Huge population choking Kampala hospitals

Patients wait in a tent at Kisenyi Health Centre IV in Kampala in 2018. The facility is overwhelmed by the number of people it serves. PHOTOS/RACHEL MABALA

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Each year, a good number of people migrate to the city in search of greener pastures. All these people fall sick at some point or have medical needs, meaning the increase in population stresses the health facilities and its workers, writes Tonny Abet.

A strange skin disease is peeling off and leaving unsightly wounds on Bob Sseka’s legs. But even at his second visit to the government owned Kisenyi Health Centre IV in Kampala, the helpless 19-year-old says he has not been attended to by a doctor.
“They have told me to come back on Monday because there are too many patients to serve. I came here yesterday [Thursday] and today [Friday] was my second time, but it has been the same experience. I have no money to go to a private hospital, so I will return next week,” he says.

Sseka, who is both illiterate and jobless, lives in Kisenyi, one of the largest slums in Kampala City. He is one of about 16 young people who were not attended to by a doctor at the youth corner in the facility on May 7.
“I have waited for more than four hours now. I reached here at 8am and it is now 12.30pm [when a doctor has not attended to me]. They say free things are expensive and now I can understand it,” says 15-year-old Robert Nabongo, who had gone for medical examination but was told to return the following week.

About 89 per cent of Kampala City population is young, ranging from 0-29 years and nearly six in every 10 of the city dwellers live in slums, according to Kampala Capital City Authority (KCCA).
Between 2014 and 2019, the city’s population rose from 1.5 million to 1.65 million, according to government statistics.

But a good number of those migrated to the city for greener pastures but can’t afford the high costs of most private health facilities in the city.
By last year, Kampala City had an estimated four million people as its day population and two million residents by night, according to the KCCA executive director, Ms Dorothy Kisaka.

All these people fall sick at some point or have medical needs, meaning the increase in population stresses the health facilities and its workers.
Babarah Babirye, an expectant mother, says she spent six hours before getting medical care at Kisenyi Health Centre IV.

“I came here at 7am and I got medicine at 2pm. I stay in Bulenga, Waksio District,” she says.

Bulenga is about 14 kilometres away from Kampala. At the youth corner, a bench that sits a maximum of three patients in light of the current social distancing context, was seating up to six patients.

Adam Kassim Kyazze, the Kisenyi I parish chairperson, says with a population of 40,000 in the area, the number of people has outgrown the health facilities and sanitation services such as toilets.
He says Covid-19 caused an increase in disease burden in the area, but the residents are finding it tough to access care in nearby public facilities.

“In this pandemic, we have had more young people indulging in prostitution and so cases of sexually transmitted diseases (STDs) have increased, especially among girls who do not have money,” Kyazze says.
“If you look at Kisenyi, we only have one public health facility [Kisenyi Health Centre IV] yet we have more than 40,000 people who live in the area. And at the facility, there is only one unit that handles young people and there are always no kits for testing some diseases, let alone medicine,” he adds.

When this reporter approached the offices of the management for comments, he was referred to KCCA.
Kyazze adds: “We want the government to provide all parishes within the city with a public health facility because the number of patients is overwhelming this health facility. They should also avail enough medicine and access to services should be free of charge.
Kyazze says sometimes young mothers abandon their sick children because they cannot get medicine from public health facilities yet they do not have the money to buy from private facilities.

Then State minister for Health Sarah Opendi (4th left) speaks to health workers at Kawaala Health Centre III
in Rubaga, Kampala in 2019.

“We still face a very big problem, especially with the toilets that are too few for the rising population. Although there is a presidential directive that the public toilets are supposed to be free of charge, people are being asked to pay between Shs300 and Shs500. And if you want to bathe, you pay between Shs500 and Shs1,000,” Kyazze says.
Dolphin Atieno, a resident of Kansanvu, one of the major slums in Makindye Division, Kampala City, says at Kisugu Health Centre III, she gets a lot of challenges in accessing care.

“The health workers at Kisugu are very kind but there are always many patients and the medicines at the facility are not enough,” she says.
At Kasanvu, a population of 1,500 people is sharing three public toilets of four stances, according to local leaders.
The Katanga authorities say most of the drainage channels in the area are either broken or blocked.

