Health promotion way to go for Uganda’s fragile system

Health is a critical part of our being because when we get it right, every other pursuit follows suit.  And in this article, I am addressing myself specifically to physiological health. And with the current Covid-19 pandemic scare, a discussion on health has never been timelier! 
No doubt Uganda’s health sector, like others, too, continues struggling to hold itself together, Uganda’s health sector has a total of 6,937 health facilities distributed throughout the country. These facilities are responsible for provision of health services to an entire population estimated at approximately 43 million Ugandans.
 
I am not being political in any way whatsoever, but visiting most government facilities, the strain is visible. The country definitely faces increasing challenges in the health sector due to rapid population explosion and, other unforeseen pressures like Refugee influxes, etc. The doctor to patient-ratio is 1:24,725, which makes it harder for patients to have appropriate services from medical workers—especially doctors, in some facilities which hardly have doctors on duty fulltime. With private hospitals paying slightly better than government facilities, this has only abated the predicament as most private hospitals are located in urban areas hence further scarcity of qualified medical personnel in rural areas.

If there is any lesson that we should have, as a country learned from the recent waves of the indiscriminate Covid-19 pandemic, it should be the urgent need to enhance our health system! The rich and poor alike, we all struggled to access the health facilities whose capacity to absorb the overwhelming patient numbers was not anywhere near satisfaction. One of the feasible ways of reducing the burden of overcrowding in health facilities is the advancement of health promotion approaches in this country.
 
This calls for Ministry of Health paying more attention on strategies that improve health citizenry knowledge, attitudes, skills and behaviour (KAPB) within given communities; to address and prevent the root causes of ill-health, for prevention is better than cure! SOPs like wearing of masks, handwashing with soap, sanitising, and physical distancing currently used to fight against Covid-19 are visible components of health promotion, but communities, especially rural ones, need more sensitisation. 

The Ministry of Health’s efforts towards disease prevention and reduction of admissions in hospitals, are however, duly appreciated. Health promotion should be deliberately and strategically handled as a complementary drive to common efforts. Fragile health systems like ours benefit more in such strategies of disease control and prevention that try to deal with the situation at individual level before getting the disease, which in turn reduces the pressure on the health facilities and health workers.

However, the government health expenditure is heavily committed towards primary healthcare, and does not prioritise health as a part of government spending. For example, the Health sector accounted for 5.1 percent of the national budget in FY 2020/21 down from 7.9 percent in FY 2019/2020 (Unicef-Uganda-2020-2021-Health budget brief). Still, much as primary health care receives the lion’s share of the health sector budget in Uganda, singling out and focusing more on health promotion as a social mobilisation strategy for health of individuals will save our health system a great deal. 
Government needs to put more emphasis on health promotion strategies, more focused funding to the sector and capacity building of the technocrats at the national level. District Health Education team should be empowered more with reasonable resources to enhance their support for outreach programmes which later trickles down to the village health teams (VHTs).

At community level, VHTs whose mandate is to mobilise communities for health programmes, and strengthen the delivery health services at household level, should be well remunerated and trained to adequately relay information to communities. Essentially, they play a double role: service; and promotional functions. This way we will have literally enhanced the performance of our health sector lest we forget who we are—a critically fragile health care system and economy, of course, to the peril of our own progress and existence.
The author, Douglas Kaziro, is Masters student of Public Health Uganda Martyrs University-Nkozi,

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