Grieving Mulyagonja shines spotlight on Mulago hospital
Justice Irene Mulyagonja (in a gomesi) paying her last respects to her husband at Rubaga Cathedral on May 21, 2025. Photo/Judiciary
What you need to know:
- The Constitutional Court judge said she faced critical failures at Mulago National Referral Hospital, which she described as “just a monument”.
Justice Irene Mulyagonja Kakooza on May 21, during a sombre Mass at Rubaga Cathedral to honour her late husband, John Baptist Kakooza, delivered an emotional critique of the country’s healthcare system.
The Constitutional Court judge recounted the harrowing “hospital tourism” her family endured while seeking treatment for her husband. The revelations have since sparked widespread debate about the state of Uganda’s top public health facility, Mulago National Referral Hospital, and the broader healthcare funding crisis.
Justice Mulyagonja described a two-month ordeal that saw her move her husband between multiple hospitals, starting at the International Hospital Kampala (IHK), moving to St Francis Hospital Nsambya, then to Mulago’s private wing (6B), and finally to Mukwaya General Hospital in Kabalagala, Kampala. He would later pass away. “We kept on going lower,” she said, citing the prohibitive costs at private facilities like IHK, which even a high-ranking official like herself could not sustain.
“I could not start going to ask for money to look after my husband,” she added, highlighting the financial burden that forced her family to seek more affordable options. Narrating further, Justice Mulyagonja said: "We started at IHK, the costs were insurmountable. I, on my own, could not bear them. And I could not start, I am a judge of the Court of Appeal, the Constitutional Court, I could not start going to ask for money to look after my husband.”
She added: “I had to find a way of looking after him. So we kept on going lower. We left that hospital, we went to Nsambya hospital. I thought Nsambya was a place where we could find refuge, it had also become more expensive, [so] we left it and went to Mulago hospital, and I can write a book about Mulago hospital.”
‘A monument’
Justice Mulyagonja’s most biting remarks were reserved for Mulago National Referral Hospital, which she described as “just a monument,” a description which the facility management challenged and dismissed. The Constitutional Court judge said she faced critical failures at the hospital’s private wing, including the unavailability of basic medical supplies like insulin shots and nasogastric (NG) tubes needed to feed her husband, who could no longer eat in his final days.
“Someone comes in the morning and says, ‘Oh, we’ll put an NG tube.’ He disappears. The next person comes on duty and says, ‘Oh, we are going to put an NG tube,’ and he disappears. Then finally in the evening, someone comes and says, ‘You know what, we don’t have [it],’” she said. She also criticised delays in diagnostic services, noting that a complete blood count (CBC) test at Mulago took 24 hours, with patients often directed to private facilities for other tests.
Mulago speaks out
In an interview with Saturday Monitor on Thursday, Dr Rosemary Byanyima, Mulago’s executive director, expressed disappointment over the remarks, noting that Justice Mulyagonja had not raised her concerns directly despite having access to her. Dr Byanyima also said the national referral hospital offered the best possible care. “I visited them and even talked to her when they were here. I’m disappointed,” Dr Byanyima said, adding that the hospital is auditing the case to verify the claims.
“We are trying to audit that process right now to see whether there is truth or not. I'm so disappointed. A high ranking government official, she was in a government institution and had access to me,” she added.
What exactly happened?
Mulago’s executive director admitted that the hospital is “working towards improving services.” Further telling Saturday Monitor that “if you see anything, and I come to you, why don't you give feedback? I'm disappointed. But I'm glad; he came in very ill and we were able to treat and discharge him when he was talking.”
Dr Byanyima also emphasised that a multidisciplinary team treated Kakooza, enabling his discharge in stable condition. She suggested that issues may have arisen at other facilities lacking such teams.
“It (the treatment) needed a multidisciplinary team, which we constituted. We are not a monument. And I think, probably because she went where there is no multidisciplinary team, probably maybe that's where things went wrong. I wish she had come back!” Dr Byanyima said, condoling with the family.
Despite the horrible experiences reported by some patients and relatives, Mulago hospital has contributed to key milestones in the country’s healthcare advancements. The most recent are the first kidney transplants performed in the country alongside doctors from India. The hospital’s management told Saturday Monitor that while it intends to do more and different types of transplants, limited resources remain a bottleneck.
Justice Mulyagonja’s remarks, amplified on X (formerly Twitter) by users like the president of the National Unity Platform (NUP) party, Mr Robert Kyagulanyi, alias Bobi Wine, have fuelled public outrage, particularly over budget disparities.
