How city health centres struggle to cope in the face of Mulago renovations

Patients wait to be attended to at Kisenyi Health Centre as a nurse calls for some order in the waiting room. Photo BY RACHEL MABALA

What you need to know:

With Mulago hospital under renovation, many patients are experiencing hardship to access medical assistance at the lower government health facilities due to high patients’ number, limited resources and manpower.

Expectant mothers sit on the floor at different points of the room, some are lying on the floor, a few occupy the available benches while others stand, leaning against the walls.
Those who tire of standing walk outside in search of a place to sit, but keep peeking through the windows whenever a nurse calls out a name.
The mothers-to-be waiting on the benches are seated so close to each other that every time the nurse calls some names out, she requests some s to get out of the room. She promises to ensure that whoever is called out will not miss out on the opportunity, in vain.
Welcome to Kampala Capital City Authority (KCCA) Kawaala Health Centre III (HCIII) which is located in Kawempe Division. In the facility’s outpatients room, a stack of boxes competes with patients for the little space available.
I inquire from a nurse whether all the boxes contained drugs.
“The first two rows from the bottom are drugs and the rest are mosquito nets. But why are you inquisitive, are you a spy?” inquires the nurse.
I don’t want to bring attention to my curiosity lest I’m thrown out therefore, I smile and quietly move on. However, I cannot help thinking about the fact that a few minutes ago, as the cleaner goes about her duties, some of the filthy water flowed into the boxes. It is evident that this has been going on for a while since the boxes at the bottom have patches of water in different shades.

Patients rate services
Patients here have a mixed taste of the services at the facility.
Some complain about spending hours waiting to see medical personnel and having to search for the recommended drugs elsewhere.
“On Friday I failed to see a doctor [a nurse in this case] despite the fact that I had come to the facility as early as 6am to secure a number,” Jane Namanda says.
“Throughout the weekend I survived on some Coartem and Panadol; I had no change as the illness persisted. I had to come back today [Monday] to see if I can be helped. I can’t go to Mulago hospital because they will ask me for a reference letter,” says Namanda a resident of Bwaise, a Kampala suburb.
Kalema Margret, a resident of Kawaala, however, says the services are okay and at least she gets most of the drugs she wants at any particular time she visits the facility.
“I take advantage of living nearby the facility. I come and get a number, time myself, then come back later. I also know some nurses at the facility as I often serve them food,” says Kalema.
At about 10am, the health centre is at its zenith capacity, with patients crowding the waiting room, which is also an extension balcony on the facility’s main building.

Insufficient manpower
Next stop is Kisenyi Health Centre IV (HCIV) in Lubaga division, which is considered the best aided facility among all the KCCA health centres. This is evidenced by some of the state-of-the-art equipment launched early last year in the dialysis unit, dental unit and the general medical theatre.
However, some of the equipment has been underutilised due to insufficient manpower to operate it, despite the high demand for these specialised units.
Time check: 12.30pm. Patients are scattered on the facility’s balconies sheltering from the scorching sunshine. Most patients are crowded in the waiting room, majority holding exercise books, which I am told are for registration and drug prescription. Some patients are sitting under the improvised tent, which was set up to handle typhoid patients.
“It is a hustle to get services here,” says Immaculate Nyacho, a mother of three. “I brought my child to be examined. His ears have been aching and I want a doctor to tell me whether they have a problem, but since morning there’s no sign that I will see a doctor,” Nyacho says.
Nyacho says she went to Mulago but was asked to get a reference report from the immediate government health centre as a proof that they could not manage her child’s health case.

Health centre staff weigh in
Teddy Nalwoga, the in-charge at a Kawaala Health Centre complained that Mulago hospital has often sent away patients who need specialty health attendance, making patients suffer a double tragedy.
“It is a dilemma for the patients. Someone is already sick but here he or she is told to go back and forth to Mulago,” Nalwoga said.
She says in many cases it is a general hospital, a referral health facility or specialised private clinics that can satisfactorily handle most of the specialty health queries like Ear, Nose and Trachea (ENT).
Enock Kusasira, Mulago hospital’s spokesperson denied that the facility chases away patients who come for specialised services, which are not offered at the lower health centres.
Kusasira, however, reaffirmed that for one to quickly be assisted at Mulago, they “must endeavor to bring along with them a reference report” as a matter of requirement to avoid overcrowding at the facility, which is partly under renovation.

