A general view of a section of Lira Regional Referral Hospital emergency unit at the Outpatient Department OPD. PHOTO/PATRICK EBONG
Lira City has only 87 healthcare staff serving in seven government health facilities. The regional referral hospital, which can best be described as being in a critical condition, falls under the city.
As with much of the healthcare infrastructure in the country, the hospital is grappling with dilapidated buildings and a staff shortage which make it hard to deliver services to the people, as Bill Oketch reports.
Run-down structures welcome patients at Lira Regional Referral Hospital (LRRH), a public hospital where access to general care is free of charge. The distinctive cries of infants in pain rise from all corners of this 97-year-old hospital as hard-pressed nurses and doctors struggle to save the lives of both children and adults. The wards are overcrowded. In the Children’s or Paediatric Ward, for instance, three children always share one bed, leaving their attendants without a place to sit or sleep. Peter Okello Odeke, the hospital’s senior principal administrator, describes the situation in the Maternity Ward as pathetic. Due to limited space, the hospital now admits mothers who have delivered under improvised tents to make space in the ward for expectant mothers who have come to give birth. “Most structures here have been condemned but we cannot break them down when there is no space to put the patients. Sometimes, patients get lost as they walk from the ward on one side of the hospital, to the tents,” he says.
Odeke reveals that the hospital has plans to build a ward complex to remove the discomfort patients are going through and to provide a place to store equipment. At least 6,425 deliveries were conducted at Lira Hospital between January and December 2024. Unfortunately, 180 babies died in the Neonatal Intensive Care Unit (NICU) in the same period, official data shows. Located in the heart of Lira City, the hospital has 40 doctors. These doctors are part of an estimated 90 who are available to respond to the healthcare demands in the Lango sub-region.
According to the National Population and Housing Census 2024, the sub-region, comprising the nine districts of Lira, Oyam, Kole, Dokolo, Otuke, Kwania, Apac, Alebtong, Amolatar, and Lira City, has a population of 2.65 million. Dr Andrew Odur, LRRH’s acting director, says the Lango sub-region needs many more doctors than it currently has. “The World Health Organisation (WHO) recommends, a doctor-to-population ratio of one doctor per 1,000 people. This means 10 doctors should serve 10,000 people. Three million people need a minimum of 3,000 doctors. However, we have less than 100,” he says.
Official data reveals that 180 babies died in the Neonatal Intensive Care Unit (NICU) at Lira Regional Referral Hospital alone between January and December 2024. PHOTO/FILE
Staff shortfalls Built in 1928, Lira Hospital serves the Lango sub-region and parts of the Teso and Acholi sub-regions. Health workers are overwhelmed by the number of patients. The Outpatient Department (OPD) receives more than 400 patients every day.
According to Dr Odur, last year, health workers attended to 100,000 people in the OPD alone. The hospital operates under an old structure that provides for about 400 staff with various specialties. Under the new structure, a regional referral hospital should have 1,200 staff. This means Lira Hospital has a shortfall of 800 staff. Apart from providing specialised services as a regional referral, Lira Hospital’s mandate is to provide technical support to the health sector within the Lango sub-region. “We are supposed to transfer skills to the workforce in the health facilities within the region.
We also need to conduct operational research periodically to assess the problems affecting the region and determine their solution,” Dr Odur explains. But, has the hospital administration successfully implemented these key mandates as defined by the Ministry of Health for regional referrals? “I would say yes and no. We are working hard to ensure that the lower facilities, the districts, and the local governments, come up to speed to provide basic healthcare to the people around them, as opposed to them coming to the regional referral hospital,” says the acting hospital director. Dr Odur adds that the hospital still has large inflows of minor conditions such as malaria, diarrhoea, and respiratory infections. In an ideal situation, these diseases should be handled by lower health facilities. This would give LRRH a chance to focus on specialised care.
Additional challenges
The administration of Lira Hospital acknowledges that some challenges call for intervention from the government, local community, and non-state actors. “We still have many old, dilapidated buildings within the hospital. The majority were constructed in 1927 so they do not serve their purpose in 2025.
The large number of patients cannot fit within these small structures. Some of them sleep on the floor,” Dr Odur laments. Other challenges include limited knowledge within the community on the role of a regional referral hospital and some medical staff allegedly extorting money from unsuspecting patients. “We have resolved that any worker who takes money from patients will pay back double the amount he or she has taken. We hope this will deter the practice of extortion,” Dr Odur says.
