BY IRENE NABUSOBA
During a funeral service for a medical doctor at All Saints Nakasero Cathedral, a frustrated relative narrated how the bureaucracy of getting a referral abroad costs lives. Shortly before dying at the age of 29, the doctor had said â€œIn Uganda you can see death coming and there is nothing you can do about it.â€
In the doctorâ€™s case it was not lack of money. His employer, a charity organisation and relatives had mobilised the funding. They had even secured admission abroad. But he died before relatives could secure the required referral documents from the Uganda Medical Board. It is this board under the Ministry of Health that is supposed to recommend patients for treatment abroad. But since its revival in 1993, getting a referral or accessing funding for treatment abroad has almost always been a preserve of the rich.
The doctorâ€™s relative narrated: â€œAs a doctor, Francis knew that he was eligible to access funding from the Ministry of Health for his care but they told him there was no money. That the budget was already stretched. We got private funds but even when we had the money, we were told that members of the medical board were at a retreat for two weeks and were not available to sign referral forms for him to be accepted for treatment abroad.â€
The media is always awash with public appeals from desperate people seeking funds for treatment abroad. However, unknown to many, some of them are entitled to specialised medical care abroad, fully funded by Government if the services are not available locally.
Dr. Edward Naddumba, who heads the board, says it is mainly civil and public servants who are entitled to receive treatment under the arrangement. â€œThis is because the money is availed through the parent ministries,â€ says Naddumba.
â€œFor instance, teachers access their funding through the Ministry of Education, soldiers through defence and doctors through health. Public officials like ministers are also entitled, and occasionally, patients outside this category like ministerâ€™s spouses and children are considered where the condition is grave and cannot allow time for private arrangements to raise funds.â€
Dr. Naddumba explains that cases involving super-specialised skills and facilities like open-heart surgery, brain tumours and other problems of the brain are eligible conditions.
Others are some cancers that cannot be managed here like leukemia, congenital problems like sickle cell disease that require bone-marrow transplants and complex orthopaedic conditions, problems requiring organ transplant like kidney and liver and some kinds of plastic surgery, like those from acid burns.
â€œWe recommend them for treatment abroad and also recommend them to get facilitation from the Government if they are eligible,â€ he explains. â€œWe consider about five every month totalling to about 50 patients a year. It is a very critical screening process. If itâ€™s about money, then we can release the appropriate sums for support,â€ he explains. However, those who have accessed funding from the board remain a top secret.
The board meets every last Thursday of the month to screen eligible cases. Dr. Jackson Amone, the board secretary, says one has to first exhaust the national referral system in Uganda to be eligible. â€œIf Mulago, which has specialised departments fails, then you are referred abroad.â€
If satisfied, the board secretary forwards the recommendations to the Director General of Health Services, who writes to the permanent secretary in Ministry of Health, for submission to the minister. The minister then communicates to the Prime Minister for final consideration and authorisation for release of funds.
The board consists of 12 consultants in different fields appointed on a renewable three-year term. Currently members include Dr. Naddumba, a consultant orthopaedic at Mulago Hospital; Dr. Amone, the assistant commissioner for integrated curative services at the health ministry; Dr. Sam Kalisoke, the head of the Gynaecology and Obstetric department Mulago and Dr. John Omagino, director of the Uganda Heart Institute. Others are Dr. Segane Musisi, a consultant psychiatrist; Dr. Iga Matovu, a radiologist; Dr. Amooti Nkurukande of the Makerere College of Health Sciences, Dr Christopher Mukiibi, a dental surgeon; Dr Gregory Tumuheirwe, an ENT surgeon; Dr Eddie Mworozi, a paediatrician; Dr B. Byarugaba and Dr. Jackson Orem, a cancer specialist at Mulago Hospital.
Critics, however, argue that the system benefits only the rich and â€˜big shotsâ€™ while the poor are left to die. A senior official in the Ministry of Health says the system is widely abused, especially by politicians and high ranking civil servants.
â€œSome of these at times go to treat simple ailments abroad without the board approval and claim a refund,â€ said the official who preferred anonymity. â€œIt is a scheme for the privileged. We had someone sent for a fibroids operation in London when it could have even been done at Matany Hospital in Karamoja. We were so angry because we knew colleagues who were dying of more complicated ailments but were turned down on grounds of constrained budgets.â€
THE BOARDâ€™S DEFENCE
But Naddumba denies the system is abused. He said only entitled officers have benefited from the scheme, but declined to avail the list of past beneficiaries. â€œSpouses of entitled parties are eligible if the family does not have any other source of funding,â€ Naddumba said.
â€œWe know ministers can afford, but they are they entitled to the scheme.â€
Amone clarified that â€œthe board is a professional body simply charged with screening eligibility of deserving patients. What happens after that is not our business. We have no control over the ministers. We get so many MPs but if Parliament is funding them, what should we do? Once someone has been found eligible, there is so little we can do to stop the referral in favour of another person once the parent ministry backs him up for funding,â€ he reveals.
Amone said there are times the board has rejected applications especially if the treatment can be locally handled.
On bureaucracy Naddumba said acute cases like accidents and complex burns are emergencies and may not necessarily go through the bureaucracy. He admitted that they have got cases where people have gone for treatment abroad and demanded reimbursement later, but that the board is usually informed first. â€œAs long as the board is informed, one may finish the (paper) process on return,â€ Naddumba said.
The main challenge, Amone says, are patients with no parent ministries like senior citizens and retired civil servants. â€œWe see retired lecturers, professors, veterans turning into beggars because they are not recognised,â€ he says. â€œChildren, who also seem to lack a parent ministry, in this case, are afflicted,â€ he adds.
The other challenge, he said, is that of referring patients whose chances of survival are not high. â€œWe do not want to send someone who is completely finished,â€ Amone said.
â€œThere are also high costs for private individuals because the system stipulates that unless you are a government employee, then it should be your company to foot the bill. But many people cannot afford. Even for employers, sh50m for a kidney transplant is unlikely to be given.â€
Amone disclosed that the board is working towards eliminating referrals abroad by developing the capacity of Ugandan hospitals.
â€œWe are recommending that
government improves its facilities and prioritises training of super specialised skills so that every patient benefits, like we are now doing with heart surgery. Everyone should be able to access the highest level of treatment possible,â€ he argues.