Why is the health sector grossly underfunded?

Monday March 7 2011

By Vivian E. Asedri

One of the key indicators to gauge a country’s commitment to the welfare of its citizens is importance attached to citizens’ healthcare needs. This commitment must be comprehensive given the dynamics of healthcare sector. For instance, more resources cannot be channelled to one sector, say children immunisation, when other sectors such as maternal and adult health are grossly neglected.

This haphazard administration of Uganda’s healthcare system manifested itself in the first ever patients’ strike in Uganda’s post-independent history at Mulago National Referral Hospital on February 6, when they protested the lack of medical attention. Spinal injury patients due for surgery but who were rotting away in their wards from sheer neglect decided to abandon their wards and moved their beds outside the hospital veranda. Surgeons ready to operate on the patients lacked anesthesiologists.

A surgeon privy to Mulago Hospital’s budget requirements told me the hospital’s annual estimate for 2010/11 fiscal year for it to run optimally was over Shs100 billion. But what the hospital actually got from Treasury was a mere Shs30 billion, or 30 per cent. Of this amount Shs18 billion goes for staff wages and salaries, Shs9.8 billion for non-wage recurrent expenditure and balance of Sh5.02 billion for capital development.

With a budgetary deficit of over Shs70 billion, the shameful specter by the patients on February 6 should not surprise anybody who cares to pay keen attention to NRM government’s resource allocation patterns over the years.

When key sectors such as healthcare and education are under-funded at expense of non-productive sector like the legislature as reflected in hefty bonuses and the controversial Shs20 million paid to each MP “to supervise government programmes in their constituencies”, my heart weeps for Uganda’s future. As expected, Mulago Hospital and other regional referral hospitals that are chronically under-funded never benefited from the Shs602 billion supplementary budget that was rushed through Parliament.

Assuming that Mulago Hospital was given 100 per cent of its budget for 2010/11 fiscal year it wouldn’t have staved off the patients’ strike. As another surgeon from Mulago said, the events of February 6 were symptomatic and culmination of persistent under funding. After the debacle, Mulago Hospital acting Deputy Executive Director, Baterana Byarugaba, told the media that of the 40 anesthesiologists needed for the hospital, only seven are available. Anesthesiologists are one of the highest paid medical doctors.


Byarugaba’s disclosure rhymes with revelation last year by Dr Elsie Kiguli, president of Uganda Society of the Advancement of Radiology and Imaging, that Uganda has only 35 qualified radiologists/X-Ray technologists serving a population of over 30 million. This means one radiologist is responsible for diagnosing 1.2 million Ugandans.

Services radiologists perform are so integral to patient care that a single hospital in United States employs about 30 radiologists because of the heavy reliance on radiologists by doctors. This practice doesn’t mean American doctors are unskilled in their trade, but it greatly minimises chances of misdiagnoses, medical errors and saves lives.

The shortage of anesthesiologists and radiologists in Uganda gives a bird’s eye-view of the overall disconnect the healthcare sector faces from poor planning and perennial underfunding. The media has been awash with reports of chronic shortages of medicines, equipment and skilled medical personnel in virtually every hospital and health centre in the country.

My challenge to President Museveni and NRM is this: until government makes heavy investment into development of healthcare professionals and make the health sector a high national priority, what NRM hasn’t done in the last 25 years can never be realised in the next five years.

Mr Asedri is a medical information technologist, San Diego, California-USA