In defence of private hospitals and clinics
May 13, 2007
Recently there have been numerous letters and articles about equipping our hospitals so that patients can be treated within the country and Ugandan doctors can be facilitated to practice high level specialties, such as intensive care and cardiac surgery.
Recently there have been numerous letters and articles about equipping our hospitals so that patients can be treated within the country and Ugandan doctors can be facilitated to practice high level specialties, such as intensive care and cardiac surgery.
Prof. Omaswa, the former Director General of Medical Services in Uganda (DGMS), also a leading cardiothoracic surgeon, wrote expressing his support for building increased capacity in the Ugandan medical sector. I know Prof. Omaswa personally as a very dedicated man who has worked tirelessly to develop health services in Uganda and has promoted building of capacity, whether in the public or private health sector. Prof. Omaswa is a senior respected member of the medical establishment not only in Uganda but worldwide and should be congratulated for his personal contribution to medicine in Uganda and abroad.
It has also been my personal goal to help build capacity in the health sector in Uganda and to this end I first chose to work in the private sector, in a so-called ‘private not for profit’ mission hospital and more recently in a ‘private for profit’ hospital. The non government sector provides up to 50 percent of healthcare in Uganda and in recognition of this, the Government gives a limited amount of support to mission hospital budgets. In other words, health services within Uganda are provided by both government and private providers and each needs the other. I have certainly appreciated the support of Prof. Omaswa while he was DGMS, that of his successor and of the Minister of Health, Dr Stephen Malinga. However there are those who still feel that the Government is the only serious source of healthcare which should be recognised.
In the recent open heart surgery and in the struggle to save the life of Brig. Mayombo, there was excellent collaboration between the Government and private doctors. Some of the doctors who worked on these patients were consultants from Mulago, while others were fully employed by the International Hospital Kampala (IHK) — the hospital called in whoever were the appropriate specialists. Some senior consultants have refused to work with private institutions, feeling that everything should be dealt with by the Government and it is somehow an admission of defeat if the Government hospital cannot handle everything. Since this is rarely the case in other countries, why should this be the case in Uganda? Indeed Brig. Mayombo was transferred to a private hospital in Nairobi, not to Kenyatta Hospital, the government referral hospital.
Government does certain things well and the private sector does other things well and we should maximise the strengths of both. Government health services are tasked with the provision of primary healthcare in the form of vaccinations, health education and treatment of the masses. At the other end of the scale, we also turn to government for tertiary level referral services, since they generally run the teaching hospitals. This leaves the perception in some people’s minds that the private providers are simply cherry picking – providing the easy clinic, or routine hospital services, for which they can charge the most for the least effort.
It is true that certain private clinics and hospitals go after this type of business and transfer the difficult cases to government hospitals. However, this is not the case for serious private hospitals. In Nairobi, the best providers for complex medical care are private hospitals, such as Nairobi Hospital and Aga Khan Hospital. They charge commercial rates, but have made the investment in the necessary expertise and equipment and render medical service at international standards.
So in the provision of medical services, one should seek to maximise the strengths of the public and private sectors and strengthen collaborations between the two. Government can afford to buy the equipment, but does the public service have the necessary record of attention to ensure that this equipment continues to work? Government institutions are not known for their ability to maintain complex equipment. It is not simply a matter of appealing for money for equipment — the efficiency, teamwork, discipline and commitment must be there to ensure that this equipment works at the critical time.
In our recent experience of open heart surgery, it was not actually the cost of the equipment which was the most daunting – there are means of acquiring such equipment at reasonable prices, but getting the whole team to the level where they were 100 percent efficient. You cannot open someone’s heart and then take the risk that the power will go out in the middle of the operation. Although we had a standby generator, we also had someone sitting in the generator house, just in case the generator failed to automatically kick in. Every individual in the team, from the cleaners to the surgeon knew they had a vital role to play.
There has been much talk about the lack of equipment in hospitals and much blame of ‘the government’ for not prioritising these needs. Of course we all want a bigger budget and the necessary equipment, but is this all which is required? Even without the ideal level of equipment, we can take what we have and work with that for a start. I know doctors in Mulago who have solicited funds, procured second hand equipment, organised visiting teams and worked on their patients without fees in non government hospitals. In other words, they do whatever is necessary for the good of their patients. However, there is still the attitude among certain medical professionals, civil servants, politicians and critics of the Government that we just blame ‘government’ and wait until a budget is available. Then when the money is there, everything will all miraculously fall into place, but that is not real life. There are also the elements of hard work, organisation, discipline and attention to detail to ensure success. Neither the private sector nor the Government is perfect, but perhaps by working together they can grow together and take the next steps towards building the medical capacity that is required in a modern Ugandan state. As someone working in the private sector, I am ready to partner with the Government in public-private partnerships which will help build capacity.
