Monday, April 9, 2012

Uganda's health sector to limp on for sometime

By Brian Ssenoga
Peoples’ lives have improved in Uganda, schools have been built and refurbished and at least 1.5 million mosquito nets have been distributed in the last one year but Uganda still grapples with health shortfalls posing huge consequences in addition to the staggering economy.
According to Dr. Asuman Lukwago, permanent secretary ministry of health, the health sector budget has remained stagnant between Shs 660 billion for the last five years and 790 billion in 2011/2012.
This has caused stock outs of essential medicines in the country and the maternal mortality rate is still high with sixteen mothers dying daily according to Dennis Kibira, chairman HEPS-Uganda a coalition for promotion and social development.
A report released last month by HEPS- Uganda reveals that while 55percent of HIV patients are co-infected with TB about ten Ugandan districts for six months have not had TB drugs causing a 40 percent death rate of the HIV patients co-infected.
Richard Kintu, coordinator Child Health Now campaign of World Vision Uganda says that about 16 women die every day in Uganda while giving birth or during pregnancy.
He adds that, “Maternal and child health is still a challenge in Uganda, every day at least sixteen mothers die in child birth. Uganda’s maternal mortality rate is at 435 per 100,000 live births which translate to 6000 deaths annually, child mortality remains high with 137 deaths per 1000 live births”
Gabriel Opio, former gender labour and social development minister says that, “Prior to the making of the national budget, all ministries meet and propose their budgets. But in most cases, their budgets add up to 150 percent; beyond the total national budget share of 100 percent and when we reconcile to 100 percent, we discover the money is not enough. So as much as we want to increase the national budget to the health sector, the funds are not there”
However, according to health minister Dr Christine Ondoa, infant mortality rate has considerably fallen.
“The number of children who die before their first birthday dropped to 54 deaths per 1,000 live births in 2011 from 76 deaths per 1,000 live births in 2006. Also the percentage of women giving birth in health facilities increased to 57 percent in 2011 from 42 percent in 2006, with 59 percent of women in Uganda now giving birth with the assistance of skilled birth attendants” she says
In the 2010/2011 budget, the Government allocated about shs 260 billion to maternal and reproductive health. Of this, about shs 60 billion was to cater for reproductive health

In the 2003 African Union Maputo Declaration, member countries agreed to commit at least 15 percent of their annual national budgets to the health sector. Currently, Uganda’s budget share to the health sector is 8 percent, with maternal and child health among the least funded.
“Streamlining the health sector is the greatest challenge facing Uganda. The percentage of the budget allocation to health in Uganda has been reduced from 8.7 percent to 8.2 percent that is awful” says Njeri Mwangi, World Vision Uganda advisor on East Africa advocacy issues.
Even with external support, the budget allocation for the health sector in 2008/2009 was at 10.7 percent and 10.2 percent in 2009/2010 ten years down the road it is at 8.2 percent.
In 2001, African Heads of State made a commitment to allocate 15 percent of their annual domestic budgets to health during the special summit on AIDS, TB and Malaria held in Abuja. The Abuja commitment excluded external support. The budget allocations have been 9.3 percent, 9.0 percent, 10.7percent, and 10.2 percent in 2006/2007, 2007/2008, 2008/2009, 2009/2010 respectively.
“Yes, it is worth noting that government health budget has gone up since 2010, but the Abuja commitment of 15 percent has never been met, and the percentage allocated to health has stagnated. Such has created a crisis which includes deaths of mothers in childbirth, stock outs of essential medicine and health supplies and shortages of professional health workers needed to deliver the national minimum health care package” says Dennis Kibira chairman HEPS Uganda
While government still plans to carry out a national health accounts study to trace all resources that come to the sector, brain drain is yet another loophole putting the lives of Ugandans on the line. The continued reduction in the number of doctors and nurses in relation to the increasing population makes matters worse. With an estimated 33.4 million people at a population growth rate of 3.6 percent per year and a fertility rate of 6.7 births per woman, there are only ten physicians per 100,000 people according to the UN Human Development report (2010).
According to Dr. Katumba Ssentongo, the registrar Uganda Medical and Dental Practitioners Council (UMDPC) there are about 3854 medical officers registered with the council including those who are in private and NGO hospitals but of these only 2417 are in active service. However, he reveals that an average of six doctors a week seek a certificate of good standing from the council, a requirement for medical officers to work abroad.
“It is worse upcountry. For instance, Nakasongola, Moroto and Kalangala districts did not have a single medical doctor at the time of the last census. Medical officers do not want to work there, they prefer Kampala and others go for greener pastures abroad” says Dr. Katumba
However, according to the ministry permanent secretary an estimated 2000 doctors and nurses leave the country every year in search of greener pastures as if that is not enough, it is also on record that it is only recently that government started refurbishing hospitals and health centre IVs under the Health Systems Strengthening Project (UHSSP)
Dr. Ondoa says that government looks at training more health professionals and is renovating two regional referral hospitals of Moroto and Mubende and seventeen hospitals around the country. Plus twenty seven Health centre IVs which will also be supplied with appropriate medical equipment and human staff.
“To facilitate operations in the 46 health facilities scheduled for renovation, 58 multi-purpose double cabin pickups have been procured. 19 of them were distributed in February during the launch of the Uganda Health systems strengthening project to 19 hospitals to be renovated” adds Dr. Ondoa
However, Dennis Odwe the program officer in charge of advocacy at Action Group for health, Human rights and Aids (AGHA) these are all good interventions and must be respected without which it will be yet another crisis leading to more insufficient domestic investment in essential medicines and health supplies for antiretroviral therapy and effective regimens needed to prevent further upheavals.
The health sector is yet to recover from the effects of the gross mismanagement of money from the Global Fund. With the limited resource basket, efficient use of resources is a key to attaining optimal results. What the country needs more than ever is the strengthening of monitoring and accountability mechanisms to ensure that resources are effectively utilized.
Dr. Francis Runumi, health ministry commissioner Health services and planning says that Uganda’s weak economy is the lead causative for such little unsatisfying allocations, “if we had money these issues would not matter but the share we get. Because of the little money due to a weak economy government then fails to fully address and provide preventive health solutions and instead stands waiting to provide curative means which in most cases are very costly hence spending more. I think the current way of prioritizing would work for us in the future because if you have a hospital with no power then it will not work effectively but as of now the health sector will limp on for some time”