Shs204b spent abroad because Uganda cannot treat her own

Ms Deborah Achieng is in dire need of a complex heart surgery. But she cannot undergo that procedure because she cannot afford it.
According to her doctor, the sooner the operation is done the better her chances of survival.
And besides the cost element, nearly Shs30m, such a complex operation must be performed in Asia or Europe. This is because Uganda does not have modern facilities and expertise to perform such sophisticated medical procedures. Achieng says Shs30m is the kind of money she can only dream about.
The predicament that Achieng is battling with is what many more Ugandans who require specialised medical attention in Uganda often go through.
But if she was a senior government official or a top civil servant her story would be different owing to the influence and the privileges that position in government attracts.
By now she would have been treated in a specialised facility abroad and her medical bills picked up by the government.

Amount spent on treatment abroad
In an interview with the Daily Monitor recently, the Permanent Secretary at the Ministry of Health, Dr Asuman Lukwago, disclosed that every year government spends at least $2.2m (about Shs5.8b) on treatment of mostly public servants abroad.
He said: “The total amount of money we use every year for referrals [treatment] abroad is no more than $2.2m (about Shs5.8b) and that is only for civil servants.
“And for the entire country including private patients the estimated amount spent is $76m (about Shs204b).”
However, two years ago, a leaked report compiled from a ministerial retreat which was convened by the Prime Minister’s Office in December 2011 to assess the government’s performance in the previous year, revealed that the government spends at least $150m (about Shs400b) on treatment of mostly top government officials abroad annually.
This drew the attention of President Museveni who is quoted to have said the number of patients seeking specialised health treatment abroad, costing the country about Shs400b annually should be curbed and restricted to only severe conditions.
When contacted then, Dr Lukwago agreed that the expenditure was on the higher side and unnecessary although he also referred to the amount of money quoted in the retreat as “estimation”.
But when he was asked last month about the figure ($150m – about Shs400b) being used for treatment of government officials abroad, he disputed it as untrue, stressing that the amount being spent on treatment abroad every year is $2.2m (about Shs5.8b) and not $150m (about Shs400b). In an interview with the Daily Monitor, the Director of Health Services, Clinical and Community Services, Prof Anthony Mbonye, said the $150m is an exaggerated figure which has since been corrected after verification and brought to the attention of the President.

Five-year plan in place
When asked whether it is prudent to invest the amount of money spent in referrals abroad in developing medical specialised facilities here with a view to minimise future referral cases abroad, Prof Mbonye disagreed with the idea, saying it is not logical.
According to Prof Mbonye, forfeiting the $2.2m (about Shs5.8b) over a specified period of time for the sake of establishing modern medical facility here is being insensitive to the patients who need immediate specialised medical attention.
He says: “My view is that we need to have a five-year plan period within which to accomplish construction of a specialised medical facility without necessarily bringing an end to referrals abroad.”
The commissioner for planning in the Ministry of Health, Dr Francis Runumi, was also of the view that it is a bad idea to stop referrals abroad no matter its impact. Dr Runumi says in the next three to five years there will be a lot of development in modern specialised medical infrastructures.
“By 2015 super specialised heart and cancer institute costing the tax payers about $120m (about Shs324b) will be established at Lubowa on the outskirts of Kampala—it will be a centre of excellence.
“The future is bright. What we are doing now is assembling at least $400m (about Shs1 trillion) to solve the problem. In about five years we will be far ahead as we would have embarked on the projects,” he says.
Dr Rosemary Byanyima, a healthcare practitioner in Kampala, who specialised as a radiologist, aises that equipment for such complex procedures must be availed simultaneously with personnel who will put them to use. She says it makes no sense for local expertise to be trained yet they lack facilities to use. These two—infrastructure and skillful personnel – should be rolled out at the same time or else the trained personnel could end up redundant and forget the skill due to lack of practice.
According to Dr Byanyima, the biggest problem with medical technology in Uganda is the equipment and not so much the personnel.
“Most of the referrals are recommended from here after diagnosis. This means our problem is the facilities to enable us do the treatment.”
The other challenge, she says, is the lack of a law that will allow the medical practitioners to carry procedures such as tissue transplants, liver operations and blood transfusion, among others.
“So we refer these cases to countries where there are laws to facilitate such complex treatment.”
To stop the referral of complex procedures, which amount up to over a hundred cases in the last three years, Dr Byanyima says specialised medical facilities must be established quickly and training of human resource should be a permanent fixture.

Diseases usually treated abroad

According to the Ministry of Health data, heart operations top the referral cases abroad. Cancer cases, bone diseases, organ transplants and aging related complications are the other medical cases that compel Ugandans to seek treatment abroad—particularly in Asian and European-based hospitals.
Uganda Cancer Institute 2013 data, shows that for the last three years, the number of cancer patients shot up from 1,200 to 2,800 with more than 60 per cent of the patients showing aanced cases of the ailments.
According to the institute report, 70 per cent of people who turn up at the institute are normally diagnosed with cancers which are in the fourth stage, which is the very late stage.
Information from the Ministry of Health website indicates that non communicable diseases (NCDs) particularly cardiovascular (heart) diseases, diabetes, cancers, as well as chronic obstructive pulmonary diseases are becoming increasingly important as causes of morbidity (illness) and mortality (death) in the Ugandan population.
The Uganda Heart Institute records have demonstrated a 500 per cent increase in outpatient attendance due to heart-related conditions from 2002-2009.
The Uganda Cancer Institute has also reported an upward trend in cancer incidence over the past four years (2005-2009), particularly among HIV infection related cancers.
Regional referral hospitals have reported an increasing number of diabetes and chronic obstructive pulmonary disease patients either admitted in their medical wards or seen at their out-patients clinics.
The increase in the incidence of chronic non communicable diseases is predicted to continue over the years fuelled by the increasing exposure of our population to unhealthy lifestyles associated with urbanisation.

iladu@ug.nationmedia.com

SOURCE: Daily Monitor

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