Patients at Laro Health Centre IV.
Amudat District, located along Uganda’s eastern border with Kenya, faces a severe healthcare crisis, leaving thousands of residents urgently needing medical services. Stretching approximately 200 kilometres from Moroto in the north to Kween in the south, this vast district presents challenges in healthcare access, as residents must travel long distances to reach the few available health facilities.
With a population of more than 203,000 people, according to the Uganda Bureau of Statistics (Ubos) 2024 Census, the district is served by just 11 health facilities, nine government-run and two private, not-for-profit (PNFP). However, these facilities are woefully inadequate, with underfunding, understaffing, and poor infrastructure, limiting healthcare access. For many, receiving medical care is a distant dream, as they must travel long, gruelling distances to reach the nearest health centre, often with dire consequences.
The government of Uganda established the “Health Sector Strategic Plan” (HSSP), which guides the organisation and delivery of health services across various levels in Uganda. The policy aims at strengthening the country’s health system and serving communities nationwide.
Every sub-county is required to have at least one health centre III, designed to provide essential services such as outpatient care, maternal and child health, immunisations, and minor surgeries. These centres serve as the first referral point for patients from health centre IIs. However, challenges such as insufficient staffing, inadequate infrastructure, and lack of supplies often hinder their effectiveness, particularly in rural areas.
At the constituency level, each constituency is expected to have a health centre IV, which offers more advanced services, including inpatient care for complex conditions, emergency care, and maternal services like caesarean sections.
While these centres are staffed with medical officers, nurses, midwives, and laboratory technicians, many constituencies still lack fully functional health centre IVs due to funding issues, staffing shortages, and infrastructure gaps. The highest level of healthcare within each district is the district hospital, which provides specialised services such as surgery, paediatrics, and diagnostic care. District hospitals also act as referral centres for health centre IVs.
Despite this policy, many districts struggle to meet the standards due to challenges such as limited infrastructure, staff shortages, and inadequate equipment and medical supplies. Consequently, while the policy framework is in place, the full implementation of healthcare access remains a challenge across the country.
Amudat’s healthcare infrastructure is sparse. The district’s referral facility, Amudat Hospital, is owned by the Church of Uganda, while Karita Health Centre IV stands as the only government health centre IV. The rest of the facilities include two health centre IIIs and seven health centre IIs.
Health centre IIs, which make up most medical facilities in Amudat, provide only basic services, leaving residents without adequate care. District leaders and medical professionals have long called for the upgrade of these facilities. “Efforts are underway to upgrade health centre IIs to health centre IIIs to expand service delivery,” says Dr Sagan Patrick, the outgoing Amudat District health officer.
However, progress has been slow, leaving many sub-counties underserved. Nine of the 11 sub-counties in Amudat lack a health centre III, with one sub-county, Kongorok, having no health facility. The Amudat District chairperson, Mr Joseph Lobooti Nangole, underscores the gravity of the situation, stating,
“Government policy mandates that every sub-county should have a health centre III, yet Amudat, with 11 sub-counties, has only three health centre IIIs. Some sub-counties like Kongorok and Karita, don’t even have a health centre II. We need urgent intervention.”
“Karita Sub-county is the most populated sub-county in Amudat, yet it has no single health facility. Although Karita has a government Health Center IV, it is located in Karita Town Council, not the sub-county, leaving rural residents without direct access to care,” he laments.
For residents of Kongorok, with a population of 30,000 to 40,000 people, and other remote sub-counties, accessing healthcare means embarking on perilous journeys. The nearest health centre, Loroo Health Centre III, is about 34 kilometres away, while the district hospital in Amudat is 54 kilometres away. Many residents simply cannot afford transportation.
“The nearest hospital to Kongorok is in Moroto, which is extremely far, about 50km away, with no public transport available. Amudat Hospital is 54km away, so many residents are forced to either cross into Kenya for healthcare or endure long walks in search of treatment,” says Joseph Nangole.
David Lomiru, the Kongorok chairperson, explains, “When someone falls critically ill, we have to rely on motorcycles to transport them either to Moroto or Amudat. Hiring a motorcycle and rider costs more than Shs150,000, which many people cannot afford. As a result, some people opt for walking, and tragically, many die along the way.”
Expectant mothers
Expectant mothers are among the most affected by the lack of healthcare facilities. Many are forced to deliver on the roadside as they attempt to reach the nearest hospital.
“Transporting expectant mothers on motorcycles to delivery facilities is extremely challenging, often putting both the mother and baby at risk. The rough and unsafe rides can lead to serious complications, including premature labour, excessive bleeding, or even loss of life before reaching medical care,” says Lomiru.
Amudat faces a critical shortage of medical staff, with staffing levels at just 34 percent.
“Some facilities are manned by only two health workers, making it extremely difficult to deliver adequate healthcare,” says Dr Sagaki, adding:
“Staff accommodation is also a major challenge. Given the rural nature of the district, rental housing is scarce, making it hard to retain workers. Even when recruitment opportunities arise, many health workers struggle to find accommodation and are forced to live in business centres far from their assigned facilities, further complicating service delivery.”
Nangole says: “Now that the audit is complete, efforts are underway to analyse wage allocations and submit requests to fill vacant positions. However, without sufficient staffing and proper infrastructure, healthcare access in Amudat will remain a significant challenge.”
At Loroo Health Centre III, enrolled midwife Apio Gloria describes the overwhelming workload she and her colleagues face.
“We attend to 200-300 outpatients daily, bringing the total to around 1,500 patients per month. In the maternity section, some months, we handle 300 mothers, with up to 60 antenatal cases per day. However, we are only operating at 10 percent of the recommended staffing scale.”
