Squabbles, scandals make health sector sick - minister

Friday July 1 2016

Health minister Jane Ruth Aceng during

Health minister Jane Ruth Aceng. File photo  

By Emmanuel Ainebyoona

How did you receive the news of the appointment?
I received this news with gratitude knowing that the appointing authority has put trust in me and given me the responsibility of taking care of the health of Ugandans. So I am grateful. But the appointment comes with responsibility and I will take it willingly and give it my whole.

What do you consider as the responsibilities of the Health minister?
The Health minister is responsible for the health of the entire country, in ensuring that the population gets what is meant for them, the minister has a set goal; to ensure that we have a healthy population that contributes much to the economy.

It’s my responsibility to ensure the strategies in the Health Sector Development Plan are implemented, ensure that the NRM manifesto is implemented and that we work within the laws of Uganda. It’s my responsibility that we use the resources effectively and efficiently and staff is committed.

You have climbed to the top of the ladder; from a junior medical officer, director general, and now minister.
I am highly blessed, greatly favoured by God because not many people have that opportunity. I started out as a medical officer and had the opportunity to run through the clinical system from the lowest level of a medical officer to the highest level of senior officer.

At the same time when I was a clinician, I was also an administrator, which doesn’t happen to so many people, so I have also run through the administrative hierarchy from high level senior officer through medical superintendent to a hospital director up to a level of director general. And now I am at this top-most level. When I look back and reflect, I say, ‘thank you Lord for bringing me this far.’
At the hand-over ceremony, you talked about a tainted image of the ministry
The health sector has been making progress in terms of health sector delivery services and indictors. We have achieved some of the Millennium Development Goals: Goal number four on child health, we have managed to bring down maternal mortality from 438 per 100,000 to about 347 per 100,000 live births, we have increased coverage for immunisation.
We were able to control all the disease outbreaks on record time; we are giving health education and promotional messages; we have managed to put nearly 847,000 people on HIV/Aids (Antiretroviral therapy) treatment and we managed to bring down the rates of infection among infants to as low as 3,400 from 26,000 and among the adults to about 89,000. I think we have done well.
However, the population has their own ways of measuring progress. The population does not look at the indicators, they look at what they see and hear.

Some of the things they have been hearing are corruption, mismanagement of Global Funds, and mismanagement of the Gavi Funds as so on-and-so-forth.

You have been hearing about friction and in-fighting in the ministry and that tells them that the health sector is sick, and rightly so, because you cannot blame them for making that conclusion. When the system is flowing, you don’t want to hear about corruption, misuse of funds and friction among the people.

How will your administration be different?
One of the things we need to address is the issue of proper utilisation of funds, with clear and transparent accountability within ourselves and also the population.

There is a mechanism we are going to put in place so that the population can see that their money is being well utilised on the services meant for them. Of course, we have to address the issue of our interpersonal communication.

People who feel disgruntled, there needs to be a healing process. People have their own challenges and expectations that they bring on board, people have their own fears and this can only be addressed in a way that we approach it.
If you approach people with friction and force and they also approach you with the same, the result is not good. If they approach you with fighting, you counter it with love and they will understand. But regarding corruption, there is no tolerance.

How do you intend to ensure there is harmony?
Well, It’s good that we are beginning when the financial year is just starting. Now, we are going to have a mechanism in place where we can track our resources using a vote book so that each department is aware of the resources that are allocated to it.

Every time they draw down, they know the balance but also for the people who are supervising, they are able to know what the resources have gone to do and whether it has been done. We shall be requiring feedback of each of those in our quarterly review meetings.

How are you going to address the issue of low absorption of resources?
I know your question is stretching to the challenge of procurement. The challenge is also the procurement process that takes forever. That will be addressed. The order from the appointing authority was that moving forward, there should be no delays in decision making and procurement.

That will be implemented to the dot. As a ministerial team, were are going to ensure there is a critical role for supervision.

How will that be done?
One of the things we are embarking on in the first 100 days is developing a very clear support-supervision strategy with very clear tools based on the World Health Organisation. The six building blocks which will be addressed are; finance, health records, medicine and clinical workers.

