Don’t phase out health centre IIs just make them more functional

There are various accounts that the government through the Ministry of Health is contemplating scaling down and eventually phasing out health centre IIs to redirect investments towards upper levels of health establishments. The argument, although still not made public, is that government faces budgetary constraints.

Granted, the government may be genuinely faced with budgetary deficits to fund and support a robust health system that can adequately respond to health care needs of the population.

However, scaling down on the already inadequate health facilities, instead of improving on them, much less constructing new ones, only serves to further deteriorate an already fragile healthcare system.

Like the Runyankole saying that goes, “akati keinikwa kakyiri kato”, literally meaning that, “a tree is best redirected when it’s still an infant”, I would like to weigh in at the earliest opportune time to bring to attention this matter to a public dialogue by everyone concerned. Notice that Uganda’s population growth rates have remained high for the last decades which implies a corresponding trajectory of healthcare needs. In response, therefore, we as a country should be establishing more health facilities to expand health care access given an expanding demand.

To illustrate my deep-felt concerns about this impending government’s direction, I will use a real-life, personal, yet an average Ugandan’s plight. Regarding healthcare access, I come from one of the most underserved communities in Uganda, Rugando parish in Rujumbura County. Rugando is located right at the border of Kanungu and - Rukingiri District. The nearest health centre in this area, until recently, was approximately 15 miles away. On many occasions that I drove home for a visit, I would divide my time between family and transporting patients to distant health facilities most of them concentrated around Rukungiri Town.

I have experienced all kinds of health conditions while extending a helping hand to residents in my community. I have witnessed stillbirths in my car while transporting expecting mothers fatalities among varying age-groups and genders, primarily because communities, resort to traditional medicines given the difficulty to access far away health facilities. It is mostly when patients’ conditions deteriorate that communities mobilise for transportation for patients with undifferentiated illness.

This I deduce can be inferred as the experience of an average Ugandan considering that vast majority (80 per cent) of the population resides in rural areas.

Hardly a year ago, the government, through what can be dubbed a community-public partnership, secured land from the local parish and constructed a health centre IIs, which has since become a fresh breath of life to this community. At the health centre IIs, communities can nowadays access early diagnosis and treatment for common illness through outpatient care and community outreach services that are administered by an enrolled comprehensive nurse.

Disappointingly, the government through ministry of Health has recently embarked on a push to reduce investments in health centre IIs for varying yet very unconvincing explanations E.g 1.) To open up space for private healthcare providers to fill this government-created vacuum 2.) To redirect investments towards health centre IIIs that serve a larger catchment of the population 3.) to optimise the limited funds towards establishment of better equipped health centre IIIs, IVs and hospitals, etc.

During the Annual Health Sector Performance Review meeting held in Kampala in September, the Health minister Dr Elioda Tumwesigye, intimated and aocated for an increased government annual expenditure on basic healthcare for an average person from the current Shs47,000 to Shs147,000.

The minister further elucidated that an increased health expenditure would improve basic health services to ordinary Ugandans and he expressed concern about the shortfall in the health sector budgetary allocations for 201516 fiscal year. Although the Ministry of Health had recommended and requested that 10 per cent of the 201516 budget be directed to the health sector, the government committed a mere 8.5 per cent.

According to the 2011 - 2015 World Bank healthcare expenditure per capita report, Uganda spends far less (24 per cent) on healthcare per its average citizen than the amount (35 per cent) spent by an average low-income country.

Despite Uganda being a signatory to the Abuja Declaration and Plan of Action 2001 which tasks each signatory country to commit a minimum of 15 per cent of their annual budget towards health sector, Uganda has for the past decades committed no more than 8,5 per cent of her annual budget to health.

The push to downsize investments in health centre IIs comes at a time when various stakeholders, championed by the SPEEP Project under Makerere University’s School of Public Health, are devising efforts and mechanisms to institute Universal Health Coverage (UHC) in the country. UHC defined by WHO as “access to all key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost” would salvage the country from the long-standing undifferentiated poor health outcomes among the general population.

The argument that ‘health Centre IIIs will be strengthened and that they will act as an alternative for health centre IIs’ is in my opinion void, in part because the issue of proximity contributes heavily on limited access to health facilities in many districts.

Mr Akankunda is a post doctorate research fellow with the SPEED Project at Makerere University School of Public Health.



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