasongola, Masindi, Bweyale and Karuma.

He says the hospital has only four medical doctors instead of the recommended 10 and about 13 midwives instead of 32. However, he differs with the statistics provided by Mindraa who says there are only nine midwives.
“We have human resource as an issue with our staffing level being at 40 per cent,” Tumwesige says, adding that they lack crucial cadres like nurses and a pharmacist. All the hospitals covered by this media tour, lacked specialist pharmacists and only relied on nurses as medicine dispensers.
The annual Health Sector Performance Report for FY 2013/14 ranked Kiryandongo among the worst performing districts at position number 100 partly due to its staff inadequacies.

The other side of the coin
However, on the flip side, the hospitals have undergone structural renovations, which included construction of new casualty wards, staff houses, new outpatient departments, placenta pits, toilets and pit latrines, X-ray and ultrasound scan machines, 144,000 water tanks, an intercom communication system and satellite television sets in all wards connected to pay TV. Power supply has been upgraded with 650kVa transformers, among others.

Health workers not disciplined

A new report released by the Health Service Commission this week has attributed underperformance in the health sector to absenteeism and indiscipline among health workers.
The 16th Annual Report of the Health Service Commission presented to the Speaker of Parliament, Rebecca Kadaga, on Monday, cites cases of neglect of duty and absenteeism in several districts. The health centres that were visited include: Bukedea, Rugazi, Mitooma, Kabohe, Kikube, Bukomero, Hima, Karugutu, Kitido and Ngora.
“Some districts reported continued instances of absenteeism and neglect of duty by some health workers. They indicated taking measures ranging from minor to several reprimands but there were no reports on actual numbers,” Prof Pius Okong, the chairperson of the commission said.

Prof Okong also told the Speaker that many rural districts had failed to attract and retain specialised critical medical cadres like public health nurses, anaesthetic officers, midwives and pharmacists in the district and regional referral hospitals due to resource constraints.

The report also indicated that health workers complained of lack of uniforms despite repeated promises that they would get them from the Ministry of Health.
Kadaga said there was need for the health sector to review the policy on retirement to retain several of the medical experts that are laid off as soon as they clock the mandatory retirement age of 60 years, amidst the scarcity of doctors.
The Speaker noted that Parliament will consider the report and its recommendations when it resumes after the general election.

Case of Moroto Regional Referral Hospital

At Moroto hospital, which remains Karamoja’s main referral health facility, the story of inadequate and poorly remunerated health workers stands out.

Denis Onyango, a biosafety technician, says he has worked without salary at the hospital since February last year.
“Human resource is a challenge. Look at me, I am not employed by the hospital but I was previously sponsored by the Ministry of Health through a Global Fund programme. I was sent here in 2004, the contract ended and I wasn’t paid by the ministry,” says Onyango.
He says he has been volunteering in the hope that one day the Ministry of Health will consider him despite having applied several times in vain.

The hospital administrator, Geoffrey Mawa, appreciates government for the newly-constructed and renovated structures, and says the administration has received a nod from the ministry to recruit about 58 health workers this year and priority will be given to those who are already volunteering at the hospital.
Mawa adds that Moroto District should still be considered a hard-to-reach area given that it still lacks many facilities such as accommodation which causes many health workers to shun it.

Joseph Lokoru, a resident of Kathile Sub-county in Kabong District, who has been receiving treatment for ulcers at the hospital, says it was his first time in six years to see new developments.
“It is a great achievement, we thank the government for giving us a regional referral hospital,” he says.

Planned interventions

The Minister of Health, Dr Elioda Tumwesigye, says the ministry is currently in talks with the Ministry of Finance to have Shs10 billion included in the budget of the next financial year to cater for the recruitment of doctors and also an additional Shs3.4billion to hire additional doctors for the newly renovated structures.
“We are introducing a new initiative to have about 300 doctors and 50 pharmacists hired and bonded, particularly those who have been sponsored by government while at University and Shs10 billion is required per year for their remuneration,” he says.

Last year, the government dropped the much-criticised plan to export about 283 public health workers to Trinidad and Tobago. The medical positions had been advertised by the Ministry of Foreign Affairs last year, including: 20 radiologists, four urologists and about 180 midwives.
In April 2015, Dr Tumwesigye, warned that going ahead with the export of the health workers “presents serious challenges” to Uganda’s healthcare system. He argued that it would escalate the already existing shortage of health workers in the country.

Uganda’s doctor-to-patient ratio was put at 1:24,725 in 2013 as opposed to Trinidad and Tobago, which in 2007 had an estimated one physician per 1,000 people.
All the newly renovated nine hospitals, acquired new essential medical equipment procured under the same World Bank loan but had not yet been installed at all the hospitals visited during the media tour
However, wooden boxes, containing the medical equipment could been seen lying idle, with most hospital administrators, saying the suppliers have delayed to install the equipment which includes; dental chairs, and other radiology equipment.

Dr Tumwesigye says some of the equipment had earlier not met the required specifications and had been rejected, which led to delays because the ministry had to conduct fresh procurement processes.
He says the ministry is now seeking about Shs3billion to hire new staff to operate the equipment and also includes costs required for proper maintenance.

Situation at Anaka

At Anaka hospital in Nwoya District, Acholi sub-region, Dr Stephen Oringtho, acting hospital superintendent says the facility is now in an improved state unlike before when it had been afflicted by the Lord’s Resistance Army in an insurgency that lasted for more than two decades.
During a tour around the new facility, Dr Oringtho noted that most of the buildings are not utilised because there are no health workers to render the needed medical services.
Unlike Moroto, Iganga and Kiryandongo that have a few doctors, the 145-bed capacity hospital does not have senior medical personnel and is only being operated by clinical officers. Its staffing norms stand at 47 per cent, out of its expected total number of staff of 195 health workers, only 86 are on the ground to attend to its ever-increasing patient numbers.

Under the Uganda Health System Strengthening Project (UHSSP), the hospital has now acquired a state-of-the art operating theatre which remains nonfunctional due to absence of operating surgeons.
Alex Ojera, a teacher in Anaka Town says, “The health workers are doing a good job but are very few.” He says despite the hospital looking good from the outside, it needs to give proper diagnosis and treatment to the locals.