Building strong public health system is key

Monday July 26 2021
By Guest Writer

The public outcry over the high costs for Covid-19 treatment in private healthcare facilities and calls to regulate them has prompted government to engage in discussions with the private sector on finding solutions.
Recent media reports have indicated that policy makers and some private health care providers are mooting the idea of government providing subsidies to private health facilities.
Specific suggestions have been made for government to build oxygen plants at private health facilities, issue tax waivers, provide materials such personal protective equipments, offer direct cash subsidies, or pick up the bills of individuals who have been treated in private facilities.
These suggestions are misguided. To subsidise the private sector would be aiding the privileged few at the expense of the majority.
The actions and bills of some private healthcare providers at the peak of the second wave confirmed that these facilities serve the owners and not the public interest.
The need to make profit and at the same time pay off debts where they exist or satisfy equity investors, among other characteristics makes commercial health service not suited to serve majority of Uganda’s population.
 Indeed, commercial private health facilities have always had costs that are out of reach for the majority.
It, therefore, makes no sense for government to divert resources needed in the public sector in the futile exercise of trying to lower costs in private health facilities.
Public facilities, as has been shown in the last few months lack the basics including oxygen.
It is only a strong public health system that will automatically end private profiteering in health. It is a fact that as more investors have joined the health sector, the government has stepped back on its obligation to strengthen the public health system, as evidenced by the declining healthcare budget in absolute terms.
Previous efforts by government to invest in private health care have also not yielded much for the ordinary person. For example, a number of public private partnership hospitals including faith-based nonprofits  facilities that receive support from government are still detaining patients for failure to pay bills despite receiving funds from government.
 The country is yet to realise progress following investment of colossal sums of money in the FINASI-ROKO joint venture to construct the Lubowa Specialised Hospital under a PPP, a hospital that will be unaffordable for the vast majority of Ugandans.
The government plans to spend Shs2.88 billion in a Medical Credit Fund for private sector yet we have seen regional hospitals lack basic equipment and health workers.
Do we have our priorities right as a country? Who do we ultimately serve with these initiatives? It is definitely not the majority of Ugandans. Does government really think this is a sustainable solution?  
Private healthcare provision can at most only complement a fully functional public health system and must never be the first point of call for anyone seeking medical care especially in a pandemic.
 Maintaining healthcare, as a public good will require moving beyond mere regulation, a basic that government is still failing to do, to rethinking the open-ended liberalisation that opened the floodgates for shrewd businessmen to marketise the health sector in a bid to maximize profit.
The government must concentrate on strengthening the public health system. This also means that all available public funds must go towards building public health.
Salima Namusobya is the executive director – Initiative for Social and Economic Rights (ISER)