Busoga new districts: Where are the promised hospitals?

Tuesday June 18 2019

Treatment. A health worker (in white) attends

Treatment. A health worker (in white) attends to patients at Buyende Health Centre IV in Kidera Sub-county, Buyende District. PHOTO BY TAUSI NAKATO  


The promise
On October 14, 2016, President Museveni, responding to comments made by the Speaker of Parliament, Ms Rebecca Kadaga, in Kamuli District, promised to have district hospitals constructed in each of the new districts in Busoga Sub-region.
“I am aware of the big population in the region and the need for health services. We shall give every newly created district in the region a hospital,” he said while speaking at the Boma Grounds in Kamuli District where he presided over celebrations to mark the Global Hand-washing Day.
The new districts of Busoga are Buyende and Kaliro, which were carved off Kamuli; Namayingo, which was carved off Bugiri; Luuka, Mayuge; and Namutumba, which were carved off Iganga District.
Though Bugiri is a new district, it is not among those that do not have a district hospital. Bugiri hospital, which was constructed in the 1960s by the Obote I government, was one of the assets it took with it when it was formed.
Whereas the Ministry of Health’s policy stipulates that every district should have a hospital and that counties, sub-counties, and parishes must have health centre IVs, health centre IIIs and health centre IIs respectively, the three districts do not have district hospitals and have to make do with health centre IVs, health centre IIIs and health centre IIs which ill equipped and understaffed.

According to figures from the 2014 National Housing and Population Census the Namayingo, which has nine Sub-counties namely Namayingo Town Council, Buhemba, Mutumba, Bukana, Banda, Buyinja, Siguulu Islands, Buswale and Lolwe Islands had a population of 215,443 people.
Access to health facilities is a big challenge. Only 5.4 per cent of the population mostly in Namayingo Town Council live within a distance of between five and 12 kilometres to the nearest health facility.
The situation is worse in other areas. In Mutumba Sub-county for example, up to 41.5 per cent of the population have to trek between 32 and 42 kilometres before they can get to the nearest health facility.
As of 2014, the district was reliant on one Medical Doctor who also doubled as the head of Buyinja Health Center IV, which was serving as the district hospital, a scenario, which the leadership said was hampering provision of health services at the 60 bed facility.
At the same time, though serves as a referral, it lacks most of the required basic amenities to enable it serve at that level. It for example does not have an ambulance.

Buyende, according to the 2014 National Housing and Population census, had a population of 323,067 people spread out in the six sub-counties namely Kidera, Nkondo, Buyende, Kagulu, Bugaya and Kagulu Town Council.
Like Namayingo, it relies on Kidera health centre IV to handle the major referral cases. Others are referred to Kamuli.
Access to health facilities is also a challenge here. In some sub counties up to 72 per cent of the populations live more than 10 kilometres away from the nearest health centres.
Whereas most of the people in Luuka live within distances of less than 10 kilometers of the nearest health center, up to nearly 40 per cent of the populations in Bukooma and Ikumbya live more than 10 and up to 30 kilometres away from the nearest health facilities.
Prior to the promise he made in Kamuli, President Museveni had during the campaigns in the run up to the 2016 general elections promised to improve health infrastructure in Luuka District.
Speaking at two different rallies in Kiyunga Town Council and Busiiro Primary School grounds, he promised to reconstruct Kiyunga Health Centre IV, which had until the collapse of the East African Community in 1977 been one of the East African Community’s sleeping sickness laboratories.
The female ward at Kiyunga Health Centre IV, which serves as the district hospital, was destroyed during a mysterious fire that broke out at the facility on January 26, 2013.
Authorities there were forced to convert an abandoned kitchen, which had neither doors nor windows into a maternity ward for the facility which handles an average of 90 births per month.
In May 2014, former Luuka Woman MP, Ms Evelyn Kaabule told Daily Monitor that she had been assured in meetings with the then Minister of Health, Ms Christine Ondoa, and her predecessor, Dr Ruhakana Rugunda, to wait until the financial year 204/2015.
Nothing was, however, done for the facility during that year.
The district NRM chairman then, Mr Meddie Mulumba, now a Commissioner with the Uganda Human Rights Commission, said he has since taken up the matter with President Museveni, who has promised to avail the UPDF’s construction unit to handle the matter, but again nothing happened.
During the campaigns, Mr Museveni promised that the facility, which has neither a male ward nor proper beds and is plagued by shortages of drugs and medical personnel, would be elevated to hospital status.
Now more than two years since Mr Museveni made the promise to erect new hospitals in those districts, there is nothing on ground to show that any progress is being made to achieve that.
Last month, Parliament’s Committee on Government Assurances released a report in which it took issue with government’s failure to fulfill some of the promise that it had made especially in the area of health.
The report, which was compiled by the chairperson of the Committee, Mr Kaps Hassan Fungaroo, faulted government for failure to construct hospitals in Maracha, Buyende and Kumi.
“Government undertook to construct 3 new Hospitals and rehabilitate four. The Committee found out all the 3 new hospitals pledged to be constructed in the districts of Maracha, Buyende and Kumi had not been done,” the committee report noted.

