The Independent Uganda: You get the Truth we Pay the Price
THE LAST WORD: Why trying to do everything for everyone,everywhere has ended up doing little for anyone, anywhere
THE LAST WORD | Andrew M. Mwenda | The debate on health policy in Uganda is frustrating. Our health services are characterized by corruption, absenteeism, incompetence and apathy. Everyone is angry and frustrated including President Yoweri Museveni. This misery is self-inflicted because we refuse to acknowledge the limits on the state’s ability to do everything for everyone everywhere.
Uganda is a very poor country with public spending per person of Sh 635,000 ($171) annually. Health spending per person is Sh 55,000 ($12) per year. The public, most especially elites who should know better, demand that our health policy should be like that of Denmark and Norway. Yet these countries spend 100 times more money per person than Uganda, have high human skills and rich institutional endowments.
Here is the crisis: public policy on health in Uganda is that the state pays for the healthcare to all its citizens. There is no limit to this promise: whether someone is suffering from malaria (which is cheap to cure) or cancer (which is expensive to treat) public expectation and government policy is that the state will take care of them. Why no one sees this absurdity defies imagination. How can a state with a shoe-string budget make such a commitment?
The result is that limited resources – technological, infrastructural, human and financial – are spread too thin to have meaningful impact. For example, by 2014 government had two national referral hospitals, 14 regional referral hospitals, 88 district referral hospitals, 185 Health Centre (HC) Four, 1,063 HC3 and 2,461 HC2.This is too many health facilities for a poor government. Institutionalised dysfunction becomes inevitable when a governmenttries to chew much more than it can swallow.
Hence, even with the best intentions and no corruption, government cannot equip all of these health facilities with the necessarymedical equipment; staff them with the required number of medical workers and provide them with sufficient drugs to function optimally.Across every hospital and health centre in Uganda there is less than what is required.
For instance, although Uganda needs Shs 1.2 trillion to purchase drugs, government only givesShs 276 billion i.e. less than 25%. This is not to mention that nearly 40% of drugs get stolen largely at the level of the health facility. As demonstrated through budget allocation above, this is not the main reason for drug stock outs.Government can increase health spending only at the price of cutting something else.
In my earlier days I would have recommended cutting the budget for political patronage. This is a good moral decision. But when you do the numbers, it only scratches the problem. The real issue is Uganda does not have the resources – financial and human – to serve everyone’s healthcare needs. Indeed, rapid expansion has eroded even the limited ability of the state to supervise attendance by medical workers, stop theft of medicines and equipment. Critics of Museveniargue that this is a problem created by him personally and his NRM government.
This criticism makes good sound bytes but tells us little of substance. Studies on the health sector in varied nations as Zambia, Senegal and Kenya (which have three times Uganda’s per capita spending) and Cambodia and Vietnam (which have seven times Uganda’s per capita spending) show that the problems we see in Uganda are endemic to all poor countries. Rwanda manages them far much better than all her peers but it has not overcome them.
Mr Mwenda, you have written : “The problems of the Health sector in Uganda are not the fault of anyone”
As a journalist, what does it take for you to say, of anyone, “Your performance is grossly unsatisfactory; you are unfit for the job you hold”? Your article is illustrated by the picture of someone who has been in charge of Uganda’s public Health services for decades. The analysis of Uganda’s health problems that you give is a recitation of data that was known twenty five years ago. The policy approaches you suggest are out of a textbook, they were also known decades ago. The national leadership has chosen to seek medical treatment abroad for themselves and their families while ignoring the rotten hospitals at home.
You are probably too young to know this but there was a time when Uganda was the beacon country on the question of delivering medical services in a low income country; it even produced the standard textbooks on the matter.
“not the fault of anyone” is a coward’s conclusion. You are saying you have no desire to take on the powerful who have openly stolen hundreds of millions of donor dollars; who get their own treatment abroad at public expense; who just don’t care.
YES, was going to say exactly the same thing, M 9 says that “it is not any ones fault” YET he goes on to say the mistakes are because of the policies we have in place. The government is responsible for policy, its not our grandparents in the villages.SO , if the policy is wrong, it is the person who has put the said policy in place who is wrong.
IT is as simple as that in my book, that is why football managers are held responsible for the performance of a team even when they are NOT on the pitch.
MIND you, the same people who do not want to take blame, are the same people who want to take credit when we win a gold medal in the Commonwealth games, even when their input was ZERO.
SOMETIMES I wonder if M 9 passes his work to another person just to give him a second opinion about what he has written and to tell him if it all makes sense or not.
AND the likes of MWENDA, either by design or by default, conveniently forget that even during all the so called bad years, we had private medical care side by side with public health care. In NGORA for instance, you had the missionary hospital, FREDA CARR hospital, next to the government hospital, and most times those who could afford the private went there, and these were the majority. Likewise , even in the government hospital, you had MASABA wing, which was private
Well said
1.A bird in hand is worth 2 in the bush;with reference to the Uganda’s health care system Ugandans who get medical care from government facilities are better off than those who pretend to get medical care from expensive private facilities why do i say so?Just go to any top privately owned medical hospital in Uganda yes the ambience may look like a hotel but they also rely on consultants from Mulago Hospital so why would a ugandan want to pay three hundred thousand shillings in a private hospital to treat cough yet he would get free medical treatment from Mulago?
