Treat Uganda’s sick health service with change of national leadership

Dear Tingasiga,
The critical illness or death of a Ugandan celebrity triggers understandable widespread grief. We feel a personal loss because the celebrity had become a member of our household.
The community is easily galvanised to act, with donations of cash in the hope that the patients may be saved, if only we can evacuate them to Nairobi or beyond.
That Ugandans can contribute Sh100 million towards such a cause in a matter of days is testament to our generous and caring spirit. When all is said and done, we are good people.
Yet, underneath this narrative is a sadder story of a society that has resigned itself to a fate thrown at them by an inadequate and terribly dysfunctional health service.
My sadness is made worse by the fact that even as we were raising money to save the lives of these famous compatriots, millions of nameless Ugandans were enduring great pain and suffering on account of all sorts of diseases, many of them potentially curable.
Even in the wards at Mulago hospital, where these celebrities were admitted, were dozens of patients with treatable cancers, facing certain death because of the inadequate resources in what was once the leading cancer research and treatment centre in sub-Saharan Africa.
As if they are not Ugandans with a right to life, these nameless people endure the indignity of wasting away in government hospitals and health centres that would invite closure if we enforced the minimum standards of safe healthcare facilities.
When President Museveni dipped into the public treasury and “donated” $1,800 towards the evacuation of Rosemary Nankabirwa to the safety of neighbouring Kenya, it was a poignant affirmation of the failure of his own government.
This presidential vote of no confidence was not the first, of course. Eleven years ago, Gen Museveni used the country’s presidential jet to evacuate his daughter to Germany for a normal, uncomplicated delivery of his grandchild. The cost was estimated at $90,000. (Even among the elite there is an Orwellian inequity straight from Animal Farm.)
This vote of no confidence is entrenched in the governing system, with the well-connected enjoying first class healthcare outside Uganda, at the expense of the wretched of the Earth who toil to keep them comfortable. The cost to the public purse may be as much as $150 million per year.
The beneficiaries live in a world far removed from the realities of the majority. They probably have no clue about what is going on in Uganda’s public hospitals and health centres.
What is surprising is that many Ugandans, the vast majority of whom are condemned to substandard healthcare and premature death, are duped into believing that President Museveni is the best thing that ever happened to the country. They vote for no change to his vote of no confidence.
I have seen sick, helpless folks at public health facilities donning well-worn yellow T-shirts bearing the portraits of a smiling Gen Museveni. As they have narrated their predicament, some asking for financial help, my eyes have gazed at the President’s smiling image. I have often found myself smiling back at him, the irony quite overwhelming.
Uganda’s national health spending is well below the Abuja Declaration of 2001. African countries agreed to allocate at least 15 per cent of their national Budgets to health spending by 2015. (Only six countries – Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia – have met this goal.)
The 201415 Uganda budget allocated only 8 percent to the health sector. The combined spending on departments which are principally meant to keep Mr Museveni in power far exceeds public health spending. He is right to smile.
The 201516 Budget Framework Paper indicates no change in health spending. This inadequate funding is complicated by inappropriate allocation of money within the health sector. Of the proposed health sector allocation of Shs1,234 billion in the next financial year, wages will take up only Shs333 billion, while the non-wage operational funds for all services will be only Shs354 billion. A paltry Sh210 billion will go to medicines and other health supplies, while operating systems and administration get only Shs140 billion.
More than Shs540 billion will be targeted at infrastructure, equipment and services under the Global Fund. One is not surprised to find that many health facilities are dysfunctional because the human resource has been given low priority.
The solution to Uganda’s sick health service is a political one, not harambees (fundraisers,) and not even increased funding by a government that will look the other way as the money is stolen.
Uganda’s healthcare needs a major change of national leadership to one that shifts priorities to living within our means, people-focused development, massive recruitment and retention of skilled professionals, uncompromising accountability, and implementation of a sustainable national health insurance.
If some good is to come out of the recent deaths of well-known figures, let it be a sustained programme of demanding better and equitable healthcare for all.
The leaders of the fundraisers have demonstrated the ability to galvanise Ugandans to a common cause. Their efforts should not be buried with our departed compatriots.

Dr Mulera is based in Toronto, Canada.

SOURCE: Daily Monitor


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