Financial bottlenecks
Dr Byanyima’s recent testimony before Parliament’s Health Committee on January 5, painted a grim picture of Mulago’s challenges. She said the hospital requested Shs101 billion for medical supplies but received only Shs17.756 billion, forcing patients to purchase essentials from private pharmacies.
“If we receive the full Shs101 billion, no patient would be sent to buy their medication. Currently, we are allocated Shs18.3 billion, forcing us to send patients to pharmacies while reserving drugs for the critically ill," she said.
She also sought Shs43.5 billion to recruit additional staff to address the excessive workload and operationalise the Intensive Care Unit (ICU), which remains underutilised due to staffing shortages.
Maintenance costs are another concern, with Dr Byanyima warning that neglecting equipment could lead to breakdowns. The debate around the state of healthcare has become more emotional amid media reports that Uganda Revenue Authority (URA) had been allocated Shs18.2 billion for other internal expenses, such as medical expenses for its staff, more than Mulago's entire medical supplies budget for treating the entire nation.
But URA clarified that “this expenditure of Shs18.2 billion is to cater [to] a number of items namely: workman’s compensation, motor vehicle insurance of the URA fleet and general insurance for the authority’s equipment and physical infrastructure ( buildings) across the country and at all the one stop border points.”
Mulago drugs, supplies
According to details in the National Budget Estimates for 2025/2026 Financial Year from the Finance ministry, the budget for Mulago hospital medical services will increase slightly, from Shs20 billion in 2024/2025 to Shs23 billion in the next financial year. This falls short of the Shs101 billion Dr Byanyima told MPs would be required to ensure the facility does not send patients to private facilities to access care they cannot provide.
From the Shs23 billion, the specific budget for medical supplies and services will increase minimally from Shs15.3 billion to Shs15.8 billion in the next financial year. That of laboratory reagents and related supplies will remain unchanged at Shs2.9 billion despite outcry over access to diagnostic services.
This brings the total budget to around 18.7 billion. The Mulago Specialised Women and Neonatal Hospital faces similar struggles. Dr Evelyn Nabunya, its executive director, told Parliament that Shs4 billion is needed to hire 86 medical workers to operationalise seven idle theatres and improve the Neonatal Intensive Care Unit (NICU), where one nurse currently manages up to 15 babies, far exceeding the recommended ratio of one nurse per one to two babies. The hospital also requires Shs2.9 billion for equipment maintenance to support services like in-vitro fertilisation (IVF), which costs Shs13.35 million per cycle.
Steep challenges
The broader healthcare sector faces a Shs1.77 trillion funding gap for 2025/2026, exacerbated by the withdrawal of Shs604 billion in US funding, according to the April 15 report presented before Parliament by Dr Joseph Ruyonga, the chairperson of Parliament’s Health Committee. Dr Ruyonga also noted funding gaps for medicines and health supplies to health facilities through the National Medical Stores, which was allocated Shs677 billion, which is short of the required Shs867 billion.
“The committee recommends that the National Medical Stores be allocated an additional annual allocation of Shs8.8 billion to facilitate the efficient operation and optimal performance of the newly established national referral hospital at Mbuya,” he said.
Details from Parliament also show that in the Shs72 trillion budget that was passed last week, the health sector has a budget of around Shs2.1 trillion, and of this, a significant portion Shs1 trillion, is coming from Global Fund and Shs194 billion from Gavi. Justice Mulyagonja’s speech appealed for urgent action to address the healthcare crisis and ensure equitable access to care. “I have to say this, John would not forgive me if I didn't say it, because he fought for the rights of others. I, too, have fought for the rights of others. It's my passion to fight for the rights of those who are vulnerable and cannot provide for themselves,” she added.
Budget allocations for Mulago Hospital
• Shs129 billion in the 2023/2024 financial year.
• Shs119 billion in the 2024/2025 financial year.
• Shs18 billion for medicines and lab supplies for Mulago in the 2025/26 financial year against the required Shs101 billion.
• Broader healthcare sector faces a Shs1.77 trillion funding gap for 2025/26, exacerbated by the withdrawal of Shs604 billion in US funding.
• Shs677 billion for medicines and health supplies to all health facilities supplied by the National Medical Stores, less than the required Shs867 billion.
Source: Ministry of Finance National Budget Estimate for 2025/26