The lack of public health facilities in some of the districts has had the effect of pegging the country back in as far as efforts to fight diseases like malaria is concerned.
It has also been partially to blame for the setbacks that the country has been suffering in as far as fighting infant and maternal mortality rate is concerned.
In the period between 2006 and 2016 Uganda implemented very many interventions that resulted into the reduction in the mortality rate of children under the age of five. The figures slumped from 109 deaths per live 1000 births in 2006 to 53 deaths per 1000 live births in 2016.
That was commendable, but the number of deaths remain unbelievably high.
The maternal mortality rates also remain very high. They stand at around 336 deaths per 100,000 live births.
This places Uganda among the most dangerous places in the world for one to become a mother.
One of the reasons we are suffering these deaths is in part due to the huge distances that many of our people have to travel before they can access the next health center.
This is in part because there are not public health facilities in some of the districts.
In some places there are private health facilities to which government has abdicated the role of providing health care to its citizens.
That is one of the causes of continuing deaths due to even simple ailments such as Malaria. Those are deaths that could have been avoided.
Besides lack of medical facilities, the ratio of health workers to the population is appalling.
According to figures from the Ministry of Health, the number of health workers per 1,000 Ugandans is way below the World Health Organisation threshold of 2.3 doctors, nurses and midwives per 1,000 population.
In 2015/16 FY the number of doctors, nurses and midwives per 1,000 population was 0.74/1,000, of which doctors were 0.03/1,000, midwives 0.25/1,000 and nurses 0.46/1,000.

Official position

The Minister of Health, Dr Jane Ruth Aceng, while presenting before Parliament a report on the state of health service delivery in Uganda, indicated that the plan to construct hospitals in those districts is part of a wider plan by government to construct at least 41 public health facilities in districts that do not have them.
The Minister said government is embarked on the process of identifying a minimum of Shs1.4 trillion to fund the establishment of those hospitals. The startup cost for a single hospital is Shs31.3billion which would cater for the cost of construction, hiring of manpower and provision of equipment, medicines and sundries.
Besides the districts of Busoga, government has plans to construct hospitals in other districts like Alebtong, Amuria, Amuru, Bukedea, Bukomansimbi, Bulambuli, Buvuma, Dokolo Gomba, Isingiro, Kaliro, Kamwengye,Kibuku, Koboko, Kole, Kotido, Kween, Kyankwanzi, Kyegegwa and Lamwo.
The others are Lwengo, Manafwa, Mitooma, Nakapiripirit, Namayingo, Ntoroko, Otuke, Pader, Rubibiriza, Serere, Sironko, Kibaale, Kakumiro, Rubanda and Omoro, but hastened to add that some of them are to be given first priority because of their nature.
“There are districts that deserve special attention because of their geographical locations. They are either islands or mountains. These are Buvuma, Kalangala, Namayingo, Mayuge and Namisindwa,” Dr Aceng said.


Monitor Position

It is great music to the ears that the Ministry of Health is looking around for funds to help start up public health facilities in districts that do not have them. However, those plans should be implemented along with improvements to the referral system in the country.
Uganda desperately needs a functional ambulance system as an extension of the public health’s emergency system to enable citizens who can neither afford to meet the cost of primary health care or those who are tootraumatised to access treatment and leave or get access to first aid and before being referred to bigger facilities.
If one is talking about improving health systems, curbing avoidable deaths and combating infant and maternal mortality rates and morbidity, we should be talking a lunch that goes beyond opening up facilities, to equipping them and putting in place emergency response systems.