Underfunded rehabilitation services leave PWDs struggling

On February 20, 2011, Tina Amooti Kanyunyuzi was struck by a vehicle. She was rushed to Mulago National Referral Hospital where her left leg was amputated. Since then, she has been using crutches.

“The accident was not intentional, as some people think. However, after my leg was cut off, it was a tough time for me and my family. The doctors managed to save my right leg by placing screws in it,” she recalls.

Kanyunyuzi spent a month in the hospital before she was discharged. While she acknowledges that the care provided by the hospital was generally good, she also faced challenges.

“After the first surgery, I was placed in a room where the doctors neglected me. My wound started to rot, and I had to undergo two more surgeries to remove the infected tissue. Unfortunately, these services were not free. My family had to pay for some of them,” she explains.

Her family purchased the crutches she needed for walking, as the hospital did not provide other rehabilitation services. Upon discharge, friends at home took over her rehabilitation training.

“To this day, I have not received the proper rehabilitation I needed. It is a situation that must change. I hear that some people get crutches from non-governmental organisation (NGOs), but access seems to require good connections,” she adds.

The absence of specialised counselors in health facilities has made it difficult for Kanyunyuzi to manage her emotions. She finds solace in communicating with friends through social media.

“At first, I was afraid of crowds and avoided places where I knew people would stare at me. Walking in public felt like a trial—strangers' eyes following me, their whispers cutting deep. Some would point, others would gossip, and occasionally, I would hear cruel remarks like, 'Ija orole omukazi mulema aine okuguru kumu' (come and see the lame woman with one leg)," she recalls.

According to the 2024 National Housing and Population Census (NHPC), Uganda has about 1.3 million People Living with Disabilities (PWDs). Health authorities say majority of these require rehabilitation services from government health facilities, such as prosthetic limbs and assistive technologies.

These technologies are essential after someone has undergone amputation. Unfortunately, several PWDs miss out on services due to persistent underfunding of health facilities. Health authorities indicate that the demand for these services has been exacerbated by the increasing number of road accidents and diabetes-related complications.

According to the 2024 Annual Crime Report of the Uganda Police, road crashes claimed 5,144 lives in 2024, up from 4,806 in 2023. The report further highlights that 20,664 people sustained injuries in road crashes, with 17,013 suffering serious injuries, some of which resulted in amputations.

However, the government’s failure to prioritise funding for rehabilitation services places a heavy financial burden on the patients because whenever they go to health facilities, they are told to buy these technologies.

Research conducted by Knowledge for Change on universal healthcare for individuals with limb loss in Uganda revealed that accessing quality physical rehabilitation services in government health facilities costs between Shs 400,000 and Shs 3 million - an expense that many Ugandans cannot afford.

Beyond road crashes, diabetes is another major cause of limb loss. The World Health Organisation (WHO) identifies the disease as a leading contributor to blindness, kidney failure, heart attacks, strokes, and non-traumatic lower limb amputations in Uganda.

According to the International Diabetes Federation, in 2021, approximately 716,000 Ugandan adults were living with diabetes, further increasing the demand for rehabilitation services.

Lack of supplies

Abel Sevume Kahuma, a principal orthopedic technologist attached to Fort Portal Regional Referral Hospital, expressed concerns about the limited availability of rehabilitation services for individuals who have lost their limbs.

“Such services are only accessible at regional referral hospitals across the country, making it difficult for patients to receive the care they need, as many face financial burdens when traveling long distances to access these essential services,” he says.

Kahuma adds that rehabilitation is critical for PWDs and the government must take full responsibility for their care rather than relying on implementing partners for funding. He stressed that when individuals undergo amputations they are left to struggle instead of being supported to regain mobility and independence.

“As rehabilitation professionals across the country, we advocate for these services to be decentralised to district hospitals and lower health facilities. Regional referral hospitals serve multiple districts, and many patients struggle to reach them,” he explains.

His remarks follow the findings of the 2024 NPHC Report, which revealed a significant rise in the number of PWDs in Uganda to 1,289,513, with a disability prevalence rate of 3.4 percent. The Acholi sub-region has the highest number of people living with disabilities, with 93,747 individuals aged two years and above, and 85,698 individuals aged five years and above.

Other regions such as Lango (4.6 percent), Busoga (4.3 percent), Bugisu (4.1 percent), and Teso (3.8 percent) also report significant disability prevalence. The Tooro sub-region has 68,704 persons representing 3.5 percent of people above two years and 63,491 persons representing 3.6 people above five years all living with disability.

