By Moses Mukundane
The Government of Uganda through the Ministry of Health has recently issued a policy statement which stops the establishment of more Health Centre IIs in the country.
The reason for this decision is premised on the argument that since the existing health facilities – HCIVs, IIIs, and IIs have consistently suffered inadequate staffing levels and drug stock-outs, according to nationally recommended guidelines, then it is imprudent to establish more health facilities. I find this argument not only cheap but also contradictory.
One of the objectives of the HSSP II (2005/06 - 2009/10) was to increase accessibility to health facilities within at least 5km walking distance.
This prompted the Ministry of Health to expand construction of new facilities mostly HC IIs based at parish level. Unfortunately, not all areas in the country had had an opportunity of having a HC II within their milieu.
As many areas were still curiously waiting for such services, the ministry suddenly suspends this initiative.
This has created dreads and a sense of hopelessness in the communities where some HC IIs were still under construction and where they have been completed but not yet operational.
Findings from the 2014 baseline study in 16 districts of Uganda, coupled with the findings from the on-going community dialogues in the districts of Masaka, Mukono, Buikwe, Bukomansimbi, and Wakiso consistently indicate that despite inadequate staffing levels and regular drug stock-outs, HC IIs based at the parish level remain the best alternative stop centre for the initial use of public healthcare services before proceeding to HCIII based at the sub-county level.
In fact, most areas which do not have presence of HC IIs and well-functioning village health teams (VHTs), people have resorted to using traditional medicine / herbs or getting partial doses from the local private drug shops to treat the children suffering from such ailments as malaria, pneumonia, and diarrhoea culminating into the rather avoidable child deaths.
It is possible to handle these ailments with nationally recommended treatment at HC IIs or by VHTs, if well-equipped and fully functional.
With the absence of HC IIs, people in rural communities still cry foul of walking very long distances of over 10kms to access healthcare services from a ‘nearby’ health centre III or IV.
The undisputed fact is that the distance an individual has to travel to access healthcare services has an enormous bearing on his/her healthcare seeking behaviour. Long distance thus remains one of the critical systemic barriers to seeking healthcare services in most rural communities, and for that matter, it should be given serious attention by any sound healthcare system.
The Government should revoke the decision of suspending the establishment of more HC IIs, and instead let it carryon with the initiative as stipulated in the National Health Policy and Health Strategic Plans to scale up the coverage of HC IIs at parish level country-wide so as to achieve easy access to and effective utilisation of healthcare services from within a reasonable walking distance.
The Government needs to double its national budget allocation to health sector to meet the required 15% allocation as per the Abuja Declaration.
This will make it possible to meet the pertinent needs of the health sector including recruitment of adequate number of health workers in all health facilities at all levels, constant supply of sufficient essential drugs to all facilities at all levels, establishment of adequate infrastructure, inter alia.
The writer is a research fellow with Advocates Coalition for Development and Environment.
Ministry of health needs to re-visit its policy decision on Health Centre IIs