Dr James Tibenderana gave a fair analysis about the state of health in 2009 in your booklet â€˜Uganda in 2009â€™ but failed to capture some aspects. I do not know where Dr Tibenderana works but I guess he is one of the technocrats at the Ministry of Health who sometimes can be out of touch with the reality on the ground. Perhaps, he was looking at the situation from a perspective of an epidemiologist, which is different from mine, a practicing clinician.
I have had a chance to work in a Health Centre IV, a mission hospital and I now work in a regional referral hospital, in my last eight years of service. Most health workers will agree that there was a time around 2000-2003 when the Ministry of Health seemed to be getting things right, but it is laughable to say that health will improve in 2009.
The health situation in the country has never been as bad, in recent years as it was in 2008.
Hospitals experienced the worst shortage of drugs in many years, the Government ensured that fresh graduates at URA got more salary than senior doctors and the indifference of health workers who were either demoralised or bored, increased.
Throughout the year, there were several reports of ancient diseases like plague, onchocerchiasis (river blindness), filariasis and hepatitis ravaging villages and killing the common man. The health workers became less involved as they saw things fall apart.
For all the failures of government, Dr. Steven Mallinga, the health minister was a rational politician, always crying about the poor conditions of health workers.
This is what I think about 2009. The AIDS, malaria indicator surveys are unlikely to be accurate in 2009, since the officials will sit in towns, forge results like the Karamoja census and give us wrong results.
I agree with Dr Tibenderana, though, that donor funding will reduce, making many HIV patients on anti-retroviral drugs to stop and make many others die without ever having a chance to access these drugs.
The working conditions of health workers will not improve and the Mbarara Hospital building will not start until 2011 when it will act as a political gimmick to amass votes. Granted, the health budget may increase, but with creation of new districts in the year 2009, health units will also increase. Must I also mention that Ugandans are becoming more corrupt?
The officials at the Ministry of Health will prefer to hold seminars in large hotels for capacity building and consultations.
They will have a large budget to fund their avalanche of vehicles. They will make false reports whose results will never be implemented. All this will be at the expense of the basic services meant for the common man. They will wait for the end of the year to make new budgets and the situation will continue ad infinitum.
However, one thing will be consistent; our small salaries will come on time and to cover for their inadequacy, the politicians will continue bashing health workers for stealing drugs and the public will believe them. One or two big private hospitals in Kampala will close because of increasing running costs.
The doctors will leave the Government hospitals and health units more than ever before and either work in NGOs, open up private units or go out of the country where their services are appreciated.
In short, 2009 will be a nasty year for health and in my view, this will continue for many, many years.
The writer is a Physician at Mbarara Hospital
2009 health prediction was off the mark