Despite all their challenging working circumstances, medical personnel at the health centres are going by their daily operations.
It is until some share their stories that one discovers what lies beneath their hearts.
“If it was not the professional oath I signed, I would not be serving as a health worker, especially one working under KCCA supervision,” an in-charge at one of the facilities shares.
“I heard at one time that a KCCA office tea-girl earns at least Shs1m. For health workers at any level, no one earns above Shs1m and we also went to school to be able to get a decent life in future but the way KCCA and government officials treat us, they don’t see any value in our services,” she laments.
“The little salary we get,is often delayed. Getting our allowances is a tag of war,” she says.
Kisenyi Health Centre, besides leading in services provisions among all KCCA health centres has been at the head of most of the health workers strikes in all the KCCA managed health centres.

A glance at the other centres
My next stop was at Kisugu Health Centre III (HCIII) the following day. At the facility, a similar trend of crowded patients and high numbers of patient arrivals, with similar complaints of basic drugs shortages, insufficient space to accommodate the high patient numbers and the few medical workers to attend to the surging patients’ population are characteristic of the facility.
“We are over stretched, our numbers are a few and our pleas to the in-charge to increase on the medical personnel have yielded nothing,” says a nurse at the centre.
The situation at Komamboga Health Centre III (HCIII) is not any different from that of Kawaala, Kisenyi or even Kisugu. An interface with medical personnel at the facility reveals an environment that requires an urgent remedy if the final consumers of the services at the facilities are to get the best results.

Scope of patients
On average, each KCCA health centre receives a daily patient inflow of at least 150 patients. Kawaala, for example, says the in-charge, records about 400 patients, Komamboga about 250 patients, Kisenyi about 500 patients and Kisugu about 350 patients on a daily basis.
Kampala is home to more than 3.7 million people during the day. This, according to City Hall officials increases on the pressure health facilities.
KCCA spokesperson Peter Kaujju, acknowledges that there is a problem.
“We acknowledge there is a big challenge to tackle as the authority. All possible avenues are being explored to continuously improve the health services in our centres,” Kaujju says.
Dr Daniel Okello, the KCCA Health deputy director in charge of the Curative department, said the health workers at the facilities should endure the challenges saying “there’s no way they can cope up with the demands of the public for the health services but only offer the little they can.”
“Mulago, before renovation started, was delivering more than 30,000 babies a month. It has a capacity for more than 1,500 patients’ beds and has all the specialised departments,” said Dr Okello.
“Do you think our facilities can beat that pressure from such a huge hospital? There’s no way we can match it. But we can try to substitute under such circumstances like you have observed,” Dr Okello said.
Ministry of Health spokesperson, Lukia Nakamatte said it is the duty of the health workers at their various health facilities to make their weekly working schedules flexible in order to harmonise the working timeline for each other.
However, when this reporter mentions how many patients each health centre was receiving on a daily basis, Nakamatte said, “Then that is an issue we must take to the high level authority for consideration.”
KCCA manages nine health centres, which are ranked from level two to level four. These include; Komamboga HCIII, Kisugu HCIII, Kiswa HCIII, Kitebi HCIII, Kawempe HCIII; Bukoto HCIII, City Hall HCII, Kisenyi HCIV and Kiruddu HCIII.
However, three of these facilities; City Hall HCII, Kawempe HCIV and Kiruddu HCIII, are non-functional since they are under renovation.
This leaves patients with the burden of either seeking medical attention from relatively cheap private health facilities or patiently waiting for the services at the city health centres.

The healthcare system in Uganda

Uganda’s healthcare system operates basing on a referral system, where, if a Health Centre at level II cannot manage a given health case, the facility refers the patient(s) to another unit of another level.
Health Centre II
The country’s health policy proposes that every parish should be having a health centre at least a health centre II, which should treat common diseases like malaria and carrying out immunisations.
Such facility is headed by an enrolled nurse, working with a midwife, two nursing assistants and a health assistant. It runs an out-patient clinic, treating common diseases and offering antenatal care.
Health centre III
A health centre III is should be at least found in every sub-county in country. The facilities should have at least 18 staff, headed by a senior clinical officer, who runs a general outpatient clinic and a maternity ward. It should also have a functioning laboratory.
Health centre IV
At this level a health centre serves a county or a parliamentary constituency. In making, a health centre IV is a mini hospital. It should have such services found at health centre III, but it should have wards for children, women and men and should be able to admit patients.
The facility should have a senior medical officer and a doctor as well as a mini theatre for carrying out emergency operations.
Each district, preferably, should have a hospital that offers all the services found at a health centre IV. It should have specialised clinics for example those for mental health and dentistry and consultant physicians.
At the top of the healthcare chain is the national referral hospital, in this case the Mulago referral hospital. This is where some of the best medical brains can be found.