Mr Charles Onyango-Obbo
The Daily Monitor’s April 28, 2025 story, "Babies dying, patients lost: The broken state of Lira Regional Referral Hospital," wasn’t just news — it was a scream.
In 2024 alone, Lira’s Neonatal Intensive Care Unit lost 180 newborns; another 101 stillbirths left a tragic cloud over 6,425 deliveries. Everything is in short supply or simply not available. A hospital official called it a “national challenge.”
He was being mild. No, it is a national disgrace. These aren’t just numbers — they are stolen futures, grieving mothers, broken homes. Lira is merely the tip of the health crisis. Nowhere is that crisis starker than in Uganda’s endless struggle with malaria. Uganda has the world's highest incidence of malaria per capita, with a rate of 478 cases per 1,000 population per year, according to the WHO.
Nigeria and the DR Congo have more cases (27.3 million and 23.1 million in 2022), but with Uganda’s smaller population, the sting is sharper. Malaria clogs 40 percent of outpatient visits, 25 percent of hospital beds, and accounts for 14 percent of hospital deaths. It is a thief, robbing children of school and parents of wages. Neonatal deaths, like Lira’s, gut the economy.
The World Bank estimates poor maternal health shaves 2–3 percent off GDP annually. Uganda is bleeding its future away. In order not to paralyse with gloom, it must be said that Uganda is not rock bottom. Malaria prevalence has fallen by 78 percent since 2006, HIV infections have dropped 70 percent since 1990, and several times in the past it has tamed Ebola swiftly.
Community health workers weave small miracles daily. However, health received just 6 percent of the 2023/24 national budget — and 80 percent of that was donor-funded. Doctors (0.6 per 10,000 people) are stretched thinner than thread — better than Niger’s 0.2, but dwarfed by Botswana’s (3.78 per 10,000 people). Corruption — stolen drugs, ghost workers — destroy the rest.
It is not a popular view, but free healthcare has always been a fantasy in Uganda. First, the tax base cannot support it. Second, the systems are too crooked. Third, they are incompetent. So, what can be done? Before user fees were abolished in public hospitals (except in private wings), the story was different. Around 1998, I visited Tororo Hospital to see an aunt who had undergone minor surgery.
My last memory of the place dates back to the Obote II years and the early NRM era. I was blown away by the change. The hospital had been touched up. It was clean, smelling of disinfectant. All beds had mattresses, there was medicine, and the nurses were happy. A new wire fence guarded the premises.
The old hellhole was gone. This was the age of cost-sharing. I returned about six years later after user fees had been scrapped. The place had gone to the dogs — filthy, bereft of medicine, nurses irritable, doctors elusive. Relatives had to buy everything from town. We must go back to a co-pay system. Better a well-supplied hospital that saves lives for a modest fee, than a free one that kills.
It is not a matter of whether a country is rich or poor. Uganda’s GDP per capita, using purchasing power parity (PPP) estimates, is around $2,566 (2024). Botswana’s, by PPP, is around $20,158 (2024). Yet Botswana charges user fees — Pula 80 ($6.60) for non-critical services, exempting HIV and maternal care. In 2022, these fees funded 10 percent of facility budgets, restocking drugs (90 percent antiretroviral coverage) and hiring 500 nurses annually.
Senegal, which also has a higher GDP than Uganda, runs mutuelles de santé, community health insurance schemes with small co-pays ($0.50–$2) scaled to income; the poorest are exempted through subsidies. A 2018 study showed 30 percent higher hospitalisation rates among members.
Rwanda’s mutuelle de santé model exempts the poorest, helping it slash maternal mortality by 76 percent. Uganda could blend these models: income-based co-pays, exemptions for the vulnerable, and fresh revenue for drugs and staff. The second elephant in the room is corruption. Here, too, there are lessons. Ethiopia’s Pharmaceutical Supply Agency tracks drugs digitally, cutting theft losses by 25 percent in 2021, and saving $10 million. Ghana’s National Health Insurance Authority uses real-time audits, saving millions through fraud detection.
Senegal’s health committees empower communities to guard clinics, while Ghana’s 4,000 Health Facility Management Committees cut drug diversions by 15 percent in 2022. Uganda’s District Health Information Software (DHIS2) could be expanded to track every pill, with village health teams acting as watchdogs. And the thieves? Jail them.
Do not transfer them. It can be done. Uganda crushed HIV in the 1990s, tamed Ebola in months, and slashed malaria prevalence before. The World Bank says every dollar invested in health returns $20 in economic growth. We must invest now. Six percent of the budget won’t cut it. Raise it to 15 percent, as Rwanda did. Then sit back and watch Uganda win again.
Charles Onyango-Obbo is a journalist, writer, and curator of the “Wall of Great Africans”. X@cobbo3
