Quality of healthcare services in Uganda

HEALTH

Prof. Wilton S. Kezala

Before Uganda's independence in 1962 and thereafter in the 1960's and 1970's, the quality of healthcare delivery services was relatively superb.

Doctors, nurses, midwives and allied health professionals were committed to their work; they provided the services with the heart to serve and treated patients with respect and dignity and gave them the attention and care they needed. They strictly observed the oath they swore in and the professional code of conduct and work ethics.

At that time, the health workers were comfortable with the conditions of service they were given together with support resources for their work. Some senior officers were given incentives such as cars and houses for accommodation; while junior officers or workers were given accommodation within the health facilities. All health workers were given appropriate salaries, allowances, promotions and gratuity.

The good performance of health workers then may be attributed to the way they were trained and the availability of the resources in the healthcare settings as well as the conditions of service which were offered to them.

The training emphasised the acquisition of both academic/intellectual skills and soft skills. The academic or intellectual skills focused on making the right decisions and carrying out healthcare activities or procedures in time, carefully, correctly, accurately, precisely and safely (without causing harm or injury to the patient). This is done while at the same time carrying out the soft skills. These include the observation of human values of the patient such as good moral character, all values of integrity, respect, honest, trustworthiness, accountability and giving full attention to the needs of the patient. Work ethics, positive attitudes and behaviours and professionalism were key to the good conduct of a health worker. Health professionals were constantly warned against vices such as absenteeism from duty, theft of property, bribery and corruption at work.

At the work places in hospitals, health centres and clinics, the authorities ensured the availability of adequate staffing, medical equipment, drugs and supplies for the health workers to provide effective and quality healthcare services to patients. Some health workers were taught how to dispense some medicines for use when there were shortages of the same drugs. All the above, including the good conditions of services, enabled the health workers to provide effective and quality healthcare services to patients and clients.

Today, the quality of healthcare service delivery in the country appears to be different. There has been a lot of complaints in the media by the healthcare consumers and observers of healthcare delivery to patients that some health workers provide poor services to patients and clients in the healthcare facilities especially in hospitals, health centres and health clinics. Health workers have been accused of mistreating patients and not giving them the attention and care they need. They have also been accused of having unethical behaviours such as lack of commitment to their work, procrastination, absenteeism from work, not respecting patients, theft of medical equipment, drugs and supplies, not observing the professional code of conduct, bribing patients for giving them services they need, and corruption.

Certainly, there must be some reasons why some health workers behave the way as indicated above. The curricula for training the various categories of health professionals have been critised a lot that they do not produce the type of health workers needed for the country and that they should be overhauled. Some curricula are old they have not been revised for a long time to meet the current training needs of the health professionals. Issues concerning the need of soft skills in training of health workers has not been well addressed; more emphasis has been on development or academic intellectual skills for healthcare.

Another challenge that came up is lack of adequate resources in the healthcare facilities throughout the country. Health workers in hospitals and health centres constantly complain of shortage of staff, medical equipment, drugs and supplies that are needed for the provision of effective and quality services to patients and clients. Definitely, without support healthcare resources, the quality of healthcare service delivery cannot be achieved.

Poor conditions of services offered to health workers also affect their work performance. All categories of health workers in the country complain of inadequate salaries and allowances, lack of housing, lack of transport, lack of promotion, lack of gratuity, and lack of other incentives; yet they are over -worked with too many patients in the healthcare facilities.

Another challenge, which has cropped up in the healthcare delivery system in this country is the mindset of some health workers who think of getting quick money soon after their graduation from the health training. This leads to the establishment of drug shops or health clinics to get quick money and abandoning service in the hospitals or health centres. This type of mindset may tempt health professionals to engage in theft of property, bribery and corruption in an effort to get quick money.

Considering the above challenges, how can we improve the provision of quality healthcare services to people in Uganda? What is needed to be done is as follows:

Effective planning for production of the required number of health workers for the country and development of these workers equitably in the vacant posts in the hospitals and health centres to avoid the severe shortage of health workers in the health care facilities.

Innovation in designing health training curricular that can meet the current health needs of the country. The content of the curricula should focus on:

1. Appropriate and relevant courses
2. Intellectual performance skills
3. Human values - moral character
4. Management skills
5. Effective training approaches

Effective work performance by health workers needs the following to be done:
1. Ensuring the availability of medical equipment, drugs and supplies in the healthcare facilities. Local medical equipment and supplies can be produced in technological incubation centres that can be established in the regional centres in the country; and local drugs can be produced in pharmaceuticals factories in the country.

2.Development of self monitoring, self regulating and self appraisal guidelines to be used by health workers on duty.

3. Emphasis to be put on hands - on - touch skills and respect of human values of the patient.

4. Emphasis to be put on effective management of the delivery of healthcare services to patients and clients.

5. Ensure good conditions of service for health workers such as appreciable salaries and allowances and other incentives which are comparable to the level of equitable professionals in the country.

6. Improving the mindset of health workers of getting quick money while in services by exposing to them the entrepreneurship skills that can enable them to increase their income such as formation of SACCO's or creation of other enterprises.

7.Designing appropriate measures that can hinder health workers from engaging in vices that retard their provision of quality healthcare services to people.

The above suggestions are intended for the concerned authorities in the healthcare delivery system and the trainers of health professionals to make efforts towards the improvement of the quality of delivery of healthcare services to people in Uganda.

The writer is the chairman of the Uganda Private Health Training Institutions Association