Prof. Omaswa, the former Director General of Medical Services in Uganda (DGMS), also a leading cardiothoracic surgeon, wrote expressing his support for building increased capacity in the Ugandan medical sector. I know Prof. Omaswa personally as a very dedicated man who has worked tirelessly to develop health services in Uganda and has promoted building of capacity, whether in the public or private health sector. Prof. Omaswa is a senior respected member of the medical establishment not only in Uganda but worldwide and should be congratulated for his personal contribution to medicine in Uganda and abroad.
It has also been my personal goal to help build capacity in the health sector in Uganda and to this end I first chose to work in the private sector, in a so-called ‘private not for profit’ mission hospital and more recently in a ‘private for profit’ hospital. The non government sector provides up to 50 percent of healthcare in Uganda and in recognition of this, the Government gives a limited amount of support to mission hospital budgets. In other words, health services within Uganda are provided by both government and private providers and each needs the other. I have certainly appreciated the support of Prof. Omaswa while he was DGMS, that of his successor and of the Minister of Health, Dr Stephen Malinga. However there are those who still feel that the Government is the only serious source of healthcare which should be recognised.
In the recent open heart surgery and in the struggle to save the life of Brig. Mayombo, there was excellent collaboration between the Government and private doctors. Some of the doctors who worked on these patients were consultants from Mulago, while others were fully employed by the International Hospital Kampala (IHK) — the hospital called in whoever were the appropriate specialists. Some senior consultants have refused to work with private institutions, feeling that everything should be dealt with by the Government and it is somehow an admission of defeat if the Government hospital cannot handle everything. Since this is rarely the case in other countries, why should this be the case in Uganda? Indeed Brig. Mayombo was transferred to a private hospital in Nairobi, not to Kenyatta Hospital, the government referral hospital.
Government does certain things well and the private sector does other things well and we should maximise the strengths of both. Government health services are tasked with the provision of primary healthcare in the form of vaccinations, health education and treatment of the masses. At the other end of the scale, we also turn to government for tertiary level referral services, since they generally run the teaching hospitals. This leaves the perception in some people’s minds that the private providers are simply cherry picking – providing the easy clinic, or routine hospital services, for which they can charge the most for the least effort.
It is true that certain private clinics and hospitals go after this type of business and transfer the difficult cases to government hospitals. However, this is not the case for serious private hospitals. In Nairobi, the best providers for complex medical care are private hospitals, such as Nairobi Hospital and Aga Khan Hospital. They charge commercial rates, but have made the investment in the necessary expertise and equipment and render medical service at international standards.
So in the provision of medical services, one should seek to maximise the strengths of the public and private sectors and strengthen collaborations between the two. Government can afford to buy the equipment, but does the public service have the necessary record of attention to ensure that this equipment continues to work? Government institutions are not known for their ability to maintain complex equipment. It is not simply a matter of appealing for money for equipment — the efficiency, teamwork, discipline and commitment must be there to ensure that this equipment works at the critical time.
In our recent experience of open heart surgery, it was not actually the cost of the equipment which was the most daunting – there are means of acquiring such equipment at reasonable prices, but getting the whole team to the level where they were 100 percent efficient. You cannot open someone’s heart and then take the risk that the power will go out in the middle of the operation. Although we had a standby generator, we also had someone sitting in the generator house, just in case the generator failed to automatically kick in. Every individual in the team, from the cleaners to the surgeon knew they had a vital role to play.
There has been much talk about the lack of equipment in hospitals and much blame of ‘the government’ for not prioritising these needs. Of course we all want a bigger budget and the necessary equipment, but is this all which is required? Even without the ideal level of equipment, we can take what we have and work with that for a start. I know doctors in Mulago who have solicited funds, procured second hand equipment, organised visiting teams and worked on their patients without fees in non government hospitals. In other words, they do whatever is necessary for the good of their patients. However, there is still the attitude among certain medical professionals, civil servants, politicians and critics of the Government that we just blame ‘government’ and wait until a budget is available. Then when the money is there, everything will all miraculously fall into place, but that is not real life. There are also the elements of hard work, organisation, discipline and attention to detail to ensure success. Neither the private sector nor the Government is perfect, but perhaps by working together they can grow together and take the next steps towards building the medical capacity that is required in a modern Ugandan state. As someone working in the private sector, I am ready to partner with the Government in public-private partnerships which will help build capacity.