By Charles Musisi

Recently, Edward Ssekabanja, the RDC Makindye Division, closed down Life General Clinic in Nakinyuguzi zone. The clinic has been offering medical and laboratory services.

According to Henry Dungu, the area chairman, ‘Doctor ‘ Siraje Kizito refused to close down his clinic after authorities discovered that he was not a trained practitioner. Besides, the clinic lacked standard facilities.

Many private health units in Uganda are more ill than the patients they treat. They do not have basic facilities and qualified staff, consequently they cannot perform core tests to help in the treatment of patients.

Many private laboratories are an embarrassment. They are unfit for the purpose. Some leak, others have poor lighting and even lack clean water.

“If a laboratory is so small, people with highly contagious disease like tuberculosis may infect others or even the health workers,” explains Alex Ococi Jungala, board member of the Medical Laboratory Technology board.

Laboratories are an essential part of healthcare, but without basic facilities and well trained staff, they pose a danger to patients.

The guidelines for private practice for Allied Health Professionals and Registered Nurses (AHP) stipulate that premises must be adequate, clean, and of professional appearance.

“There shall be a minimum of three rooms 3 x 3 metres for reception and waiting patients, 4x4 metres for specimen collection/storage, testing and main tests, and a scheduled room or toilet for taking specimen that need such facility,” reads part of the guidelines.

Sadly, many laboratories do not conform to the guidelines. This is compounded by unqualified health workers.

“There are few laboratory technologists in the country, just about 200,” admits Jungala.
“Quacks and health units in poor conditions should be reported to the Directors of District Health Services (DDHS) or the Council.”

Unqualified staff are unable to order tests appropriately and interpret results correctly.

“This leads to inaccurate diagnosis and patients may not get the best medication,” says Cyprian Biribonwa, a laboratory technologist at Jicca Clinic Laboratory in Wandegeya.

For instance, cheap monocular microscopes are used in some laboratories. “It is not possible to get accurate results with such a microscope. Using it is dangerous because it is not for clinical laboratory diagnosis. Its magnification is meant for bigger organisms such as plant cells,” says Jungala.

Much laboratory diagnosis depends on accurate microscopy.

A good quality binocular microscope with a light source improves the quality of laboratory work and costs about sh3m.

There seems to be excessive commercialism in the private health units.

“Some NGOs and institutions such as Universities are employing health workers who are not recognised,” says Jungala.

But who supervises the health units?

To ensure maintenance of proper standards of health services, the professionals must conform to the guidelines for private practice for Allied Health Professionals and Registered Nurses (AHP).

The guidelines include minimum staffing, building structures, standard apparatus and control of the Allied Health Professionals and provides for the council to register and license the Allied Health professionals.

“Only health workers registered with AHP council are allowed to practice. They must possess a certificate issued by the council,” says Dr. John Kizito, vicechairman AHP. “The statute empowers the council to investigate professional misconduct, prosecute and monitor the performance of professionals in the units.”

This is a rather tall order for a council with only one old vehicle. “We lack financial resources. There is only one old vehicle for transport,” says Benjamin Udongo, the registrar.

The council charges between sh100,000 and sh230,000 for a licence, depending on the type and location of unit.

The first AHP council was established in January 1998. The second was formed four years later.

“In a short period we have registered about 200 laboratory technologists and the exercise continues,” says Udongo.

“We are aware that some laboratories and health units are operating illegally. We shall soon crack down on them. The council began licensing private health units in January this year. In the past they were registered by the medical council.”

Dr. Sam Zaramba, Director Health Services understands that problems can arise. After all, he sometimes passes on complaints about professional misconduct to the council. But he does not see why such units are allowed to operate.

“It is the duty of the council to ensure that professionals adhere to the guidelines and we often remind them of this. The council is an independent body mandated to oversee the operation of private health units. The Ministry of Health only appoints council members,” he says.

A source in the Ministry of Health says there is lack of an effective supervision mechanism.

“Most of the regulations are flouted because the performance of health workers in the private units is not monitored more regularly,” says the source. “Premises are inadequate, some chemicals, reagents and drugs are kept in small crammed unhygienic rooms.

This reduces their efficacy. You can’t rule out corruption. Who doesn’t know these problems?” he queries.