Scrap taxpayer-funded private healthcare

Dear Tingasiga;
I understand why patients scramble to get referred to India and other distant lands for healthcare. First, there is a deep distrust of the Uganda health services – even at private hospitals. This, together with a natural tendency to believe that healthcare abroad is always better and safer than it is in Uganda, may be the single most important reason.

Second, many ruling party cadres distrust Ugandan doctors, not because of concerns about competence and resources, but because they fear that harm may come to them, especially while they are under an anaesthetic. Partisan activities by some doctors have caused concern among some politicians and their relatives. These are the major consumers of public funding for healthcare abroad.

This is one reason why I salute Dr Violet Kajubiri-Froelich for her exemplary act when her life was at risk nearly two years ago. Dr Kajubiri, the sister of President Yoweri Museveni, was admitted to the International Hospital Kampala (IHK) following a serious motor accident near Mbarara in which one passenger died. She underwent surgery and postoperative care by an all-Ugandan team and stayed at the hospital for about two weeks.

Dr Kajubiri, who is married to a German national, could have been evacuated by the presidential jet to Germany. That she trusted her own people and benefitted from their expertise should give pause for thought to many among Uganda’s ruling class.
Third, there are a few treatments that are currently not available in Uganda. Fourth, there are times when the government orders the transfer of a patient to an out-of-country facility for political reasons – to “appear to have done something.”

Justified or not, the business of seeking treatment abroad sucks energy and other resources from the healthcare service in Uganda. Whether private or public funds are used to pay for treatment abroad, Ugandan money is contributing to the growth of health systems abroad instead of improving and building Uganda’s own capacity to care for all its citizens at home.
Before we suggest a solution to the problem of escalating medical tourism, it is important to recognize that it is only a small part of a wider crisis. First, corruption that has eaten at the core of Uganda’s soul has not spared the country’s once celebrated health services.

Second, the neoliberal health sector reforms that started nearly 30 years ago, have commercialised health services, turning citizens into for-profit-commodities in a market that has become increasingly devoid of a human heart.
Public hospitals and health centres have fallen far down on the funding totem pole. They are poorly staffed and equipped, often offering a quality of healthcare that is desperately wanting.

In 2013, a service delivery study that was commissioned by the World Bank, the African Economic Research Consortium and the African Development Bank reported that only 35 per cent of Uganda’s public health system providers “could correctly diagnose at least four out of five very common conditions (like diarrhoea with dehydration and malaria with anemia).”

In health centres that only offered outpatient services (health centre 2), half (49 percent) of the providers could not identify more than one of these conditions. The study also found that public healthcare providers “followed only one out of five (20 per cent) of the correct actions needed to manage maternal and neonatal complications.” That is the dysfunctional system to which the majority of citizens have been relegated by the ruling classes, even as the latter continue to pad their remunerations and “entitlements.”

I hold the view that Ugandans are born equal. I believe that good healthcare is a human right, not a favour by governments or rulers. I uphold the principles underlying the Constitution of the World Health Organisation (1946), one of which states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” So, I firmly believe in equal access for all Ugandans to the best publicly-funded healthcare available in and outside our country. I object to the use of public funds to provide private healthcare to a small number of citizens, regardless of their role or station in society.

To me, the lives of President Museveni and peasant Yowaasi Kabuye Museruka, have equal value. Their jobs may be different, but their prostates cause similar discomfort, pain and death.
A First Lady’s breast mass is not scarier to her than it is to a Last Lady. The death of either woman is equally devastating to their children and grandchildren. Parliamentary Speaker Rebecca Kadaga’s gynecological health is no more important than that of plantation servant Rabeeka Kagodo.

The recent report that parents of Uganda’s MPs would be covered by Parliament’s group insurance triggered a public conversation that revealed the disconnect between the rulers and their subjects. Reacting to the public’s dismay about the news, Chris Obore, Parliament’s director of communications and Public Affairs, clarified: “MP’s are entitled to group insurance where they are allowed to include at least five beneficiaries.” So, what are the rest of Ugandans entitled to? Substandard healthcare and selfcare? Long wait times for lifesaving treatment? Overcrowded and unhygienic clinics and hospitals? Catastrophic out-of-pocket health expenditures resulting in greater impoverishment? Prolonged physical and psychological suffering? Premature death? Do other Ugandan professionals not have parents that need healthcare? What entitles an MP to a great salary, a car, other benefits and high-class health care abroad while a police officer, a soldier, a teacher, a nurse, a doctor or farmer and their families make do with that which the MPs are running away from?

The solution lies in a changed mindset and governance culture that scraps all taxpayer-funded private health care, where all public servants – including the president – are mandated by law to receive healthcare in public hospitals.
Now, I believe in people’s freedom of choice and I affirm every Ugandan’s right to use personal money to seek health care abroad, including the cost of transportation.

However, the need to engage in medical tourism can be dramatically reduced if the elite class makes the necessary sacrifice and investment to create a state-of-the-art public health service for all Ugandans. That was what the British Protectorate and the Obote I governments tried to do.

Clearly this is unlikely to happen soon. The current rulers and their courtiers are not about to let go of their privileged “entitlements.” It is the mass of Ugandan citizens – the Wretched of the Earth - who must reclaim their right to access the same health care that their rulers take for granted. The new mantra, completely devoid of partisan politics, must be: “We are all human and we are equal!”

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