State of health: Understaffing, drug stockouts cripple services in districts

When Mr Robert Wanyoro, 66, suddenly fell ill and was rushed by relatives to Buginyanya Health Centre III in Bulambuli District, he was diagnosed with a heart failure that needed oxygen therapy.
But to the relatives’ surprise, the health centre had no lifesaving gas. So, Wanyoro was instead referred to Muyembe Health Centre IV, which is seven kilometres away.

“We had to mobilise the money, which we finally got and took him for treatment,” Mr James Wepukhulu, a resident of Kidodi Village in Buginyanya Sub-county, said last week.

He added: “But the fact remains that our health centres have become places for only the very poor who can wait when told that there are no drugs because that is their last resort.”

Although for the past years, there have been notable achievements in the health sector through numerous interventions by government and non-government organisations, there are still myriad of challenges hampering health service delivery in the country.

An investigation conducted by Daily Monitor on the health centres countrywide show that most facilities, especially in hard-to-reach areas, have no access to electricity, have limited infrastructure and lack basic facilities such as toilets and incinerators. They also lack essential drugs, have few beds for patients and face a challenge of poor road network.

Other health centres do not have out-patient department shades, others are understaffed, face drug stock outs, lack of safe and clean water and inadequate funding from government, among others.

Bukedi
The government policy of having all sub-counties in the country with a public health facility has not yet been achieved.

In Bukedi sub-region, all government health facilities in Busia District by the end of June had run out of drugs for treatment of malaria, the leading cause of death in the country.

The worst hit health centres were Lumino, Buhehe, Busitema, Bulumbi and Lunyo. At Busia Health Centre IV and Masafu Hospital, they had run out of artesunate, a vital drug for treatment of severe malaria cases.

Dr Yusuf Lule, the in-charge Busia Health Centre IV, said the facility faces numerous drug stock outs because of the overwhelming number of patients.

“Like now, we have run out of artsunate. We are diagnosing and referring our patients to the drug shops to buy but some are poor and cannot afford,” Dr Lule said.

Daily Monitor learnt that at Lumino Health Centre III, the facility had spent a month without coartem and artesunate, and they had suspended treatment of malaria.

Attempts to speak to Dr Bena Nanyama, the acting district health officer, were fruitless.
In Tororo, the district health officer, Dr David Okumu, said the health facilities located on the border consistently face drug stock outs.

“Those health centres handle huge numbers of patients from the Kenyan side. This has continuously affected their smooth running,” he said.
At Tororo referral hospital, Dr Okumu, however, said the expectant women are no longer delivering on the floor.

Tororo District has 56 government health facilities, 34 health centre IIs, 18 health centre IIIs, three health centre IVs and one district hospital.

In Pallisa, most of the health centres do not operate on weekends and they also have no access to electricity.

Mr Andrew Omagor, the Kamuge Sub-county chairperson, said health workers at Kamuge Health Centre III, find it difficult to attend to patients at night due to lack of power.

In Budaka, the inadequate funding, coupled with lack of enough staff, persistent drug stock out and inadequate infrastructure, remain a major challenge.

The district health officer, Dr Elisa Mulwani, said the facilities face drug stock outs as a result of overwhelming number of patients.

Bugisu
In Bugisu sub-region, most of the sub-counties in Sironko District have no health centres, including Bukyabo, Buhugu, Bukyambi, Bunyaffa, Busulani, Busiita, Buiise and Bukulo. As a result, residents move long distances to access treatment at Buwasa and Budadiri health centre IVs.

The district education officer, Dr Nicholas Wabomba, urged the government to upgrade Budadiri Health Centre IV to hospital status in order to accommodate the increasing population of patients.

“This will increase on the number of doctors in the district to offer the much needed medical services,” he said, adding that health workers also trek long distances for work due lack of staff houses.

The paediatric ward at Budadiri Health Centre IV is also in a sorry state.
In Bulambuli, Dr Mupale Gidale, the district health officer, said most of the health centres are not connected to the electricity because of insufficient funds.

