Enough of empty budgets, just fix the sick health sector

Sunday April 28 2013

At the height of the nodding syndrome, some parents used to tie their children to prevent them from falling  into fire.

At the height of the nodding syndrome, some parents used to tie their children to prevent them from falling into fire. It took the intervention of area MPs for government to respond. 

By Yasiin Mugerwa

Budget process. Productivity is a function of the health condition of the human resource. Improving the
condition of the health sector should therefore remain one of the top government priorities in the 2013/14
budget.

Some time in September 2011, the Daily Monitor published a painful story of Cecilia Nambozo, a teacher at
Busamaga Primary School in Mbale District, who was left to bleed to death after she failed to raise Shs300,000
the medical officers had asked for.

According to Nambozo’s friend, Ms Grace Atcham, who took her to hospital, they arrived at 6am but Nambozo was
neglected in the labour ward until 8pm when she breathed her last together with her baby. A post mortem by a
police surgeon, Dr Bernabas Rubanza, indicated that the baby weighed 5.2kg and that Nambozo died due to failure
to push the baby, rupturing the uterus. Before Nambozo died, her friend begged the health workers to attend to
her as the husband ran to the village to sell his property and raise the required funds but the medics
declined.

Days after Nambozo’s episode, in Lyantonde District, another woman died after the doctors failed to get
stitches to sew the wound after an operation. The deceased had gone to Kasambya Health Centre IV to give birth
only to pay with her life.

On Wednesday, the Daily Monitor published a story titled: “Kitagata Hospital a death trap”. In this story, the
MPs on HIV/Aids Committee narrate the unacceptable state of a sick hospital in Sheema District, with mattresses
infested with maggots. The hospital is without electricity and the water taps ran dry two years ago. The same
hospital has no personnel. The angry MPs wanted to close the hospital and burn the mattresses with maggots.

These and more hurting stories continue to dominate the media space, painting a glum picture of a healthcare
system, neglected for years under the pretext of a small resource envelope. Our health sector remains
significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending.
At less than 9 per cent of total government expenditure, public spending on health is far below the Abuja
target of 15 per cent that the government committed to.

With pitiful funding to the sector, aggravated by corruption in the system and a careless Parliament, there is
a fear that Uganda’s target and the United Nations obligation to reduce childhood mortality by two-thirds by
2015 is unlikely if interventions to reduce malaria deaths are not scaled up. Ministry of Health statistics
show that Malaria kills 320 Ugandans every day.

But for how long are we going to keep losing our people unnecessarily? When shall we stop singing the sad song
of a sick healthcare system in the country and help our people. What we need is a budget that takes unequivocal
action to promote equitable health care financing by increasing salaries for health workers to stop the
excruciating brain-drain, recruit more health workers in the hard-to-reach areas, establish pre-payment
schemes, and put in place equitable subsidisation mechanisms - targeting the neglected health facilities.

Presently, we have intolerable gaps in access to quality health care between urban and rural areas; high and
stagnant infant and maternal mortality rates by international standards, continued prevalence of communicable
diseases such as HIV/Aids, increasing prevalence of non-communicable diseases such as cancers, cardiovascular
diseases, threats of epidemics and the absence of a national health care insurance scheme has made matters
worse.

Point of focus
An improved health budget should focus on insufficient health infrastructure, inadequate distribution of health
workers at different levels of service delivery, low morale and motivation of health workers due to low pay and
absence of basic facilities, high attrition rate of health workers and insufficiently equipped health
facilities. There are also weaknesses in the supervision of health sector programmes leading to poor health
service delivery.

It’s shameful that the same MPs who for long have failed to claim their power to increase the funding to the
health sector are the ones feigning ignorance of the trauma Ugandans are going through. They had the
opportunity to fix the health sector in the current Financial Year but on account of dishonesty, our
legislators especially from the ruling party, hatched a deal with the Executive to deny the health sector
Shs260 billion.

At the height of the budget crisis last year, a section of outspoken legislators hissed the President when he
said he could not sacrifice the defence budget for anything. Ultimately, we continue to talk about the need to
fix a dead health care but without action. Our chameleons, the unashamed legislators in the House, have
continued to watch Ugandans bleed to death and at the same time pass the empty budgets. If these chameleons
were to be impugned for anything, they should be arraigned on murder charges.

Parliamentarians must ensure that this year’s budget improves the health infrastructure gaps in order to ensure
access to health care through rehabilitation of a dead sector, focusing on the sick Referral Hospitals, Health
Centre IVs and IIIs and at the same time ensure recruitment, contracting, appraisal and facilitation of
critical health care personnel and improve the efficiency and effectiveness of the health system. Like an
injection of Adrenaline, more funding to health sector would put life into our economy.