Uganda's health system, where are we?

Feb 23, 2017

In 2014, National referral, Mulago Hospital, for example, ordered items worth sh531m, but it only got items worth sh380m in March 2014.

The health budget got a boost from Sh1.2227 trillion in 2015/2016 to 1.828Tn in 2016/2017. The monies were broken down as follows; health ministry took sh505.56b, Uganda Cancer Institute sh25.67b, district primary health care sh30.86b, regional referral hospitals (sh19.86b) and Mulago complex (sh7.04b) and the National Medical Stores (NMS) sh10b (to offset currency depreciation in drug procurement).

Notice the allocation to NMS? In last year's elections, the MRM had promised just that. "In order to solve this problem, we will progressively increase the budget of the National Medical Stores. Also, the distribution of drugs will put into account the population served instead of giving all health centers the same amount of drugs as it is now," the president said.

In 2014, National referral, Mulago Hospital, for example, ordered items worth sh531m, but it only got items worth sh380m in March 2014. The brief states: "Phenytoin Sodium (an anticonvulsant) required by the neuro unit to treat emergency or traffic accidents cases and convulsions among others had not been received since February 2014 yet the unit receives over 47 medical cases daily."
 

That very year, 43% of health facilities reported a stock-out of tracer medicines in the six months ahead of the survey. This though was an improvement from 79% of facilities that had reported stock-outs in 2010. The growth one would argue has been consistent with funding to NMS growing from sh201.7b in 2010/2011 to sh219.4b in 2013/2014 including anti-retroviral, vaccines and malaria drugs. And now the boost of sh10b should go towards reducing some of these gaps.
 

Will this go far in reducing the Ugandans' out-of-pocket expenditure on health? Health activists like Patrick Ojilong, of the Action Group for Health Rights and HIV/AIDS (AGHA), have told of a worrying 33% of healthcare financing coming from Ugandans' out-of-pocket expenditure.

"This is far above the maximum of 20% out-of-pocket expenditure recommended by World Health Organisation (WHO) if households are not to be pushed into impoverishment," he argues.

Though Ojilong's argument raises concern, it can be argued though that it should get better, as only five years ago, the household health financing expenditure was at 50% and a lot more has been promised.

"There are some sub-counties without Health Centre IIIs. These sub-counties were not being considered in drug distribution and as a result, they have been putting a lot of pressure on the neighboring sub-counties that have Health Centre IIIs thus sharing medicines that were meant for one sub-county being shared by two or more sub-counties, hence, leading to stock-outs," the president promised early last year.

Health facilities and staffing

Uganda has 5,418 health facilities; two national referral hospitals (Mulago and Butabika), 14 regional referral hospitals and 144 general hospitals. It has 197 health centre IVs, 1,294 health centre IIIs, 2,941 health center IIs and 831 clinics. Sadly, these are not enough, but luckily the ruling party reckons this.

"There are challenges in the sector, which we promise to handle. For instance there are 225 sub-counties without Health Centre IIIs and 100 constituencies (including the newly created) without Health Centre IVs," the president spoke earlier this year.


Despite the fact that there was an increase in staffing to the health sector of up to 28,900 staff, there is still a staffing gap of up to (12,400) 30%.

According to the Health Sector Development Plan 2015-2020, only 45% of positions at health center IIs are filled as compared to the 70% at health center III and 71% at Health center IV. In the regional referral hospitals 81% of positions are filled.

Quoting the same report, private health researcher, Lydia Mbabazi previously of Makerere University, argues that if nearly 70% of medical doctors and dentists, 80% of pharmacists and 40% of nurses and midwives work in urban areas, who will cater to the nearly 80% of Ugandans in the rural areas.

However, the president, Yoweri Museveni, in his manifesto, promised to solve this dilemma. He told of a plan to offer bursaries where the hard-to-reach areas identify students willing to study courses in nursing, midwifery, laboratory technicians, clinical work and medicine at degree level. "After studies, the students will be bonded to work in areas, which nominated them," he promised.

"This is a good idea, but I worry it might stay on paper," she starts. "First of all; how many of the students from these rural areas can qualify for this bursary?" She says that it is quite obvious the will is there, but the execution will take so much more than that.

Maternal and child health

The Health ministry tells of a reduction in maternal mortality from 435 per 100,000 live births in 2010 to 360 per 100,000 live births in 2015. The percentage of expectant mothers helped by skilled health workers to deliver has increased to 60% (2014) up from 38% in 2010. As a result, there has been a reduction in infant mortality from 76 per 1000 in 2010 to 44 per 1000 live births in 2015. Not to forget is the reduction in under five mortality from 90/1000 to 69/1000 (2011-2014) live births.

Also, in his manifesto, the president said; "The Current antenatal care coverage indicators show that 95% of pregnant women visit a skilled health professional at least once, while 48% visit at least four times to any health provider during pregnancy." As a result, there has been a reduction of the mother-to-child HIV/AIDS transmission from 9.8% to 5% between 2010 and 2014 as these services increased from 53% to 74% in 2014.

Ojilong believes that a lot can be harnessed if government prioritizes the right areas. "It took concerted advocacy for government to increase staffing from 52% - 64% over a span of 7 years," he starts. "Currently the sector needs to recruit 3400 health workers to cover up the gap which money is not provided in the FY 2016/17 budget."

Also, at less than 9%, Uganda health budget falls shy of the April 2001, Abuja Declaration, where of all African Union Countries, Uganda inclusive, committed to increasing their health budgets to at least 15% of their annual budgets. In Africa, The African Union Commission (AUC), reports that at least six AU member states have met the 15% benchmark. In East Africa, countries like Rwanda and Tanzania, which have up to 18.8% and 15% respectively, have met their target.


Dr. Fred Muhumuza, a development economist and former financial advisor to the minister of Finance, insists health ought to be a component of its self and not depend on other sectors. "Health needs to go back to the lowest structures, look into Village Health Teams (VHTs), as they will be the ones that deliver the preventive approach success," he says.

(adsbygoogle = window.adsbygoogle || []).push({});