Sarah, Nyanga and other patients wait for medical care at Kotido General Hospital. She says healthcare is a right, not a privilege and the government must do something before it is too late. PHOTO/ HERBERT KAMOGA
Sarah Nyanga resides in Lokiding village, Kacheri Town Council, in Kotido District. She arrived at Kotido General Hospital early in the morning hoping that her children would be immunised on time.
However, the hours passed and still, no health worker attended to her. She sits on a wooden bench, holding her restless twins, watching other patients, some visibly weak and in pain, also waiting for the medical assistance that, increasingly, seems out of reach.
“I arrived here at 8am and it is now past midday. We are all just sitting here, waiting to see if anyone will come to help us,” she says, frustration evident in her voice.
Nyanga’s experience is just a snapshot of the situation at Kotido General Hospital, a facility struggling with severe staff shortages and a lack of essential medical supplies. The few available health workers are stretched beyond their limits, handling an overwhelming number of patients daily.
Paul Komol, the LCV chairperson for Kotido District, expresses deep concern over the state of the hospital, which was upgraded from a Health Centre IV to a general hospital in 2021. However, the upgrade did not come with a corresponding increase in staffing and wages.
“The hospital operates with only 24 staff members because from 2021 until now, we have not recruited new staff. For over four years, the district leadership has been pushing for the government to allocate funding for wages to address the crisis. It is embarrassing to have a hospital in name, yet in reality, it does not exist,” he says.
Komol criticised the government's approach, arguing that any facility earmarked for an upgrade must have a wage allocation.
“The staff members are exhausted and are impatient with the sick people. Sometimes, when they are too tired, the medical workers abandon the patients and go and take a rest. I do not blame them because they are human beings who need food and rest,” Komol adds.
The staffing crisis left Kotido General Hospital without a doctor. Komol reveals that the doctor the hospital had “took off for study leave,” yet he continues to receive a salary.
“To fill the gap, I reached out to Kotido Municipality to provide additional health workers. Luckily enough, they accepted and gave us a medical officer, who we made the hospital superintendent. He is the only doctor there now. It is unfortunate that when it comes to sharing national resources, the Karamoja sub-region is thought of as a last resort,” Komol explains.
Few hands carrying heavy burden
Dr Gabriel Acheboi, the medical superintendent of Kotido General Hospital, describes the immense pressure faced by the facility.
“We treat about 900 to 1,500 patients a day in our outpatient department (OPD). Yesterday, we started with a staff meeting at 8am which went on for one hour, then carried out ward rounds at 4pm. I rested for two hours. At 6 pm, I was called for an emergency and at 10pm, I was called to manage a referral with obstructed labour. I was there until 3am and by 8am, I was back at work,” he says.
The hospital is operating at only 14 percent of its required staffing levels and the exhaustion among the health workers is evident.
“The majority of the staff are not technical and we may not be meeting the required standards of the Ministry of Health. You must be committed to your profession because the situation can make you give up. I have seen colleagues leave the hospital due to the heavy workload and go into private practice,” Dr Acheboi notes.
Another health worker, who spoke on the condition of anonymity because he is not authorised to speak for the hospital, describes the dire conditions.
“We are doing our best, but the numbers are too high. Imagine one doctor handling dozens of patients in a day. We are exhausted, and as a consequence, the patients are suffering. Some emergencies are delayed simply because there is no one available to attend to them on time,” he says.
In some cases, patients are forced to wait for days before receiving treatment. The situation is alarming for expectant mothers because delays in accessing skilled maternal care puts their lives and their unborn babies at great risk.
“Sometimes, we only have two midwives on duty, handling multiple deliveries. Imagine managing labour, birth complications, and postnatal care at the same time. The conditions are not safe for both mothers and babies,” says a nurse at the maternity ward, who also requested anonymity.
No Imaging services
Earnest Ayen, the chairperson of the youth in Abim district, highlights another major challenge in the region, the lack of imaging services.
“We do not have imaging machines in the four districts of Northern Karamoja. These include Kaabong, Karenga, Abim, and Kotido districts. Several patients need the services of those machines daily," he says.
Dr Acheboi confirms that Kotido General Hospital only offers ultrasound services. The hospital does not have an x-ray machine and all those who need its services are first stabilised and then referred to Moroto Regional Referral Hospital.
“One has to part with Shs300,000 to afford a referral from Abim District to Matany Hospital in Napak District or to the regional referral hospital. That amount excludes feeding and accommodation costs. People are very poor in this region, barely able to afford a decent meal. Very few can afford specialised treatment,” Ayen says.
