We are taming the thieves in Health – Dr Atwine

By Mubatsi Asinja Habati

In 2009 President Museveni set up the Medicines and Health Services Delivery Monitoring Unit to rid the health sector of corruption. The unit has caused arrests of many health officials for alleged corruption. The Independent’s Mubatsi Asinja Habati spoke to the unit Director Dr Diana Atwine and below are excerpts.

You have been unearthing corruption in health facilities in the country. What do you do after arresting the culprits?

Once a culprit has been arrested, the usual course of the law is followed. When we follow the line of prosecution all our files are sanctioned by the Director of Public Prosecutions’ office. They are then sent to courts of law.  But cases are not the same, so we treat culprits on a case-by-case basis. For example in some instances administrative measures usually led by district heads have been recommended and  used to bring about the  desired positive change among errant workers.

In your 2010 report some health workers would ask pregnant mothers or patients to bring them foodstuffs like cassava, eggs, millet etc as “appreciation”. What does this say about the code of ethics and corruption in the health system?

It means the code of conduct is either nonexistent or not taken seriously – both of which are absurd.  It implies that corruption gets worse by the day.

Other than exposing the corrupt, what else are you doing about corruption?

We are engaging stakeholders at both health worker training and workplace levels to take the code of conduct in healthcare delivery seriously. We are advocating a number of changes including within the curriculum itself and also on-the-job assessment as far as proper conduct is concerned. We are also engaging the public as receivers of this service and letting them know their rights. If they become aware that they should be at the heart of healthcare delivery  and what to expect when they go to health facilities, then patients will realise that health workers are not doing them a  ‘favour’ by treating them. Rather it is their basic right and no one should ask for anything in return. With these and other measures we shall see the return of proper code of conduct among health workers.

In Kagadi Hospital a hernia patient died after his relatives failed to raise 150,000 the doctor demanded an operation. Have you encountered such cases?

Many of them. For example in Itoojo Hospital parents of a young girl who had been defiled were turned away by a doctor who wanted money to give a medical report which the police required in order to work on the defilement case. The young girl later died. Such cases are leading us to the medico-legal territory.  You see such an issue is multi-faceted and requires looking at it from at least three different angles – the medical, the legal and the law enforcement side. Most of these cases are very complex. The capacity in our nation in terms of medico-legal experts to handle some of these cases is still limited. But we are beginning to engage clinicians, the judiciary, police and other stakeholders to act.  Those found guilty of charges such as neglect of duty or extortion in government hospitals are being dealt with.

In the same report, Mulago Hospital was transferring government medicines from the hospital’s public pharmacy to the hospital’s Private Wing pharmacy for sale. Yet in April 2010 a decision was reached by the hospital administration to stop this. What are you doing about it?

There has been change of guard at Mulago Hospital and a new management is in place. We are working with the new management to ensure that past mistakes are not repeated. On our part we shall continue monitoring how things take shape at Mulago.

Are local leaders supportive of your efforts to improve the health system?

We have found majority of local leaders very supportive of our initiatives. In places where we have gone we have called most of them to witness what’s going on in their backyards. This has served a dual purpose – making the leaders more responsible and knowledgeable as local monitors but also making health workers more accountable to their local leaders who are more accessible to them than us. Most of the local leaders thought that monitoring health requires very complex and technical skills so they shy away from asking about anything.  Wherever the Monitoring Unit has gone it has tried to demystify health monitoring and show people how they can be involved. And this has yielded results. But monitoring service delivery is everyone’s responsibility. If all people in their different roles contributed to improving healthcare delivery it would be more effective.