Nkoyoyo's health, Dr Mungherera's death and Uganda's health system

By Mayora Chrispus

Since Saturday February 4, 2017, Uganda, and indeed the rest of the world generally, has been mourning the passing on of Dr. Margaret Mungherera - an icon in the medical fraternity. I also add my voice to everyone's in rather celebrating a life well-lived, a life of selflessness!

Indeed, Dr. Mungherera has fought a good fight and kept to her faith, her calling, and her professionalism (2Tim 4:7).

Dr. Mungherera spent virtually all her life as an advocate for better health for all, but thought this would only be possible if a health worker was well skilled, well deployed, and well-motivated to perform. Her message was one of passion and consistence. Her crusade indeed has had successes and for those areas she could not achieve, we should all - for her sake - continue to work towards making better.

About 7 months ago, Dr. Mungherera attended - as a panelist - a workshop on Health Workforce in Uganda, organized by the Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health coverage in Uganda ) project at Makerere University School of Public Health.

At this forum, I was struck by the consistency with which Dr. Mungherera holds and articulates her long-held views about improving working conditions as a prerequisite to better performance. Her views never changed, whether in public before the cameras, or behind conference rooms or at localized conversations.

Unfortunately, Dr. Margaret fought hard to improve the system, yet she may have been betrayed by the same system. This view is based on the fact that she died while under the care of another country's health system (India).

In the recent past, many Ugandans have sought care in other countries, especially care for chronic illnesses such as cancer. Some weeks ago, the media was awash with a story about how Archbishop Dr. Mpalanyi Nkoyoyo was stuck in a London Hospital and an appeal for medical support from the general public was made. 

In their medium term expenditure framework, laid before Parliament, the ministry of Health (MOH) provided amazing amounts of expenditure on treatment abroad for just government officials. Add individuals who often run public campaigns for support, and families who travel abroad for some specialized care, the cost to the country on treatment abroad is immense.

Imagine the thousands of Ugandans out there who unfortunately cannot access the media or such attention to be supported! I have come across families that have sold almost everything to treat just one of either the children or a dad and are literary left on God's mercy. This trend is likely to continue in the near future unless something is done to reverse it.

But why do patients end up seeking care outside the Ugandan system? This is a question that occupies most people's minds. A partial answer seemed to have come my way when I recently attended a forum on health technology management (HTM), again organized by SPEED for Universal Health Coverage.

At this HTM seminar, it seemed some patients either were referred out of country appropriately, while others may be due to a wrong or an inconclusive diagnosis.  The HTM forum concluded that while diagnostics played a central part in health care delivery, in Uganda, this seemed a forgotten area.

While Dr. Mungherera advocated for improved health worker conditions, others have focused on financing, human resource, supply chain management, but health technology is yet to receive this much needed attention. At the heart of quality care, is quality diagnosis.

The Uganda National Academy of Sciences, recently put out a report indicating that more than 40% of diagnoses were incorrect and this was attributed to obsolete technology, limited diagnostic capacity including skills, or inappropriate diagnostics.

I have come to learn that many of the cancers are curable or could be prevented from progressing) if they are diagnosed early enough. Early diagnosis and detection is critical in guaranteeing better treatment outcomes.

The recognition of this fact is what has eluded us. We however must appreciate that new medical technologies and related capacity building processes, is costly, and so we must be conscious as we adopt new technologies to ensure the procurement and maintenance costs do not bankrupt the systems.

Nonetheless as a country, we must start a serious discussion on how to harness health technologies for health systems improvements. With new diseases emerging and others re-emerging, technology is going to be crucial. Alongside this, will be developing capacity building interventions, infrastructure development, and health research to facilitate evidence-based medicine and building a culture where people seek health care early.

The focus of the ministry of health, to create Centers of excellence in different areas of health - well equipped with modern technology and expertise is a welcome move aimed at reducing cost of treatment abroad, rather use these funds to improve the local system for the benefit of the many. This is what Universal health coverage is about - essentially that everyone will have access to better care without suffering unnecessary costs.

As long as we don't work towards improving our health systems, I am afraid Dr. Mungherera struggle would have been in vain, and you will be the next victim!

The writer is a CARTA PhD Fellow, Lecturer and Health Economist