Hospital management boards crippled by low funding
Some of the Kisoro District, Health Unit Management Committee members during a meeting recently. Photo BY PAUL TAJUBA
With no financial support, Jack Katarangi, has worked as chairperson Rubuguri Health Centre 1V in Kisoro District, Health Unit Management Committees (HUMCs), for five years
Katarangi, became involved in the management of Rubuguri Health Centre 1V, following a 2003 Ministry of Health initiative that saw the establishment of HUMCs to among others, supervise health facilities.
Each hospital, according to HUMCs guidelines, is supposed to have a committee of nine members drawn from sub-counties where these facilities are located with powers to examine and approve annual work plans and budgets.
But by all standards, public healthcare in Uganda is free- falling, with several reports indicating drug stocks out, absent health workers among others, an indication that something is wrong with these management committees.
“These boards do a lot of things and they are working but they have some challenges,” Dr Asuman Lukwago, the Ministry of Health permanent secretary told Daily Monitor.
In the remote Rubuguri, like rural areas, Katarangi says, few health workers treasure working in the district meaning a supervisorial hand comes in handy.
“The biggest challenge we face is lack of support from the ministry. We cannot move and supervise centres without transport or lunch,” Katarangi, a retired teacher, said.
Dr Lukwago says the ministry knows this challenge and its negative impacts on the performance of these boards and hospitals at large but little can be done for now “since we are already underfunded and we cannot create another extra burden”
“Even the board of a big hospital like Mulago [national referral] is not paid,” Dr Lukwago said, adding, “Our hospital services are free; a small private wing cannot generate enough money to pay board members.”
The magic that will see the committee members get facilitated, Dr Lukwago says, is in the hands of parliamentarians to expeditiously pass the 2007 National Health Insurance Scheme (NHIS) Bill into law.
The scheme, proposed in 2007 is premised on helping all Ugandans access basic healthcare services through compulsory contributions of 4 per cent of employees’ salary and the employer contributing another 4 per cent to make it 8 per cent per worker.
With this scheme, Dr Lukwago says institutions will be able to generate incomes either from government or private sector to make it easier for the ministry to pay committee members.
“Our expectations from committee members are high. We want lawyers, engineers… but we cannot retain such people if we don’t pay them. It is a matter we are going to discuss, especially when we make our institution fairly private by having the insurance scheme,” Dr Lukwago, said.
In Kisoro District where Reproductive Health Uganda (RHU), a non-government organisation, has been working jointly with district administration to advocate for better health programmes, Dr Stephen Nsaniyumva, the district health officer, says if government can facilitate boards, community healthcare will greatly be improved.
But Dr Nsaniyumva is also quick to point out that government should provide funds to facilitate the training of these committee members.
“When they were appointed, there was no funding to train these committee members in their roles and responsibilities. They only got one copy of the guidelines of how they are supposed to operate,” Dr Nsaniyumva said.
Dr Christine Nimwesiga, the assistant district health officer says “What we need from the ministry is real support to these HUMCs members… they need some facilitation in terms of transport and lunch. You cannot engage people for a whole day without lunch or refreshments.”
Doreen Kansiime, the RHU project coordinator, says, through advocacy for better health project, a four-year programme funded by United States Agency for International Development (USAID), they are creating an enabling environment for community groups to raise their health demands and hold duty bearers accountable for improved health and social services.
“We are calling upon government to allocate enough primary healthcare funds to cater for the sitting of the HUMCs activities,” Kansiime said, adding that they are utilising the community groups such as; Village Health Teams, Village Savings and Lending Associations (Saccos), women groups who will then be given power to deliver health services. The project is currently being implemented in Kisoro and Kabale districts.
