We need to keep our eyes on health system

President Museveni noted in the National Resistance Movement (NRM) Manifesto for 2016-2021 that ‘the NRM has been like a political doctor trying to solve the problems of Uganda.

In order to treat a disease, however, you must first diagnose the illness. Judging by the themes of various manifestos, it must be a long journey to diagnosis. One may add, to make the correct diagnosis requires not just an excellent doctor, but a system that permits them to not only make that diagnosis but also give the correct treatment.
 It may seem, we are still making diagnosis of what ‘illnesses’ really plagues Uganda’s socio-economic transformation.

Judging by the many poverty alleviation experiments of the last many years, we are yet to name the correct illness. There have been people, discussing on end, the cost of keeping our Speaker of Parliament alive in the United States of America. Like most things, this was bound to be politicised and some understandably angry when the figures pop-up. 

First, many best wishes to the Speaker, and hope that he will be back on his feet and daily grind soon. The Alur say, maractho, which loosely translates to ‘death is bad’ and so everything must be done to keep people alive. It happens to be my name so I will not engage in the discussion over the cost, because every life matters.  We need not make the conversation about Mr Oulanyah as a person. However, we need to return to the real issues of health service provision in this country.  We should remember Mr Museveni’s words that in order to treat a disease, the first step is to diagnose the illness. Whatever the disease of our health sector must be, we should correctly name it.

This week on Wednesday, I will be launching a research report that explains how Ugandans feel about short term volunteer missions in health and what can be done to enhance its value. 

For the most part, we focus on our leaders being taken abroad for treatment, and not the many Ugandans who have to find their way abroad for specialised treatment, often raising their own resources, and many more who simply resign to fate or wait for when some experts are coming over and giving free services like in the volunteer missions my study focused on.

I first experienced the notion of short term medical missions in the late 2000s when my Rotary Club of Makindye at the time organised a medical camp in Gulu. I volunteered as a clerk, taking records of the patients and simple things that did not require medical knowledge. What shocked me, was how many people showed up for those services, and how long many of them had lived with those conditions. It was traumatising for me, but I kind of forgot about that experience, until I started to conduct this research.

My colleagues and I attempted to answer questions around what specific concerns host community members and leaders may have regarding their experience with volunteers and what efforts have been made by host countries to address these concerns. 

In order to answer these questions, we started by looking at the overall health needs of Uganda which relate to medical missions. 

Through qualitative methods that included in-depth interviews, document reviews, analysis of policies and laws as well as media review, we were able to appreciate why in spite of the short comings of volunteer missions that are globally recognised, Ugandans looked to them. 

What was interesting for us was to examine the gains and gaps in the health sector. We found that, contrary to the dominant negative stories coming out of health, there were actually many gains over the years. These gains, as a result of focused policy changes and partnerships, had led to specific benefits in the areas of reduced child and maternal mortality, increase in life expectancy and greater achievements in HIV/Aids prevention and treatment. 

These gains are rarely the subject of stories out of health. The reason, we found out, was that despite these incredible gains, the gaps in health service delivery, owing to the lack of a national health insurance system, and a rapidly growing population that is largely located in rural areas made service delivery a challenge.  

As such, serious gaps in health financing remains, although this has improved with Covid-19 interventions. Health care financing is largely met by development partners, who put in a lot of money but sometimes very little is seen in outcome when compared to the investment put in, while health infrastructure, health staffing, and access to care remain huge gaps. 

It therefore follows that these gaps also drive the need for short term medical missions. It should be possible to do more for Ugandans in healthcare provision. This research was a community engagement project, seeking to contribute to how these volunteer medical missions can better serve host communities. It has also been able to contribute to a global agenda for ethical volunteer missions.  

Ms Maractho (PhD) is the director of Africa Policy Centre and senior lecturer at Uganda Christian University.                     [email protected]