“The rehabilitation departments in regional referral hospitals, particularly prosthetics and orthotics, which provide artificial limbs and appliances to support weak body parts, are not considered a priority. As a result, the government does not procure the necessary materials and components for these services, making them non-funded priorities,” Kahuma says.

Robert Ssekitoreko, the head of Biomedical Engineering at Makerere University, has called on the government to extend its commitment to free medical care by ensuring that assistive devices and rehabilitation technologies are provided at no cost to PWDs.

“Even the few devices supplied are not included on the national list of priorities for NMS. The government must prioritise local innovations to produce assistive devices for PWDs. Many PWDs are economically disadvantaged and cannot afford them,” he says.

Kanyunyuzi says while some PWDs come from well-off families, others cannot afford the care. For instance, each bandage costs about Shs150,000. Kahuma further explains that the government employs a limited number of specialists to provide these services.

“We last received supplies from the government in 2011. To date, the National Medical Stores (NMS), which supplies all government health facilities, has completely overlooked this section. Essential materials for making prosthetic limbs, crutches, neck collars, and orthopedic corsets have not been provided for years,” he says.

When contacted for a response, the NMS spokesperson, Shiela Nduhukire, says if assistive technologies are part of the procurement plans of a regional referral hospital, there is no way NMS can provide them.

“NMS procures to the extent of what is requested for in the procurement plans of health facilities across the country,” she adds.

Taxes on assistive materials

The materials the rehabilitation departments use are imported, and suppliers face high taxes, making them more expensive for patients.

“The importers of these materials receive no protection from high taxes, and the Ministry of Health insists that unless the assistive materials are distributed free of charge, they cannot be exempted from taxes. It is unfair for the government to tax materials PWDs rely on while failing to provide them in public health facilities,” Kahuma adds.

Prof. Louise Ackers, the Director of Knowledge for Change, an organisation that provides rehabilitation services to PWDs in Fort Portal City, also criticises the government for imposing high taxes on imported assistive devices.

“While past wars were a major cause of limb loss, road crashes and diabetes have now become leading contributors. If Uganda does not address these factors, rehabilitation facilities will soon be overwhelmed by demand. The government’s failure to finance these services has left the supply chain in the hands of heavily taxed partners, making prosthetic devices extremely expensive," she says.

PWDs pay taxes, yet the orthopedic workshops in government health facilities have no government-procured machines or tools. Everything is provided for by implementing partners.

“The government cannot leave these services entirely to implementing partners. We have already seen organisations like USAID withdraw their funding. The responsibility to meet the needs of citizens lies with the government. It is unfair to neglect PWDs—it is like imposing a death sentence on them,” Kahuma laments.

A regional referral hospital is expected to have at least six orthopedic technologists and six occupational therapists, yet these personnel are not being recruited, leaving facilities understaffed.

Government response

Andrew Mubangizi, the assistant commissioner for Disability and Rehabilitation in the Ministry of Health’s Department of Community Health, acknowledges that the country’s rehabilitation infrastructure remains inadequate, with staffing and supply shortages.

“The service providers of rehabilitation materials need to be involved in hospital planning to ensure these supplies are prioritised alongside other medical essentials. This has been a major gap in our system,” Mubangizi states.

He added that the health ministry is working towards establishing a National Assistive Technology Framework to ensure that rehabilitation supplies are procured through the NMS.

“A pilot initiative is already underway to include some assistive devices in NMS procurement through partner organisations, and the ministry aims to harmonise this process so that health facilities can directly budget for these materials when funds are available,” Mubangizi says.

Currently, the health ministry relies on various partners, such as Knowledge for Change, which has partnered with Fort Portal Regional Referral Hospital to support its orthopedic unit. Mubangizi urged other organisations, including Kyaninga Children’s Foundation in Fort Portal City, to collaborate with public facilities.

“These organisations are here to serve Ugandans, and they can also help our hospital staff learn innovative techniques, such as making wheelchairs out of bamboo,” he explains.

Going forward

Despite the stigma she has faced over the years, Kanyunyuzi refused to let her disability define her life. Instead, she has risen above her challenges to become a social media influencer who actively engages in community mobilisation and online marketing.

Her work involves promoting products, sharing vital information with the community, and earning a living through digital marketing and promotional campaigns.

Beyond her work, Kanyunyuzi is passionate about sports. She pursued a certificate course in stewardship organised by the Federation of Uganda Football Associations (FUFA). She is a registered security officer for Fort City Football Club and Tooro Queens Football Club.

Her involvement in sports has taken her to different places across the country, and she dreams of visiting Old Trafford—the iconic home stadium of her favorite football team, Manchester United, in the United Kingdom.

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