From death traps to living hope: Untapped potential of Uganda's regional referral hospitals
My appeal to the Ministry of Health, the Ministry of Finance, Planning and Economic Development, Parliament and other relevant stakeholders is to reconsider the strategic importance of regional referral hospitals in Uganda's healthcare investment priorities, writes David Mugarra
David Mugarra. (File)
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OPINION
By David Mugarra
Not long ago, I was among the many Ugandans who had lost confidence in regional referral hospitals. For many families, these institutions had increasingly become places associated with desperation, uncertainty and, in some unfortunate cases, death. Many people were uncomfortable referring their loved ones to these hospitals, often fearing that the quality of care would be inadequate.
In some instances, private health facilities appeared to refer critically ill patients to regional referral hospitals not necessarily because they had exhausted their capacity to provide specialised care, but because there were limited alternatives for managing complicated medical conditions. For families, such referrals sometimes felt less like a transition to better care and more like a last resort.
Uganda, like many African countries, continues to grapple with significant challenges within its health system, including inadequate human resources, shortages of essential medicines and medical supplies, limited specialised expertise and infrastructure constraints. However, I want to look beyond these challenges and explore what our regional referral hospitals can achieve if their potential is fully harnessed.
Uganda has an extensive healthcare delivery structure, beginning with community-level health services and extending through Health Centre II, III and IV facilities, district general hospitals, regional referral hospitals and national referral hospitals. This network is designed to bring healthcare closer to citizens while ensuring that patients with complicated conditions are referred to facilities with greater capacity. In principle, this is a sound arrangement. A properly functioning referral system should ensure that citizens can access appropriate healthcare without necessarily travelling long distances to Kampala or other major urban centres.
I will not dwell on the challenges facing the lower-level health facilities. Instead, I want to share a personal experience from Fort Portal Regional Referral Hospital, popularly known as Buhinga Hospital, which has significantly changed my perception of what our regional referral hospitals can deliver.
A few months ago, following reports of a prominent musician's death at the hospital and allegations of negligence, concerns about the quality of care at the facility resurfaced. I had also previously experienced the loss of loved ones at the same hospital. Like many people, my confidence in the institution had been considerably shaken.
However, in June this year, my 69-year-old father came face to face with death. He had started his day normally but could not complete the approximately five-kilometre journey to his shop along Magambo Street. His condition deteriorated rapidly, and he was diagnosed with a serious infection associated with pneumonia and other complications that required urgent medical attention.
The immediate response from those around him was to take him to a private hospital in Fort Portal, whose name I will withhold. The expectation was that the facility would stabilise him. However, after assessing his condition and recording his vital signs, the medical team referred him to Fort Portal Regional Referral Hospital for further management. Given my previous experiences with Buhinga, I must admit that I was not optimistic. My immediate thought was to arrange an ambulance and transfer him to Kampala, where I believed he would have a better chance of survival.
What I encountered in the ICU was my first major surprise
The unit was equipped with oxygen cylinders, including reserve cylinders secured for emergencies which challenged the allegations of no oxygen cylinders at the facility. There was dedicated support staff during the day and evening, while doctors made frequent visits to assess patients and monitor their progress. Within four days, my father's condition had stabilised sufficiently for him to be transferred from the ICU to the private wing.
What particularly surprised me was that, despite the critical care he had received, we were not charged for the ICU accommodation, oxygen and the care provided there. We only had to purchase medicines that were unavailable within the hospital. I could not help imagining what the same period of intensive care would have cost us in a private hospital. More importantly, I began appreciating the immense value of having a functional ICU within a regional referral hospital where critically ill patients can receive essential care without necessarily incurring prohibitive costs.
The experience did not end there. Following his transfer to the private wing, the commitment demonstrated by Dr Francis and Dr Ocaaki, together with the nursing team, was remarkable. Their dedication during both day and night shifts was reassuring. They took time to explain the medicines being administered, the purpose of the different interventions and the additional medicines we needed to purchase. As a family, we were not simply watching our father receive treatment; we were being involved in understanding his recovery. I particularly appreciated the willingness of the doctors and nurses to communicate with us and respond to our concerns.
The second major surprise came when we needed specialized diagnostic services.
In many instances, families are accustomed to being informed that certain tests cannot be conducted at regional hospitals and that patients must be transferred to Kampala or other major facilities. Sometimes, patients are first stabilised before being advised to travel elsewhere for further investigations. I was prepared for a similar experience.
However, my father underwent a CT scan at the same hospital, with the results made available within approximately 12 hours. The scan helped the doctors investigate possible blood clots and other complications. He was also advised to undergo cardiac investigations, including an electrocardiogram (ECG) and an echocardiogram (ECHO), to assess his heart condition. We were informed that the hospital had a cardiology clinic, and the necessary investigations were conducted using equipment available at the facility.
Other laboratory investigations were also undertaken through the hospital's laboratory services within a relatively short period. I could not help wondering: Why should a family have to travel to Kampala for services that can potentially be provided at a regional referral hospital?
What makes this experience even more remarkable is that it happened within a hospital that, like many public health facilities, continues to operate under considerable constraints. The hospital reportedly has a staffing level of approximately 33 per cent, faces persistent shortages of medical supplies due to the high number of patients it serves, and operates within budgetary limitations.
This raises a fundamental question: What more could our regional referral hospitals achieve if they were adequately staffed, equipped and funded?
Fort Portal regional referral hospital occupies a strategic position in Tooro’s healthcare delivery system. The facility serves large populations across several districts and receive patients referred from lower-level facilities, often with complicated medical conditions. It’s not simply an institution for receiving patients who cannot be managed elsewhere; it’s also a critical center for specialized healthcare, emergency response, medical training and the broader functioning of the national referral system.
Investing in these hospitals would have several benefits. First, it would reduce the pressure on national referral hospitals, particularly Mulago, by ensuring that patients receive appropriate specialised care closer to their communities. Secondly, it would reduce the financial and logistical burden on families who must travel to Kampala for investigations and treatment. Thirdly, it would improve the chances of survival for critically ill patients who may not withstand long-distance transfers. Finally, it would strengthen public confidence in government health institutions.
My experience at Fort Portal Regional Referral Hospital has not made me blind to the challenges that remain. Neither does one positive experience suggest that every patient receives the same quality of care or that all regional referral hospitals are performing equally well. There are still serious gaps that require urgent attention.
However, it has changed my understanding of what is possible.
The doctors, nurses and other health workers are an important part of this story. Their commitment should be matched by investments in the systems and resources they need to perform their duties effectively. We cannot continue to demand miracles from health workers who operate with inadequate staffing, insufficient supplies and constrained resources.
My appeal to the Ministry of Health, the Ministry of Finance, Planning and Economic Development, Parliament and other relevant stakeholders is to reconsider the strategic importance of regional referral hospitals in Uganda's healthcare investment priorities. Rather than viewing them merely as intermediate facilities within the referral chain, we should deliberately strengthen them as centres of excellence capable of providing quality and affordable specialised healthcare.
The investment required may be significant, but so are the potential returns in lives saved, reduced household expenditure, improved productivity and public confidence in government institutions. I went to Buhinga Hospital with fear, scepticism and the expectation that I would have to fight to get my father transferred to Kampala. I left with a renewed appreciation of what a properly supported regional referral hospital can achieve.
My father survived, and for that, I remain grateful to the medical team that attended to him. Regional referral hospitals should not be places where Ugandans lose hope. With the right investments, they can become places where lives are saved, dignity is restored, and confidence in public healthcare is renewed.
The writer is programme manager Netherlands Institute for Multiparty Democracy Kampala Uganda