2.Those who opt to pay for medical services in private hospitals do so coz they care afford.
3.NDA must be having quality assurance challanges for example, why would the dosage for treating malaria vary especially if the tablets are made in UK,India or Egypt?
4.It would be good for govt to offer free medical insurance to those with complicated diseases like Cancer,Heart complications.
5.Most private companies offer fringe benefits like medical insurance to its workers probaly to dodge taxes why do i say so on average a normal adult falls sick once in 5 or 10 years.
6. Diseases like HIV can be avoided when men keep their pants on and women keep their legs closed.
7.Ugandans have very poor working habits at times i think the wages govt offers is worth their work.
8.DIGP Sabiiti we know you have have nice eyes but please bring some order in Munyonyo I know that people who live in Munyonyo always have dubious life styles but why would Byran White the new (Don/Sheriff in town) be allowed to be escorted to and from his home by a line of rowdy boda bodas, a police lead car for me once those goons hit my expensive car with their recklesness,i will sue police.
I went to Mengo Hospital for a minor eye treatment i was so impressed with their services can you imagine the consultation fee was just 5000/= i would have paid 50000/= in a private facility and the whole medication cost me 15,000/=that is about 3 dollars i guess if i went to Mulago Hospital it would have cost even less so what does this say about the health facilities in Uganda?i think its promising and secondly with the freedom of speech and the social media,its easy to expose a medical officer who is always not on duty.
Mwenda is always shamelessly apologizing for Museveni’s corrupt government including writing fictitious letters or memos on their behalf. It is so pathetic and tawdry, the groveling, like a puppy. Not being a wealthy nation is not an excuse for corruption and incompetence and mendacity. It should be a motivation to be more creative and innovative. In Uganda Museveni’s government has the country in a headlock and guns pointed at their heads. They can do whatever they wish. Thirty years of the same huffing and guffing; the tyranny has been more than normalized; it has been glorified, deified.
Mwenda leave matters health to the experts, and let the bag holders(Politicians/beuraucrats) listen and implement the advice given by the experts.
“Who will speak for the children of Uganda, especially from poor families, when public debate on health policy is dominated by ignorant and self-interested adult elites?” So who does Mwenda speak for when he states: “The problems of the healthcare sector in Uganda are not the fault of anyone.” when in fact Uganda has office bearers; is he speaking on behalf of the poor Ugandan Child, or on behalf of the ignorant and self-interested adult elite Ugandan?
Sorry – ladies and gentlemen – if I may sound a bit inward looking on this issue: The fundamental problem with Africa’s and Uganda’s health care – like with all other so called ‘social services’ has to be an insufficient supply of scientific and consequent technological minds within its human resource! You see, all health problems giving us headaches and debates today have a direct root in science. When Mwenda and others before him talk of primary health care, they are really referring to tackling causes and/or development of disease: Understand what, how, where and when these diseases are caused and developed – then you will, with a bit of creativity and innovation – be able to either eliminate them or disrupt their progression within whatever available non human resources. But to do so systematically, first we need a set of nature-inclined inquisitive/curious people to establish or even unequivocally confirm the critical linkages (scientists). Then a second set is needed to understand work of the first and consequently – using available human and non human resources – design, construct, and operate – where necessary) systems either to destroy or to distort the linkages (engineers/technologists/technicians/artisans). There are no two ways about this except in so far as you could be lucky enough to get rare individuals serving in both sets. It is after the existence of these two sets whether from without – but most preferably from within – that others can come on board. These ‘good for nothing’ politicians claiming to allocate resources they do not produce; both the ‘informed’ and ‘half baked’ economists pushing pencils to compute wealth they never generate; both the ‘pundit’ (i.e. the Mwenda likes) and ‘semi literate’ journalists/commentators (most others) —- all come later in importance of putting our health care right.
I do not have space-time here to illustrate my view point (and Mwenda & Co – you are in part responsible for this —–). In summary however, our African/Ugandan societies ought to start channeling their youth to these fundamental knowledge creation/discovery/creativity areas and to consciescise them about our problems and resources. It used to happen in precolonial days but European invaders ensured a long term stoppage of that process. And today, it is unfortunate, we cannot simply leave it to governments because almost all of them are manned by compromised semi illiterates in these matters.
Cheers brothers and sisters,
Dr. Eng. Kant Ateenyi – Cape Town
Andrew mwenda is more of a govt spokesman than a journalist.he is doing ofono’s job defending an indifenceable regime.he forgets that Uganda’s bigedt cause of health care decline is corruption and embezzlement. its not anyone but the nrm regime.
Failure starts from govt failing on policy.