He further reveals that some people are forced to heal at home or to use local herbs, without medical care. Many of these suffered fractures and because they did not get the proper treatment, the bones did not set properly.
“I call on the government authorities to prioritise the installation of x-ray and scanning machines. In Abim district, they keep saying the x-ray will be operational next month, but nothing happens,” he laments.
Patients waiting for medical workers to attend to them. PHOTO/ HERBERT KAMOGA
Promises of improvements
Kalisto Alepper, the chairperson of the youth in Kotido District, echoes similar concerns, saying trust in public health services has eroded because it is difficult to find basic drugs such as paracetamol in health facilities.
“The majority of those affected are mothers and young people. We have many cases of child marriages in the Karamoja sub-region. Several young girls become mothers early and they are the most affected by this failing system,” he says.
The lack of medical supplies has forced patients to bear additional costs, as they are often required to buy their medicines, gloves, and syringes from private pharmacies. Many, especially those from poor backgrounds, cannot afford these extra expenses, leaving them without the care they desperately need.
Charles Ichogor, Kotido’s resident district commissioner, acknowledges the severity of the staff shortage and emphasises the ongoing efforts to address the situation.
“Our health system is crippled by a lack of human resources. I have been in Kotido for five months now, and I have felt the burden. We have been raising this concern with the government and I am happy to report that we received confirmation that the recruitment freeze has been lifted. The district service commission, is planning to advertise 60 positions for health staff,” he says.
Ichogor highlights the upcoming infrastructure projects that will strengthen healthcare service provision in the district. For instance, Kacheri Health Centre III is set to be upgraded to a Health Centre IV.
“A modern maternity ward, a theater, and a VIP latrine will be constructed at Kacheri, which is about 50 kilometres from the main hospital. Instead of referring patients to Kotido General Hospital, they will be treated closer to home,” he notes.
Ichogor assures the public that sooner, rather than later, the health challenges in the district will be addressed since Kotido General Hospital is set to get a second doctor.
“This is part of steady progress. The government plans in a phased manner, prioritising key issues,” he says.
However, as the sun sets, patients continue to wait for treatment, health workers push through exhaustion, and the hospital struggles to stay afloat. Sarah Nyanga, who had waited for hours to immunise her twins, sums up the frustration of many.
“We deserve better. Healthcare is a right, not a privilege. We are suffering, and the government must do something before it is too late.”
Her words echo the sentiments of thousands of others who depend on the hospital for medical services. The situation at Kotido General Hospital is a true reflection of a larger problem facing Uganda’s healthcare system, particularly in rural areas.
Uganda’s health sector challenges
On January 29, 2025, Kotido General Hospital received drugs from the National Medical Stores after weeks of enduring stockout of most medicines. The facility had been operating with only antimalarial drugs, painkillers, and a few antibiotics in the outpatient department.
However, Kotido General Hospital is not alone. Uganda’s health sector is grappling with perennial structural challenges and a lack of adequate funding. According to the 2023 Harmonised Health Facility Assessment in Uganda report, the number of health facilities (public, private, and private not-for-profit) now totals 6,937, out of which, 3,133 are government-owned.
However, these facilities are not enough for Uganda’s population of 45.9 million people, with an annual growth rate of 2.9 percent.
In an earlier interview, Eng George Otim, the Commissioner of Health Infrastructure in the Ministry of Health, said the country has about 60,000 beds in its facilities, “I believe these are adequate for this population.”
The Director of Clinical Services at the Ministry of Health, Dr Charles Olaro, said in an earlier interview that the concern should not be about the number of health facilities, but about how efficiently the health system is running.
“We want fewer people to attend our health facilities. We are encouraging prevention (of sickness). But, if a health centre has a maternity ward, an outpatient department, and inpatient department, a laboratory, and a good referral system this should be enough,” he said at the time.
Currently there is a Health Centre III for every 20,000 people. Uganda has 155,000 health workers but needs 187,000 more.
The health budget for the 2024/2025 Financial Year is Shs2.946 trillion. However, this budget does not cater for the new staffing structure at health facilities. l “That is now the paradox. The health budget has been increasing and progressing, but not in proportion to the growing population. So, it will bring a few challenges in terms of long-term planning. However, we are optimistic that our plans of upgrading Health Centre IVs and recruiting more health staff will come to fruition,” Dr Olaro said at the time.
Addressing these challenges to give Ugandan’s the services they need will necessitate increased investment in the sector, recruitment and retention of health workers, and more investment in medical equipment.
