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Makerere University launches programme to revitalise district hospitals
Mothers are taken through postnatal counselling at Kisenyi Health Centre IV in Kampala in April 2021. People in some regions with poor coverage of health facilities and poor water and sanitation indicators also had better life expectancy. PHOTO/FILE
What you need to know:
- Its primary goal is to evaluate and enhance the capacities of General Hospitals, which serve as the essential link between primary healthcare centres and specialised medical facilities
The Ministry of Health has admitted that funding for general hospitals found at the district level has reduced over the years as the government moved to prioritise health centres.
“For decades, the government has been allocating more funds to Health Centre IVs, IIIs, and IIs because they are the main centres for primary health care,” said Dr Sarah Byakika, Commissioner of Health Services Planning, Financing, and Policy at the Ministry of Health.
She highlighted that 75 per cent of the population access health services through these centres. This focus on community-based services and lower-level health facilities brought significant gains in accessibility and disease prevention but has unfortunately left general hospitals chronically underfunded.
This scenario was described as “The Neglect of General Hospitals in Uganda." In response to these priority imbalances, the Makerere University School of Public Health has launched Africa’s First Referral Hospitals: Innovations and Care (AFRHiCARE) project.
The launch was attended by district health leaders, hospital directors, and administrators from 10 districts, joining academics from Makerere and the Ministry of Health officials.
The AFRHiCARE multi-institutional initiative brings together experts from Makerere University (Uganda), the University of Oxford (UK), the University of Witwatersrand (South Africa), and the KEMRI-Wellcome Trust Research Programme (Kenya), with funding from the Wellcome Trust.
Its primary goal is to evaluate and enhance the capacities of General Hospitals, which serve as the essential link between primary healthcare centres and specialised medical facilities.
“A well-facilitated general hospital should be able to provide a good range of surgeries beyond obstetrics. If there is a hernia, that’s the level to deal with it,” explained Dr Michael Kakinda, one of the project’s PhD researchers.
His observation highlights the critical but underrecognized role that General hospitals play in routine surgeries, diagnostics, and treatments—responsibilities they struggle to fulfil due to outdated equipment and limited support.
Professor Freddie Ssengooba of Makerere University’s Department of Health Policy, Planning, and Management noted that current investment patterns can create bottlenecks across the health system.
“Patients often end up being referred to general hospitals that lack the necessary investment to fully support their crucial role,” he said.
This funding imbalance translates into chronic shortages of staff, infrastructure, and modern technology, all of which hinder these hospitals’ ability to deliver quality services.
General hospitals remain the first line of referral when primary healthcare centers can no longer meet patient needs. Yet they grapple with harsh realities.
“When I joined my work, things were bad and it was hard to change,” said Dr. Rogers Musinguzi, acting Medical Superintendent of Masindi General Hospital. “The staff quarters are dilapidated and we have just two doctors running the hospital. How can we work in such an environment?”
AFRHiCARE seeks to confront these structural challenges by conducting rigorous research and deploying innovative solutions that increase the capacity of general hospitals.
“I always tell people, if we are scientists, we should always use science. Our actions should be based on research. That’s why these studies are important,” remarked Dr Alfred Driwale, Commissioner of Health Services, Institutional Capacity & Human Resource Development.
Through this evidence-based approach, the project aims to spark much-needed policy reforms, allocate resources more equitably, and ensure that frontline hospitals can deliver a wider range of services without compromising quality.
By shining a spotlight on the indispensable role of General hospitals in Uganda’s health network, AFRHiCARE is urging the Ministry of Health and all stakeholders to reevaluate long-standing funding practices.
In doing so, the project hopes to pave the way for a more balanced, robust healthcare system, one where first referral hospitals are empowered to meet community needs, mitigate congestion at higher-level facilities, and ultimately contribute to better.
