Like it or not, Uganda’s health sector is better than before!
Annually , 26th of January is the liberation day , an opportunity to appreciate our past political ,and socio economic history .To me this is not just a mere commemoration time for institutional evaluation pivotal in reinforcing government performance .
Let’s gaze at the health sector, I can vividly and assert myself that we have had remarkable accomplishments in the sector for the past 30 years than ever before
If we make a reference time of 1986 when the NRA captured power, the economic strife, insecurity created restlessness, health workers would hardly concentrate, creating a shaky health system, worsened by the few health development partners that feared for their lives.
The period before was characterized by the doctor as the kingpin of the health service, health care was largely facility based with a few community health programs which could be attributed to low health sector budget. Health facilities were largely hospitals at regional level, low morale of health workers as the salaries were not ‘tasty’, these challenges nurtured a crippled health system
As NRM took power, normalcy returned into the health sector, Primary health care (PHC) was operationalized that serves as the basic health care services for all Ugandans. A number of community based programs were launched including but not limited to nutrition, immunization, reproductive health and hygiene and sanitation. These gained more momentum with the influx of health development partners due to the created political stability by the Museveni regime.
The decentralization policy of 1997 created a friendlier and closely available health services to the common Ugandan. The administrative powers of managing health sector at a district level is in the powers of the District health team and local administrative units creating autonomy in monitoring ,supervision and efficiency in drugs and supplies management .
Currently, a number of health programs and projects aimed at health promotion are in place facilitated by a VHT per village, a health educator per health facility and every parish is to have 4 salaried Community Health extension workers (CHEWs) as cabinet has already approved the CHEWs policy .This will see government enroll & train over 15,000 selected CHEWS across the country to provide preventive health services. This is intended to reduce cost of curative services as prevention is better than cure.
The community health programs are facilitated by the much stretched health facilities. The total number of hospitals (public and private) in Uganda is 155. Of these 2 are National Referral Hospitals (Mulago and Butabika), 16 are Regional Referral Hospitals (RRHs) and 139 are General Hospitals (GHs), construction of 193 Health Centre IVs, 930 Heath Centre IIIs with each parish and sub county having a HCII and HCIII respectively, but most outstandingly, most of the not well to do facilities are under renovation with the most recent completed being Mulago National Referral Hospital at a cost of sh176b)
As if that not enough, upgrade of 125 Health Centre IIs to IIIs and as well as renovation of 80 Health Centre IIIs to fully functionalize their maternity wards, laboratories and provide staff accommodation for critical staff is ongoing.
We can’t go ahead and disremember the most fresh salary increments for health workers, A senior consultant who previously earned sh3,447,065 earns sh4,500,000, a consultant who previously earned sh3,059,079 earns sh4,200,000, an enrolled nurse who earned sh413,158 earns sh613,158.,this has never existed!
Well, let’s not go far, in the 2018/2019 FY, sh2.3 trillion was allocated to health budgetfrom 1.8 trillion in 2017/2018. Sh276b was allocated to the National Medical Stores (NMS) in the 2018/2019 budget higher than the ush 230 bn of 2017/2018 to arrest the challenge of drug stock outs.
Recognizing the value of mothers to the development of the nation, government saw it paramount to enhance maternal health care .With support from the Islamic Development Bank, a 320 bed Specialized Maternal and Neonatal Healthcare Unit at Mulago National Referral Hospital was erected and now fully functional. This is a multi-storied building that offers facilities for High Risk Antenatal Care, Delivery and Postnatal Services, Gynecology Uro-gynaecology especially obstetric fistula, Assisted Reproductive Health Technologies, Pharmacy, Blood Bank, Labor Suites, Intensive Care Unit and Operation Theatres. This gives hope that soon or later, Uganda will have no maternal deaths cases.
Another palpable achievement is the much celebrated cancer services .ACobalt 60 radiotherapy machine procured from the Czech Republic at a cost of 665,000 Euro (3 billion Shillings) was installed, the machine can treat up to 80 patients per day. A second cancer machine is expected soon at a cost $3.5 million (about Shs 13 billion) which will treat up 120 patients per day.
The quality of health services have also unbelievably improved. In January 2018, Doctors at Uganda Heart Institute at Mulago hospital conducted the first-ever highly specialized open-heart surgery known as coronary artery bypass grafting surgery, Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart.
, In October 2018, the President Museveni launched Presidential Fast-Tracking Initiative on the Elimination of HIV/AIDS that targets total elimination of the scourge from the Ugandan society, conversely, in July 2017, Ministry of Health introduced an oral HIV Self-test kit to complement the existing strategies in the fight against HIV and a feasible way to promote Male involvement in this fight. This kit was introduced under the theme; “Improving Access to HIV Testing through Self-Testing, isn’t this worth appreciating?
While most of us have vehemently refused to protect ourselves from Non communicable diseases, His Excellency the President on July 2018, launched National Day of Physical activity in a drive to promote healthy living among the populations, an added effort to disease prevention.
Skills development has also been a priority in this government, , in January 2019,720 health workers from across the country, particularly those from the hard- to- reach areas were awarded scholarships in reproductive health, certainly, more of the same should be expected.
As malaria continues to be the leading cause of deaths in Africa and Uganda, government has used various malaria control and elimination interventions. From Feb 2017 to March 2018, free mosquito nets were given to over to over 38 million Ugandans under the ‘Chase Malaria’ campaign. In 2015 6,100 people died of malaria, which reduced to 5,700 in 2016. The death figures further reduced to 5,100 in 2017 and 1,600 in the last nine months of 2018. This represents a reduction from 15% to 7%.
Government through Ministry of health must be appreciated for managing outbreaks with the most recent being Crimean Congo Hemorrhagic fever and Rift valley without forgetting Ebola in the Democratic Republic of Congo (DRC) which was successfully bared from crossing the borders, cholera in some parts of Kampala is too under control. In November 2018, over 2,000 health care and front-line workers along its border with the Democratic Republic of Congo were vaccinated against Ebola.
In June 2018, the Government of Uganda rolled out Rotavirus vaccine into the Routine Immunization Schedule to protect children under five years of age from diarrhea. This is the 11th vaccine that is provided free to infants and children at all health facilities and selected community outreaches within the country, this is projected to arrest the high infant mortality rate in the country.
To effectively manage and coordinate emergency services countrywide, information available indicates that a fully-fledged emergency services department is under way, this will see availability of ambulances countrywide, facilitating rapid response to emergency cases.
However, as we recognize these inestimable milestones, a number of challenges still prevail; understaffing, behavioral change, extortion, duty negligence, drug theft, and limited funding for the sector not withstanding corruption. None the less. It should though be noted that all these challenges are not solely a government responsibility, but rather a collective effort, for example if we all adopt disease prevention approaches, there will not be any need for a high sector budget.
We should therefore not consider the conspicuous revolution in the health center as activities happening by default but rather deliberate intentions by government of President Museveni to avail and improve health service.
Happy liberation day to all Ugandans.
For God and My country.
Bahikire Daraus ,2019