About Uganda’s usurious non-profit health facilities

Author: Asuman Bisiika. PHOTO/FILE

What you need to know:

Health workers like to work at PNFP facilities because their government-paid salaries are enhanced with allowances.

The Minister for Health was visiting Karamoja Region. Making a stopover at Matany Hospital, he met a young doctor running stuff under challenging conditions. The minister wondered how and why this young man decided to work upcountry in a very challenging situation when there were opportunities elsewhere.

The young doctor told the minister that there was a need for government to resource private healthcare facilities. The minister took up the idea. And that was the genesis of the Ministry of Health’s PNFP (Private Not for Profit) policy on resourcing privately owned healthcare facilities.

And by the way, need I say the said minister was Dr. CWC Kiyonga.


One of the curious Covid pandemic stories was that of the hospitalisation of the mother of a Member of Parliament for a peri-urban constituency in Buganda.

As is commonplace with money-enabled Ugandans, the MP’s first port of call for his mother’s medication was a privately-owned healthcare facility. He was scandalised by the ‘unhealthy’ treatment his mother received from the private facility; even as he was required to pay exorbitant bills. He protested the poor services and ‘long’ bills (from the private facility) by moving his mother to Mulago Hospital (a public facility run by the government). But Mr.MP’s mother’s story was not the biggest story of the Covid pandemic. No. The biggest was the usurious billing protocols by the privately owned health facilities. The ‘bills from hell’ were so deathly that even people hitherto thought to be above board (wealth wise) failed to clear them. A story is told of a member of an exclusive club of Kampala’s rich men who sought refuge in the public treasury:Government paid his hospital bill.

Yet most of the privately-owned healthcare facilities in Uganda operate under PNFP (Private Not For Profit) NFP). In this programme or policy, privately owned healthcare facilities are heavily resourced by government. In fact almost all healthcare facilities run by the Anglican and Catholic churches are under PNFP.

 Government resources input in these church-run facilities is very deep; if government withdrew from the PNFP, these private health facilities would collapse. In most facilities, over 50 percent of the staff (and stuff) are government resourced (for free). It is very heartening (actually hurting) that Ugandans pay for a drug carrying the mark: ‘Government of Uganda, Not For Sale’. And oh yes, they also pay for seeing a doctor paid by government.

In other places, a privately owned healthcare facility may be mapped under PNFP as a HCIV while the nearby the govt facility (five kilometres away) is relegated to Health Centre III. And that means government will facilitate the private facility to qualify as its HCIV status.

Now, we have learnt that the Ministry of Health wants divorce from the PNFP marriage. But with the depth of PNFP (there is even a Commissioner for PNFP), it won’t be an easy divorce. Our advice: Divorce must happen.

Right now, the public resources for PNFP are accounted on district local governments votes. Now the ministry wants to manage the PNFP vote resources. And it is not uncommon for districts to recruit say 10 health workers and all deployed in PNFP facilities. Health workers like to work at PNFP facilities because their government-paid salaries are enhanced with allowances.

And the churches know how to work the government down. Our research on six districts found that the church leadership co-opt district civil servants in a clever way. In one district, the Human Resource Officer was the Chairman of the Management Committee a PNFP healthcare facility. In another, the head of the laity was a senior district official. Stuff like that...

Mr Bisiika is the executive editor of the East African Flagpost. [email protected]