By Dorcas Amoding Kiyemba
Uganda is known for the best health policies but this does not relate to services delivery as we still have over 16 mothers dying from preventable causes, translating to 435 per 100,000 and infant mortality rates at 54 per 1,000 live births, under five mortality is at 90 per live births.
These seem like mere figures but actually this are lives lost.
The state of health centres across the country, especially health centres two, three and four are in a pathetic state and over crowded with patients with few health workers to serve the patients, limited and lack of equipment.
It is hard to believe that most of the health centres in Kamwenge district like Rukunyu health centre IV, Ntara health centre IV, Bwizi health centre III Kicheche health centre III and many others across the country relay on rain water and during the long dry spells they have no water.
And not to mention the common lack of electricity in rural health centres where most citizens get medical services. One wonders how mothers who visit these health centres are able to give birth and survival with their babies.
Health workers at the forefront are working tirelessly against all odds to save the lives of mothers and their babies despite the norm of delays in payment of their humble salaries.
Our leaders on the other hand have continued to boast about steadily growing GDP of about 6.7% per capita but to citizens dismay the condition of the health sector has continued to worsen with few health workers, lack of medical equipment, and with a low primary health care package that cannot make any impact on what its intended for like paying for electricity, water, security for health centres, fuel and maintain the ambulance and cover costs for outreaches among other.
One would expect that since the GDP is steadily growing, then important sectors like health would be seen improving as well over the years since it is believed a sick population leads to a sick economy as well.
With the health sector domestically financed at only 6.7% and over 40% is funded externally and yet the irony is that some schools of thought have urged that we actually don’t need donor funding. Let us talk of patriotism here, wouldn’t it be realistic to analyse who does get affected if this donor funding is withdrawn?
I was involved in the dissemination of the promise renewed for reproductive maternal, newborn and child health sharpened plan in various districts across Uganda that was launched by the Vice-President, Edward Sekandi in November 2013.
The dissemination targeted majorly members of local government but the major challenge was that most of them seemed not to be aware of what was happening in their constituencies’ in relation to health; worse still not knowing what their role was in relation to health service delivery.
This was evident in the districts of Kamwenge, Bushenyi, Tororo, Busia, Bugiri, Kyangegwa; that they were so detached with the concerns that were affecting the health centres. They had this attitude of gavumenti etuyambe (the government should help) even in the basic roles that they should be taking lead.
This is meant to be an army of government that is meant to demand for services for grassroots and monitor the delivery of these services. Health advocacy efforts should, therefore, focus on engaging with local government members especially the secretaries for health and education, the district planners and the offices of the district health officers to equip them with advocacy and lobbying skills that will improve health services for the grassroots.
The political wing at local government should to be engaged to demand for services for the community and not just looking for votes when it comes to elections. It would be true then, if one urged that limited understanding of local government of their role is partly the reason Uganda has good policies but with poor service delivery.
Local government should be the most important stake holders in monitoring health service delivery, if not Uganda will continue lag behind in meeting basic expectations of its citizens. Could it be that limited involvement and awareness of local government in what their mandate in monitoring service delivery that Uganda is not achieving MDG 4 and 5 that focuses on reducing maternal and child mortality by 2015?
We have seen cases where some districts have returned funds to ministry of finance and this could be lack of competence to absorb this money and manage accountability and yet local communities’ demands are not met.
This same lack of competence has related to drug stock-outs in some health centres because the health workers do not have the ability to place proper orders as required by National Medical Stores. Who is responsible in such cases in building the capacity of these health workers to be able to place right orders on time for medicine supply?
Most times it ends at health centre were not able to place right orders but the consequences of patients losing lives and others progressing to advanced disease conditions is never considered.
Local government should be given the necessary support to enable them demand for better health services for citizens of Uganda.
The writer is the programme officer with Policy Advocacy and Networking Action Group for Health, Human Rights and HIV/AIDS – AGHA Uganda