The hospital uses the QR code system to gather client feedback and track health worker performance. Even with a limited resource envelope, the hospital administration has painted some of the walls. There is now a private wing that offers space to patients who can afford it. The money is used to cover the funding gaps in the hospital. Some of the hospital’s walkways have also been paved to ease the movement of equipment from one location to another.
Regional challenge
The problems in the health sector cut across the region. Alebtong District has only five doctors serving an estimated population of 300,000. The government banned the recruitment of health workers in national, specialised, and regional referral hospitals. The district has 184 health workers against the required 650 under the new staff structure.
Alebtong Health Centre IV serves more than 10,000 patients monthly. There are 12 health centre IIIs including two which are private non-for-profit and five health centres IIs including one private-not-for-profit. Dr Tony Odung, the district health officer, notes that the inadequate personnel has crippled effective service delivery.
“Health centre IIs are supposed to have 19 health workers each, including support staff, but they operate with only three staff. Health centre IIIs are supposed to have 55 staff, but we have between nine and 10. The health centre IV should have 135 staff, but there are only 48,” he says. I
Lira Hospital's Outpatient Department sees over 400 patients daily from northern Uganda and neighbouring areas despite a shortage of 800 staff members.
In Dokolo District, health facilities face a number of challenges ranging from inadequate drug supplies to shortage of personnel. This district, which became operational on July 1, 2006, has one health centre IV, 11 health centre IIIs and six health centre IIs, all serving a population of about 240,000 people. Under the new staffing structure, the district is supposed to have 850 health workers deployed in the 18 government health facilities. Currently, though, it has only 255 staff, according to the district health officer, Dr Samuel Ojok.
“The funds that the district receives for primary health care are too little to do the required work. Health centre IIs get only Shs2.6m per quarter (four months). Luckily, the health centre IIIs get Shs26m while health centre IVs receive Shs40m within the same,” he says.
Dokolo receives timely delivery of essential drugs and medical supplies from the National Medical Stores. However, the supplies cater for only 40 percent of what the patients require. “That is why those with complications are always asked to buy medicine. Most times, this medicine is costly and is not included among the drugs delivered to government health facilities,” Dr Ojok adds. Kwania District, with its health centre IV, eight health centre IIIs, and four health centre IIs, also suffers from understaffing in the health sector. Currently, the stuff level is at 22 percent. “These days, medical supplies are delivered in time.
However, some commodities such as antibiotics, gloves, suture materials, and anesthetic drugs are not enough for the facilities,” says, Dr David Okino, the district health officer. Apac District has one health centre IV, seven health centre IIIs, and seven health centre IIs. Sam Opira, the district’s secretary for education and health, says Apac is faced with challenges of inadequate personnel, equipment, and medical supplies.
“In most cases, health workers only diagnose and write out prescriptions for patients, who then have to buy essential medicines from private pharmacies,” he says. The district’s staffing level as per the new structure is at 43.7 percent.
Recommendations
David Kennedy Odongo, Alebtong’s LCV chairperson, who also serves as the chairperson of all LCV chairpersons in the region, says the government should relax the policy on recruitment if the challenge of inadequate health personnel is to be addressed.
“Parliament should budget more funds to recruit specialists and critical staff. Essentially, they should prioritise health. Parliament is putting a lot of money in non-priority areas. That is very dangerous for the country because the health and wealth of a country depends on the quality of its human resources,” he says.
A general view of the entrance to Lira Regional Referral Hospital.
A sick population automatically translates into a healthcare burden that affects the population’s productivity and country’s development.
Health infrastructure in Lango
Amolatar District has 18 health centres, including two government health centre IVs, nine government health centre IIIs, one government health centre II, one private not-for-profit, and four private-for-profit health centre IIs.
In Kole District, there are 15 health centres; one government health centre IV, eight government health centre IIIs, two government health centre IIs, two private-not-for-profit health centre IIs, and two private-for-profit health centre IIs.
Oyam District has one government health centre IV, 13 government health centre IIIs and three private-not-for-profit health centre IIIs; 13 government health centre IIs, and one private-for-profit health centre II.
In Otuke District, there are 15 government and two private health centres. These include one government health centre IV, six government health centre IIIs, one private-not-for-profit health centre III, one private-for-profit health centre III, and eight government health centre IIs.
