Poor state of health centres in Teso leaves patients stranded
Dr Julian Nabatanzi, the deputy director of State House Health Monitoring Unit (right), addresses residents at Kumi District headquarters during community dialogue organised on May 9. PHOTO | YAHUDU KITUNZI
What you need to know:
- A three-week-long investigation by HMU officials across three districts of Bukedea, Kumi, and Ngora revealed a pattern of chronic neglect, extortion by health workers, and widespread mismanagement that has left patients stranded.
At Kachumbala Health Centre III in Bukedea District, health workers use torches to attend to patients at night. With load shedding in the facility and no backup power system, the facility descends into darkness in the evening when there is a power blackout, which is frequent in the district. When it happens, health workers are compelled to use torches and candles to conduct their duties.
“We improvise. That’s the only option. We are saving lives in the darkness whenever electricity goes and it’s common,” said a nurse who requested anonymity. Electricity remains a luxury in several facilities around Teso Sub-region. One midwife said she sometimes delays night deliveries until morning if there’s no urgent danger. In another village, a father carried his feverish child 15 kilometres on foot, only to find the health post locked.
It is also common to find a pregnant woman waiting on a cracked concrete bench, clutching her belly in pain to be attended to. Teso’s rural health facilities are no longer places of healing, they are symbols of neglect. With no lights, a shortage beds, no drugs, and often no staff, they serve as reminders of promises made and broken.
“For us, mothers, children, and the elderly continue to suffer silently,” Maria Ocen of Bukedea Town Council said. In remote parts of Bukedea and Serere, some women walk over 15 kilometres to the nearest facility, often in labour. “I started walking at night. By the time I reached the health centre, I had already delivered by the roadside,” recalled Grace Apio, a mother of four.
Health challenges faced
The Bukedea District Health Officer, Dr Emmanuel Okallany Odeke, acknowledged the health challenges in the district. “The staffing levels in the district currently stand at approximately 55 percent, which continues to strain service delivery,” Dr Odeke said. Dr Caroline Kirya Otede, the Senior Medical Officer and in-charge of Kachumbala Health Centre IV, said the non-functional theatre and lack of critical infrastructure affect their work. “The theatre is not yet operational, so patients who require surgical interventions are referred to other facilities for better management,” Dr Otede added. She revealed that the facility receives about 200 outpatients daily, with antenatal services drawing approximately 250 expectant mothers each day. The patients are paying the ultimate price for a health system that has been neglected for years.
This prompted the State House Health Monitoring Unit (HMU) officials to camp in Teso Sub-region for three weeks to conduct unannounced spot checks and detailed investigations across various health facilities, including hospitals, to ensure accountability in the delivery of public health services. The Daily Monitor learnt that the inspections uncovered issues such as absenteeism, extortion, corruption, drug theft, and incomplete infrastructure. Dr Elijah Ssemaganda, the Assistant Director of HMU, said the majority of health centres in Bukedea and other districts are no longer admitting patients due to a lack of infrastructure. “Some health facilities don’t have wards to admit patients. Currently, only Bukedea Health Centre IV admits general patients besides pregnant women,” Mr Ssemaganda said during a stakeholders meeting at Kachumbala Health Centre IV.
Bukedea District has 15 government health facilities. It has two health centre IVs, Nine health centre IIIs, three health centre IIs, and one of these was closed because it was dilapidated. The Uganda Health Sector Strategic Plan recommends that health centre IIIs provide inpatient services, including maternity care. But in Teso, many health centre IIIs function more like drug shops, dispensing only painkillers. For years, residents of Teso have relied on a fragile network of rural health centres. But mismanagement, staff shortages, and government neglect have pushed these facilities to the brink. Dr Ssemaganda, who led a team to Bukedea District for a comprehensive health monitoring exercise, highlighted several critical issues affecting the delivery of healthcare services in the area. “In some instances, health workers have been found to sell medicines intended for public use, leading to shortages and compromised patient care,” he said.
HMU investigation
The health system in the area is crumbling, slowly, silently, and dangerously. A three-week-long investigation by HMU officials across three districts of Bukedea, Kumi, and Ngora revealed a pattern of chronic neglect, extortion by health workers, and widespread mismanagement that has left patients stranded. For instance, Bukedea District has the lowest staffing levels in the region, standing at just 25 percent. Some of the health centres in Teso do not receive Primary Health Care (PHC) funds, which affects their operations. Dr Warren Naamara, the director of HMU, said Teso is a large and highly populated region, but health services remain substandard. “It’s an important area, and that’s why we decided to camp there, to directly address the issue of poor service delivery and work to improve healthcare outcomes,” Dr Naamara said. He explained that the HMU conducts wide-ranging investigations, including inquiries into the distribution and use of drugs. “We assess whether the available doctors and nurses are doing their jobs.
We also follow the money, both government and donor funds, including Primary Health Care and Results-Based Financing (RBF) funds,” he said. During the Ngora District dissemination meeting with HMU at the council chambers, it was revealed that several health workers had gone on leave without obtaining approval from the chief administrative officer and the district health officer, resulting in a shortage of health workers and leaving a significant gap in service delivery. The Assistant Director of HMU, Dr Stephen Atari Ayella, said their investigations uncovered several challenges in the Ngora District health sector. These included absenteeism among health workers, late reporting to duty, and poor attitudes towards work. He further noted incidents of extortion within the theatre at Ngora Health Centre IV. “There was no proper accountability for Primary Health Care funds in some facilities, and essential items like gloves were being removed from Mama Kits. The staff were not working on weekends,” Dr Ayella said.
The Agu Health facility lacks electricity, and the labour suite is housed in a small, inadequate structure. Expired medical commodities were also found at Ajelek Health Centre III, and the children’s ward at Ngora Health Centre IV was found to have been poorly constructed, Daily Monitor learnt. Dr Julian Nabatanzi, the deputy director of HMU, highlighted concerns over financial mismanagement, stating that some facilities lack proper accountability for PHC funds. She made the remarks during a community dialogue which was held on May 9 at Kumi District Headquarters. Dr Charles Oluka Onyait, the district health officer of Ngora, said the contractor abandoned the two projects at Agu Health Centre III and at Ngora Health Centre IV. “The Project of Agu Health Centre III could have been finished, but the contractor abandoned the site. The maternity ward at Ngora Health Centre IV was also abandoned by the contractor,” Dr Onyait said.
TAKING ACTION
Kumi Municipality Member of Parliament, Mr Silas Aogon, urged the HMU to take firm action, including the arrest and prosecution of health workers found to be involved in extortion and other forms of malpractice. The CAO of Ngora District, Mr Francis Opolot, pledged to take immediate action to address the gaps in health “Some health workers went on leave without our approval. They will be asked to refund the money they received without working,” Mr Opolot said. In Bukedea, four health staff were arrested by HMU on allegations of failing to account for the missing drugs at Malera Health Centre III.
