One ICU bed for 188,000 Ugandans

Health workers attend to a patient in the ICU section of  Mulago National Referral Hospital last month. PHOTO/FILE

What you need to know:

  • Health administrators say an increase in Covid-19 admissions puts a strain on the available bed capacity across the country.
  • 3,100: The number of HDU beds across the country.
  • 218: The number of ICU beds across the country
  • 475: The number of standard beds put in place across the country.

At least 1,072 Ugandans were as of June 5, admitted with Covid-19 at different health facilities across the country. It is not clear if all these numbers are with critical cases that need ICU or not.

Government took a decision for home-care management for those who do not show severe cases and with that decision, the majority are being managed from homes and only those with several cases are referred to the Covid-19 treatment centres.

In our study on June 3, the positive rate stood at 10.3 per cent, the rate went up to 13.2 per cent on June 4, and later reduced to 9.4 per cent on June 5.

In the event of increasing Covid-19 cases as it were in May and June,  the available bed capacity across the country will be strained, posing a huge challenge for healthcare gives,  both in public and private health facilities.

Currently, the country has a bed capacity of 3,793 dedicated to manage Covid-19 patients. Of this, 3,100 are standard beds, 475 High Dependency Unit (HDU) beds and 218 are for ICU section.

Of these, Mulago National Referral Hospital has the biggest capacity with 600 standard beds, 300 HDU bed and 27 ICU beds. All the regional referral hospitals combined have 900 standard beds, 115 HDU beds and 150 ICU beds. On average, each regional referral hospital has 10 ICU beds, much below the demand, forcing many to send away the excess patients.

Bombo Military Hospital has 120 standard beds and 10 ICU beds, while the seven Ministry of Health accredited private facilities have a combined 180 standard beds and 31 ICU beds.

On June 18, while addressing the nation, President Museveni said: “Unless we urgently intervene to reverse this, the estimates and observations by scientists show that the number of people needing care will double in less than one month, outstripping our bed capacity.”

The situation across the country
The fewer number of ICU beds across the country has also been worsened by few personnel trained to operate the facilities. While officials from the Health ministry were not readily available to explain the few numbers and plans to add numbers, in a recent interview with this newspaper, Dr Diana Atwine, the ministry’s Permanent Secretary, blamed the delays in procurement of more ICU beds on global demand that has outstripped supply.

She also said plans are under way to procure some of the beds locally to support Ugandan manufacturers.
On Wednesday, Dr Jospeh Muvawala, the executive director of the National Planning Authority, blasted the government for misplaced priorities noting that while government is busy procuring pickup trucks, focus should have been on procuring ICU beds.

“We should have had more oxygen, we should have had more ICUs, the President told us to have 42,000 beds, and we never delivered them. We are still talking of bringing in ambulances one year later, and the ambulances we are talking of are pickups,” Dr Muvawala told the media at Uganda Media Centre in Kampala.

In Lira, health officials have raised concern over the increasing cases of Covid-19 in the district, overwhelming the available facilities. Acting district health officer Edmond Aceka said the number of positive cases is overwhelming health workers.
“Coivd-19 treatment centre in Lira City is currently managing more than 37 cases, against its bed capacity of 30 and 12 ICU beds...,” he said.

“The inadequate ICU beds are being overstretched as other districts across the region rely on the same beds. The districts include Oyam, Kole, Apac, Kwania, Dokolo, Amolatar, Alebtong, Kole, and Otuke,” he  added. In Mbarara District, the hospital has 15 ICU beds to cater for critically-ill patients. Dr Celestine Barigye, the executive director for Mbarara Regional Referral Hospital, says while they have 55 beds to care for the Covid-19 patients, 20 beds are put in emergency and another 20 beds are in a private wing where oxygen is fixed to manage moderate to severe cases.

“At the Covid-19 treatment unit, we have 15 beds. We have divided management of Covid-19 in three sections, emergency and private wing where we handle moderate to severe cases and the Covid -19 treatment unit where we handle critical cases,” he said.
Ruharo Mission Hospital, another private hospital in Mbarara does not have any ICU beds but are in dire need of these.

“We are in dire need of ICU beds and I wish I could be supported to have these because they are essentially needed. We could be supplementing government facilities to handle critical Covid-19 cases,” Dr Beckson Taremwa, the executive director of the mission hospital, said.

Eastern region
In eastern Uganda, the director of Jinja Regional Referral Hospital, Dr Florence Tugumisirize, said the beds in the ICU are not enough to accommodate the increasing number of Covid-19 patients.

“Since the patients that are being admitted are critically-ill and in need of oxygen, they spend three weeks in the hospital compared to the Covid-19 patients in the first wave, who were spending only 10 days. The beds are not enough...,’’ he said.
Dr Tugumisirize said they have 12 beds in ICU.  

“Due to the increasing number of Covid patients and referrals from other facilities, we have been compelled  to expand the ICU by temporarily converting the general male ward and part of the private wing into Covid treatment wards,’’ she said.  
Dr Tugumisirize said almost all the patients they are receiving at the facility need to be put on oxygen.

“Almost all the current 53 patients that are undergoing treatment are on oxygen. Our Oxygen plant releases between 30 and 32 cylinders’ in every 24 hours , our worry is that the number is increasing every day,’’ she said.

Dr Tugumisirize added that they are relying on well-wishers who are donating life-saving gas for Covid-19 patients.
“Currently, the hospital is relying on Mayuge Steel Ltd under the Indian Association, which is donating 40 oxygen cylinders on a daily basis. When we add on our 32 cylinders, those are 72..,’’ she said.

In Tororo, where the Covid-19 cases are already overwhelming the health workers, the district general hospital lacks ICU facilities.
The district health officer, Sr Connie Bwire, said lack of such facilities is limiting their capacity to handle Covid patients.
“We feel that the facility is underutilised and it’s the reason we have a high number of people dying,’’ she said.

She said the hospital refers most of the patients, who are in critical conditions, to Mbale, Soroti and Mulago. 
Dr Godfrey Mulekwa, the district health officer for Pallisa District, said they are struggling to contain the virus.

“The hospital lacks ICU facilities. We monitor Covid-19 patients under home-care arrangements, which at times is ineffective,” he said.

In Tooro Sub-region, the administrator of Fort Portal Regional Referral Hospital, Dr Luis Muhindo, said they have 10 beds in the ICU section.
Fort Portal Hospital serves the entire two sub-regions of Rwenzori and Tooro.

Dr Muhindo said they have dissolved two other wards to create more space for patients. He said they have another 45 beds for Covid-19 patients at the facility. 

In West Nile, Arua Regional Referral Hospital only has eight ICU beds, while in North, Gulu Regional Referral Hospital has eight ICU beds and Lacor Hospital has five. Moroto Regional Referral Hospital has five ICU beds, the same number with Soroti, and Masaka. Mbale Regional Referral Hospital has 10 beds, just like Bombo Army Hospital and Naguru Hospital. 

Compiled by Franklin Draku, Tausi Nakato, Isaac Otwii, Rajab Mukombozi, Abubaker Kirunda, Alex Ashaba, Francis Mugerwa, Polycarp Kalokwera, Tobbias Owiny Jolly Joseph Omollo & Fred Wambede

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