National policy on PPP in health is important

Emilly Comfort Maractho

What you need to know:

  • Ms Maractho C Emily says: Covid-19 is an expensive disease, even government knows and also knew this time would come. 

Covid-19 is one of those health issues that low income countries like Uganda lack resources to critically address. The pandemic has also put to the test, Sustainable Development Goal 3 which requires nations to ‘ensure healthy lives and promote wellbeing for all at all ages’. 

Of course, health is not achieved in isolation, it is closely tied to other SDGs like ending poverty, ending hunger, ensuring equitable education, achieving gender equality, provision of water and sanitation and promoting sustainable climate. 

For people to be responsive to standard operating procedures, we must ask ourselves how well we are doing in the attainment of these other SDGS - education, equality, water provision, ending poverty and hunger. 

Whether people listen to and adopt new behaviour change messages is directly related to investments in the social sector. 

Uganda’s health care system is planned around various laws, policies and regulations to which medical practioners and service providers are expected to adhere. Yet, in much of the conversation the cost of treating Covid-19 patients by private providers, I am yet to hear any arguments pertaining to non-compliance with these legal and policy frameworks. 

There are close to 20 laws, policies and regulations for health care provision in Uganda, I cannot begin to name them. 
My interest is the National Policy on Public Private Partnerships in Health of the Ministry of Health.

The adoption of a public – private partnership in the delivery of health care is a clear demonstration that public service is not enough, that partnership is important. 

The purpose of the policy is to provide guidance to mainstreaming, establishing, implementing, coordinating, monitoring and evaluating partnerships between the government of Uganda and the private health sector within existing laws, policies and plans. 
Yet, Covid-19 has exposed how little understanding there is between public and private providers of health care or how much of that partnership is healthy.

However, to what extent are private providers supported to ensure they complement public services? For instance, how much of the drugs at the National Drugs Authority end up in the private entities to facilitate and reduce cost of treatment? Are there public paid medical personal in private facilities on secondment? What is the cost of an ambulance and equipment for laboratories? All these things count.

We have over the years mismanaged social service provisioning. Government allowed key social sectors to run purely as businesses for profiteering. And somehow, we expect these businesses to fill the gaps where government has failed.

It is almost the same story in education. I remember the former Vice Chancellor of Uganda Christian University, Dr John Ssenyonyi, belabouring the point that running a private university was extremely expensive. 

He engaged people that mattered and even wrote on these pages, when there was uproar about high fees the institution was charging. Providing education of excellence is not cheap, in the absence of fair tax considerations, he argued. Funding research by government in private universities was another key issue.

The current uproar over fees charged by private health care providers for Covid-19 patients is symptomatic of our rendering social services to business while government is doing little to create an enabling environment to ensure these services are provided with quality but also affordable. In education, we have watched Covid-19 deal a heavy blow to private education providers in the last year with little remedy.

Someone has to pay the cost of social service provision.  In the public service, we pay through our nose in taxes and interest on loans our children’s children will pay dearly. 

Sadly, most tax payers, still have to pay with everything they have in private hospitals or schools in order to get what they hope is quality services.

If government wants these services provided where it is unable to, it should find ways to make that possible, but not by patronizing those complementing service. 

Government should look deeply into what they can manage and pursue possibilities afforded by the policy on public - private partnerships.

Secondly, government should improve public service provision and perceptions around them. With just notable exceptions, many district hospitals are struggling in the face of Covid-19 and poor facilitation by government. When public social service provision is so poor, even poor people do not want them except in desperation.

Covid-19 is an expensive disease, even government knows this and also knew  that this time we are in would come. They could have made testing cheap and available in many hospitals. 

Currently,  in as far as government response is concerned, we have no reason to make a moral judgement on private sector players. What we need is for them to be engaged and supported to supplement services.

Ms Maractho (PhD) is the head and senior lecturer, Department of Journalism and Media Studies at UCU.  [email protected]