“We have 26 health facilities, almost all have power poles in the compound but we have not connected them because there is no money for wiring,” he said. Mr Gidale also revealed that the district has only two ambulances with only two doctors.

In Mbale, Mr Jonathan Wangisi, the district health officer, said the biggest challenge affecting the health sectors is lack of staff accommodation.

“Only 14 per cent of our staff stay in government facilities. This has resulted in absenteeism and reporting late for duty,” he said.

Sebei
In Sebei sub-region, the Bukwo District Health Officer, Mr Satya Collins, said the district has only 17 health centres and that the staffing levels stand at 57 per cent, which is below the national average.

He added that at Bukwo hospital, they refer two patients per week to either Kapchorwa or Mbale referral hospitals for surgery because they have no capacity to handle the cases.

Mr Chemos Godfrey, the Kween district health officer, said the district has 24 health centres but only three are connected to electricity.

“Most of our health facilities operate in temporal structures and when it rains, the health workers do not work,” he said.

Central
In central region, Njeru Municipal Council in Buikwe District, which has an estimated population of 159,549 people, lacks a doctor and the biggest health facility is a health centre III.

There are 13 public health centres; three of them are health centre IIIs and the rest health centre IIs.

The municipal health inspector, Mr Andrew Kaitaita, said most patients are referred to Jinja Regional Referral Hospital or Kawolo Hospital .

A visit to some health centres in Njeru Municipal Council revealed that most lack basic facilities such as toilets and incinerators while others do not have out-patient department shades and clean water .

Last month, running water found its way into Buikwe Health Centre III and destroyed drugs, medical equipment and documents.

The facility offers inpatient and outpatient services, antenatal and postnatal services, family planning, laboratory services counselling and HIV screening.
Mr Kaitaita said lack of enough health workers is also still a challenge and those in service lack accommodation.

“This financial year, we are going to embark on renovating the health centres and put the necessary medical equipment but we cannot do everything in one day,” Mr Kaitaita said.

In Rakai District, which has 10 health centre IIIs, health workers rarely report for work and those who report leave before official time.

A nurse at Kibanda Health Centre III, who preferred anonymity, said they trek longer distances to access their respective places of work.

“Whenever it rains in the morning, we stay home because the swamp we cross to connect to the health centre gets flooded. If we were not patriotic, we would not be working here; some of our colleagues crossed to Tanzania and Rwanda where working conditions are relatively good,” she said.

In Mubende, Mr Deo Semujju Lubowa , the district health officer, said all the health centres in the area face a challenge of understaffing.

The district has 40 health facilities, of which 31 are health centre IIs, seven health IIIs, one health centre IV and one hospital.

Acholi
In Acholi sub, region, the situation is not any different.
At Anaka Hospital in Nwoya District, the staffing levels stand at 45 per cent and there are no specialists.

According to the district spokesperson, Mr Geoffrey Axuma, they advertised four times for medical specialists and no one applied.

“We advertised four times and we did not get any specialist. Many specialists are not attracted with what we have in place being a rural place; they prefer cities,” he said.

At Todora and Lii Health Centre II, essential drugs at times are out of stock.
“You might find that the turn-up of patients is up to 100, against the three health workers in place,” Mr Axuma said.

Amuru District, which was carved out of Gulu in 2006, has Atiak Health Centre IV, which acts as a district hospital.

The facility, however, has no mortuary. The facility receives patients from lower health centres in the district and from South Sudan.
Mr Emmanuel Ainebyoona, Ministry of Health spokesperson, said the problems at Atiak Health Centre IV would soon be solved.

“We are in the process of upgrading health systems across the country where we put up new facilities and equipment, including fridges in morgues,” Mr Ainebyoona said.

For the last 17 years, Pader District has been operating without a district hospital and without a single gynecologist.

The district has two health centre IVs, 13 health centre IIIs, and 20 health centre IIs.
Recently, Ms Anna Apio, the acting district health officer, said due to the absence of a district hospital, the health department has been operating without a gynaecologist. In Agago District, patients mostly seek medical care from Dr Ambrosoli Memorial Hospital, a Catholic Church-founded facility.

