Will ‘fishermen’ cabinet salvage the health system?

In the Bible fishermen were for the most part just ordinary people doing regular work, they were not clean, probably they had a smell about them. They were gruff and rugged. But they possessed useful skills including top notch knowledge of the area, and challenges faced by their communities.

They were in most cases multi-lingual and were hard working.  So, when the president indicated to Ugandans that the current Cabinet is a “fishermen’s” collection, there was both excitement and scorn. In the true spirit of the “fisherman” , the Prime Minister hit the road, making  impromptu visits to a number of health facilities in Gombe, Iganga, Kyotera and Uganda Cancer Institute, among others, where she was met with complaints of drug stock-outs in health facilities, absenteeism of health workers from duty stations, demand for illegal payments by health workers and inability of public health facilities to handle some medical emergencies because of lack of equipment and supplies. 

In line with her practice, she dished out “brown envelopes” to patients at will.  Speaking to health service users and the media, she castigated health workers and health facilities’ leadership for the poor state of service delivery and promised to crack the whip.  

While at the cancer institute the Prime Minister was shocked by the high number of patients and advocated for the expansion of the infrastructure at the cancer institute. Her findings were not new as these had been reported over and over in the media and are common knowledge of any public health service user in this country.  

What was shocking was the fact that the Prime Minister was surprised by what she found out in the field. This is uncharacteristic of the fishermen’s knowledge of their environment.  The trappings and privileges of state power could have washed away some attributes of a fisherman.

Beyond the powerful statements made to the media and patients, we have not seen any strategic outcome of those visits. Her words have not been backed by action; in some cases, we have actually seen reverse action.
In her visit to Uganda Cancer Institute, she is quoted to have said: “We need to fight cancer like coronavirus was fought by involving all stakeholders’ ‘.  In the 2022/23 Financial Year the government reduced the budget allocation to the cancer institute by Shs11 billion from Shs75 billion in 2021/22 to Shs64 billion  in 2022/23, and is further proposing to reduce the same by 55 percent in 2023/24 financial year. 

Similarly, it may be easy to accuse the staff of absenteeism, but there are more serious staffing challenges at health facilities. Our health staffing level is at about 78 percent of the approved staffing levels for the health sector with some districts operating at about 50 percent of their approved staffing levels. 

It should be noted that this is 78 percent of a staffing structure established in 1999 when Uganda had a population of about 19 million people. Certainly, even if the current staffing level was at 100 percent, it would still be way below what the current population of more than 43 million people would require. There is a need to strengthen monitoring and inspection of public health facilities to ensure presence of staff at duty stations.

For most health facilities essential drugs last for not more than three weeks from the date of delivery. This implies that the supply does not match the demand for drugs. This situation is worsened by irregular supply of drugs. In Uganda, on average 42 percent of the mothers who die while giving birth lose their lives because of haemorrhage.

While Uganda needs about 500,000 units of blood, we are currently able to collect and process about 350,000 units of blood leaving a gap of about 150,000 units of blood. To remedy this, the government needs to invest in blood collections, processing and distribution. A number of health facilities have broken down medical equipment that cannot be repaired because of limited budgets. These are the strategic issues that the Prime Minister must address her mind to if we are to heal our ailing public health service delivery. The “fishermen’s” Cabinet is uniquely positioned to deliver a well-functioning public health system.

The Prime Minister and Leader of Government business, the Speaker of Parliament, the Minister of Health, the Minister Health in charge General Duties and the state minister for Primary Health Care just like other women in Uganda know the importance of a functional public health service delivery system. 

Mr Peter Eceru is a Program Coordinator-Advocacy at Center for Health Human Rights and Development.