UGANDA: Patients go private as state sector crumbles
KAMPALA, 18 September 2012 (IRIN) - Free healthcare is, in theory, available
to everyone in Uganda but in practice, the state system, where thousands of
doctors' and nurses' positions are unfilled, is so run-down that patients
are increasingly turning to private facilities.
The crisis in the public health sector has led to threats by members of
parliament to block next year's budget unless the government finds an
additional 260 billion Uganda shillings (US$103 million) to recruit staff
and upgrade dilapidated health centres.
"We need to bring in some money to stop the deaths of mothers," said Sam
Lyomoki, who chairs the Parliamentary Social Services Committee. Uganda's
high maternal mortality rate,
<
http://www.measuredhs.com/pubs/pdf/FR194/FR194.pdf> at over 430 deaths per
100,000 live births, has led activists to
<
http://www.irinnews.org/Report/95659/UGANDA-Activists-to-pursue-maternal-he
alth-case-against-government> sue the government.
According to Lyomoki, the health sector accounts for 8 percent of government
expenditures, barely half of its obligations under the 2001
<
http://www.who.int/healthsystems/publications/abuja_declaration/en/index.ht
ml> Abuja Declaration, in which African leaders pledged to spend 15 percent
of their national budgets on healthcare.
"Really serious, serious action" is needed, according to Diana Atwine,
director of the country's Medicines and Health Service Delivery Monitoring
Unit.
John Okwonga, the health inspector in the northern Amuru District, which has
a single state-employed doctor for a population of 234,000, said, "Most of
the health units in villages are understaffed. They do not have enough
health staff to diagnose and administer treatment to people who are ill...
The health centres run out of drugs.
"Do you think it's easy for a doctor to come and work in such a place,
without accommodation, medical equipment, and supporting staff?" he asked.
Paying for free care
Corruption is widespread, according to the Medicines and Health Service
Delivery Monitoring Unit, which noted in its
<
http://www.mhu.go.ug/Docs/MHSDMU%20LATEST%20REPORT%20FRM%20NEWVISION.pdf>
2011 report that, despite the free healthcare policy in public hospitals,
several facilities were found to be "charging patients even for basic
services".
"When you come for treatment, the doctors will say the hospital is out of
drugs, but they will direct you to a clinic where you can buy the drugs,"
recounted Kimulula Semanda, a resident of Wakiso District in central Uganda.
For his child's supposedly free medical consultation, Semanda had to pay the
doctor the equivalent of $10.
"Those who can afford to normally go to private clinics for treatment,"
Okwonga added.
Private healthcare providers account for 46 percent of all health facilities
in Uganda, <
http://www.health.go.ug/docs/HSSP_III_2010.pdf> according to
government figures.
"The fact of the matter is, the private sector is a lot more efficient than
government," said Ian Clarke, who chairs the board of Uganda Healthcare
Federation ( <
http://www.uhfug.org/about-us.php> UHF), an umbrella group of
health companies and associations.
"You can take the same amount of funds, and you can probably make the
delivery much better," he added.
Imperfect private healthcare
But not everyone is in agreement;
<
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.100
1244> a study published in PLoS Medicine in June found no support for the
theory that the private sector was "more efficient, accountable or medically
effective" than the public sector in low- and middle-income countries.
And the standards of care can vary wildly: In Uganda, the amorphous private
sector includes private clinics, large hospitals, drug shops and traditional
healers without one specific oversight body.
The authors of a
<
http://www.biomedcentral.com/content/pdf/1472-698X-10-29.pdf> 2010 study on
public and private healthcare in rural Uganda found that private providers
played "a major role in health care delivery in rural Uganda", but noted
that there was a need for a policy to address "quality and affordability
issues" in the sector.
Clarke says the UHF is looking to introduce cross-cutting ethical standards
and begin self-regulating so that it can ensure patients a reliable level of
care if they go to certified facilities.
A third way
While the for-profit health industry is a boon to middle- and upper-class
Ugandans who can afford the services, it does not address the needs of the
country's poorest. Some donors, looking to circumvent public healthcare
shortcomings, are investing in not-for-profit private practitioners to help
reduce their costs and improve their services.
"The critical end of this is to ensure service delivery... [so] that the
lowest person will be able to access health services," said Tadeo Atuhura,
the communications specialist at <
http://strides.sacitsolar.com> Strides
for Family Health, a US Agency for International Development-funded
organization that offers performance-based contracts to private health
facilities in areas where government services are lacking. The
subcontractors are provided with incentives to reach specific health targets
and reduce costs so more of the population is able to visit private
facilities.
Strides funding has allowed Suubi Medical Centre, based in the Lake Victoria
fishing village of Busu, to expand rapidly - eclipsing the basic health
services offered at the local government health centre.
One of the centre's patients, 17-year-old Kate Namuloki, went into labour
two months ahead of schedule, a spontaneous delivery caused by a bout of
malaria. The government health centre has been without a midwife for more
than a year, so to deliver in a fully staffed government facility she would
have had to travel from for more than two hours over unpaved roads.
Instead, she delivered her daughter at Suubi; her grandmother sold a duck to
pay for the delivery, which cost about $4.
Stanley Kwiri, a laboratory technologist, started Suubi in 2011; he said he
is offering 11 different services with the funding from Strides, including
the antenatal, delivery and postnatal care that the government health centre
down the road cannot. He even helps supplement state programmes, providing
government teams with transportation when they go out for routine
immunization campaigns.
Dr Christine Kirunga Tashobya, the public-private partnership in health desk
officer at the Ministry of Health said subsidized private healthcare could
also help ease the pressure on public health facilities. "You could say if
people who can afford [private healthcare] go to public facilities and get
free services, there is leakage of public resources to people who could
afford to look after themselves," she said.
The government has even encouraged the growth of the for-profit health
sector by allowing health workers in public facilities to moonlight in
private clinics. Tashobya said without this policy, the majority of doctors,
nurses and midwives would opt to work in higher-paid private facilities,
leaching the public system of the limited health workers it does have.
Fixing public healthcare is key
But according to Margaret Mungherera, president of the Uganda Medical
Association, a professional association for health workers, this is already
happening; she says high rates of absenteeism at public health facilities
are caused by health workers "running around trying to supplement their
income" by working at private facilities where they can command better pay.
Speaking alongside Lyomoki during the announcement of parliament's plan to
block Uganda's pending budget, Mungherera she said the only lasting solution
to the country's health system woes must involve lifting the salary freeze
on current health workers and finding the money to recruit new ones.
ag/ca/kr/am/rz
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Received on Tue Sep 18 2012 - 18:02:23 EDT