In July last year, President Museveni officially commissioned a Shs1.6 billion building by David Fagerlee, an American businessman.

In Lamwo District, Dr Charles Oyoo Akiya, the district health officer, said they have one functional ambulance which was procured in 2008. The second one broke down and is yet to be repaired.
In Apac, there is chronic absenteeism of health workers, which has crippled service delivery in the district.

A case in point is Wansolo Health Centre II in Akokoro Sub-county, which does not operate on Fridays and Mondays because health workers are always absent. The unit opens at 11am and closes at about 1pm.
Mr Denis Ojok, the health assistant, said most staff stay away because of inadequate accommodation.

“Our in-charge shares a house with two other staff. Bats have infested and destroyed our outpatient department and the stench is so bad,” he said.

The State Minister for Health in-charge of General Duties, Ms Sarah Opendi, said despite the challenges, government has improved the welfare of health workers by increasing their salaries.

Ms Opendi said health centres across the country also receive drugs in time, adding the government has also equipped and improved on their infrastructure. She added that government is working to ensure that each sub-county has a health centre to ease access to health care.

Leaders in western region decry limited staff accommodation
In Kabale, the district health educator, Mr Alfred Besigensi, said limited government wage bill is responsible for the shortage of health staff.

He, however, said plans are under way to renovate and construct enough staff houses so that the employed health workers can stay at the health facilities all the time for timely health service delivery.

The Kisoro District Health Officer, Dr Stephen Nsabiyunva, said lack of accommodation for health workers, health equipment and inadequate facilitation are some of the major challenges affecting health service delivery in his district.

“Once the highlighted challenges are fixed by government, health service delivery in the district shall be okay,” he said.
In Rukungiri District, staffing is at 69.5 per cent and the government offers accommodation for only 10 per cent of them.

“A unit meant for one health worker is shared with others because of lack of accommodation facilities. Overall 10 per cent is accommodated,” Dr Kasiima Mucunguzi, the district heath officer, said.

In Mbarara, Bwizibweera Health Centre IV, the best rural government health facility in the district, has 36 of the 49 required health staff.

However, according to Dr Cranimer Mugasira, the in-charge of the health centre, only 40 per cent of the staff are accommodated at the facility.
For Ibanda District, the staffing level is at 61 per cent and only 30 per cent can be accommodated, according to the District Health Officer, Dr Julius Bamwine.

Dr Bamwine also said lack of accommodation has led to failure to attract health workers.
“We need to increase in funding to cater for wages so that we are able to recruit more staff; we need grants for staff accommodation and renovation of buildings,” hesaid.

The Mbarara District Health Officer, Dr Peter Ssebutinde, said the staffing level is at 94 per cent and of these, only 60 per cent is accommodated.

In Kabarole, the District Health Officer, Dr Richard Mugahi, said understaffing is the biggest challenge.

“There is overwhelming number of patients at health facilities, especially at Fort Portal Regional Referral Hospital, yet health workers are few,” Dr Mugahi said.

Govt speaks out
Dr John Baptist Waniaye, the commissioner-in-charge of ambulance services in the Ministry of Health, said health service delivery is improving. He said that currently, there are 173 government functional ambulances distributed in different parts of the country. He added that the government is working to ensure that each constituency owns one ambulance.

The State Minister for Health in-charge of General Duties, Ms Sarah Opendi, said government has improved the welfare of health workers by increasing their salaries. Ms Opendi said health centres across the country also receive drugs in time, adding the government has also equipped and improved on their infrastructure.

Compiled by Fred Wambede, Al-Mahdi Ssenkabirwa, Cissy Mukimbi, Alfred Tumushabe, Denis Edema, Joseph Omollo, Robert Muhereza, Scovia Atuhaire, Rajab Mukombozi, Bill Oketch, Micheal Woniala & Mudangha Kolyangha.