We are going to look at incorporation of more people to carryout support-supervision not only people from the ministry but we have been training schools, retired people who are not tired but are able to move around with experience. We shall have people for every region and once they go to carry out the support supervision, a very clear feedback is given out to the district regarding every facility based on tools.

Immediately there after, there will be a follow up to find out whether you actually implemented the recommendations in the tool. We are not going to leave anything regarding support-supervision because if we don’t do it, we are not going to move forward.

How do you intend to streamline the drug supply chain?
If you look at the supply chain, the challenge is two ways; the centre and the district. NMS is going to procure software known as “Enterprise resource plan” which is able to capture whatever comes into the store and whatever leaves the stores very clearly. We have been having challenges with the mark at site which does not capture the results very well. We are going to have a system to track the drugs that have gone to a health facility.

The biggest challenge is at the other end of the chain where the drugs have been received at the health facility. The challenges we have been having there include poor management of the store, poor arrangement in the stores and the challenges of filling in the stock cards and monitoring to see what goes in and what comes out (to ensure first expiry first, first out).

As a director general, I did write a letter to all the health facilities clearly indicating to them that once you have made a procurement plan and given it to NMS, that procurement has the amount of funds we have allocated to you. Now if you leave drugs to expire, you are responsible because you have wasted government money. We have already developed guidelines for redistribution; if you have requested excess, don’t let them expire from there, ensure that they are redistributed to the facilities within.
If there is excess, alert medical stores and they will redistribute it to a district that needs it. The challenge is how to manage that because sometimes you find that people like district health officials are not available to follow up, sometimes the store keepers don’t have the knowledge and the skills. All this will be addressed through support-supervision.

Uganda Cancer Institute has been complaining that they are getting medicine at inflated prices?
That is not true. That challenge happened only once, and that was around March and May 2014.

It is the “Mark-and-send” system which has been a challenge to NMS. If you key in figures and one of the items is 19,000, this system adds four 000s at the end. And everything appears inflated but NMS detected that problem very fast and addressed it and informed the cancer institute in writing, but they went ahead to work out and credit that money.

It is an issue being blown out of proportion for nothing. The UCI should be working on the availability of drugs to patients and avoid selling the medicine to the patients. Government provides money to procure medicines. The issue that NMS has been having is that the manufacturing plants only provide one of the molecules and yet cancer drugs go in a combination.

Sometimes, you have to wait for one week to have one of the molecules supplied from different companies. However, Clinton Health Access Initiatives (CHAI) is working out a solution to have all these companies together to have the molecules at ago. NMS was given mandate by Parliament to buy and distribute drugs and you cannot change it.

How are you going to tackle the issue of health equipment lying idle?
Government made a deliberate effort and this was done under the Uganda Systems Strengthening Project with the World Bank support to procure requirement nearly for all the health facilities. It’s true that there is equipment lying idle, it’s also true that some is dysfunctional and needs repair. We have carried out hospital surveys and we know where this equipment is and one of the undertakings is to ensure that it is put where its required.

State of the medical workers, poor pay/housing/facilitation?
What motivates health workers is not only pay but also working environment. Have you got a good working environment, where you are accepted, have I got the equipment, medicines and other resources? The government has largely addressed infrastructure issue and medicines. The challenge facing the health workers is the work overload and attitude.

Government is now recruiting more health workers, already Health Service Commission is advertising for recruiting health workers for all the re-modelled and renovated health facilities.

Addressing the attitude is going to be an on-going process. Attitude has been eroded over time. The challenges are not only monitoring but also governance issues. Through support-supervision, we shall be discussing this on case by case. If you are not up to the job, you can find a way of exiting quietly.

Do you ever see yourself joining elective politics?
I don’t think so…I have never thought of going into elective politics where I have to go down to the voters and look for votes.

Do you have any other message to Ugandans?
Ugandans should know that your health is your responsibility and you need to focus on prevention. With prevention, we ensure that people are protected from non-communicable and communicable diseases. I want the population to be positive towards the preventive aspect rather than focusing on the clinical aspect of health because by the time you go for the clinical aspect, you are very sick. But if you focus on prevention then, we could save our country numerous sums of money.