At Katanga, one of the major slums near Mulago National Referral Hospital, the village chairperson, Moses Ssempewa, says the more than 20,000 residents lack access to medical care.
Like other slums, Katanga grapples with poor sanitation due to lack of toilets and blocked or broken drainage channels.
“Katanga slum is occupied by the urban poor. The major challenge we are facing is lack of access to public health services. Whereas we have many people, we do not have any health centre in the slum,” Ssempewa says.

“Mulago hospital is near us but it is an inconvenience because being a national referral hospital, there are people from all over the country seeking care and also the new charges that slum residents cannot afford,” he says.

Experts speak out
Dr Peter Waiswa, a researcher at Makerere University College of Health Sciences, says a recent assessment they did in Kampala slums indicates severe shortage of health facilities to off er affordable health services to slum dwellers.

“We have public, private-not-for profit, and for-profit health facilities in Kampala. Government should come up with ways to make sure the facilities work for slum dwellers because access to quality health care is everyone’s right,” he says.
There are more than 1,700 private and not-for-profi t health facilities in the city, according to KCCA.
The expert urges the government to address the shortage of medicines, increase staffi ng and adopt a national health insurance strategy to enable equitable access to healthcare in the city and across the country.

On the concerns at Katanga and Kisenyi, Dr Charles Olaro, the director of clinical services at the Health ministry, acknowledges there has been too much focus on increasing access to healthcare upcountry, but that they are now shifting focus to slum dwellers.
“The initial intervention focused on rural areas but right now, more facilities are being established in urban areas. Maybe there are problems around the functionality of the facilities. The facilities are directly supervised by KCCA,” he says.

Dr Dan Okello, the head of public health services at KCCA, says they are reviewing the need to put in place health facilities in some of the slums where the population has outgrown the capacity of health facilities.

“We don’t have a facility around Katanga, but we are looking into the issue. But about existing facilities, we don’t have issues with access to health services,” he says.

Patients wait to be attended to at Naguru hospital in Nakawa, Kampala in 2018.

“When you look at our statistics, the seven health facilities under KCCA, see 40 per cent of the antenatal cases and 20 per cent of out-patients in the city,” the KCCA chief of public health adds.
Most health centres in Kampala give priority to HIV/Aids and resultant opportunistic infections, including diarrhoeal and respiratory diseases, and malaria, according to KCCA.
The 2019/2020 health sector performance report indicates that the “highest number of perinatal (under fi ve) deaths were reported in Kampala (3,009), followed by Wakiso (757).”

On the issue of sanitation, Dr Okello says they are constructing more community toilets and asking landlords in areas where toilets can be constructed to do so.
“We have a whole citywide inclusive programme to address the problem of poor sanitation in the city. There are a number of factors that are driving poor sanitation in slums. One of them is the security of tenure, where you don’t have where to construct a toilet,” he says.
The KCCA public health chief says: “The other challenge is technical expertise on the type of toilet that can be constructed in a particular place. Some landlords don’t want to construct toilets.”
He says the other challenge is that some of the dwellers who own toilets were failing to empty them periodically Some of the slums are not connected to the central drainage channels of National Water and Sewerage Cooperation, or the connections are blocked or broken, according to local leaders.
Dr Okello says: “So we came up with a programme where we connected toilet owners with companies that empty the toilets free of charge on the first service and owners pay for the second emptying.
About 60 per cent of toilets that the government constructed in the city slums were abandoned due to  non emptying, according to information from KCCA.
“We are also training people in slums and availing prototype plans for the toilets so that people can construct with ease,” Dr Okello adds.

A Health Centre IV (HCIV) is meant to serve a population of about 100,000, while a Health Centre III (HCIII) is meant for a community with a population of 20,000, according to the Ministry of Health.
Among the five divisions in the city, Makindye which has a population of 438,300 is served by Kisugu HCIII. Rubaga has the second-largest population (427,300) but it is served by Kawaala HCIII.
Nakawa has a population of 353,500, which is served by Kiswa HCIII.
While Kawempe, which has a population of 377,700 is served by Komamboga HCIII.
Kampala Central Division, which has a population of 83,800, is served by City Hall clinic and Kitebi Health Centre III.
Although the facilities are already stretched, several patients from neighbouring districts such as Wakiso and Mukono come to KCCA health facilities.
The city has experienced a 3.9 per cent population growth in the last fi ve years, according to KCCA.