Tuesday, December 14, 2010

The plan is to revamp the health sector

In this Daily Monitor article published yesterday, Margaret Wokuri shows how the IPC government is determined to resurrect the health situation in our land.

Uganda’s health sector has been in steady decline over the last several years. The first Health Sector Strategic Plan (2000-2004) was poorly implemented and the second (2005-2010), was plagued by gross theft of funds, mismanagement, and poor service delivery. Health Sector Strategic Plan III will commence in a context of chaotic and ill-planned fragmentation in the name of decentralisation, a grossly deficient and demoralised health work force, and reckless under-resourcing.

A recent study by the ministries of Health and Finance, and the World Bank, estimated health sector losses at Shs36.7 billion annually due to waste through staff absenteeism, expired drugs and poor payroll management (ghost workers). Absenteeism is the single largest waste factor in the public health sector in the country. The government seems to be puzzled by this. But the treatment of health workers – a nurse earns $100 a month – should shed light on this.

Most health workers cannot afford health care for their families. A severe illness of a nurse’s child means serious impoverishment. A single room in a slum, with no running water and no electricity, costs about Shs70,000. This is one third of the nurse’s income per month.

Over the years more money has shifted from districts to MOH headquarters. From being 54per cent district and 18per cent MOH/HQ in 2005/6, it is now 45per cent district and 27per cent MOH/HQ (2009). This trend can only mean worsening delivery, even as government claims it is taking services closer to the people. The results for such undertaking have been malnutrition for under-fives hovers around 40per cent; 20.4per cent of Ugandan children go to bed hungry; 13.7per cent of children die before their fifth birthday; of every 100 babies born, only 41 are delivered by a skilled health worker; for every 100,000 new mothers, 435 die while giving birth.

Twenty women die of pregnancy-related causes every day. Between now and tomorrow when you read the Daily Monitor again, 20 families in this country will be preparing to bury their mothers/daughters as a result of a pregnancy. Only a small fraction of these mothers will have been seen by a doctor.

6.4per cent of the Ugandan population is infected with HIV/AIDS, and most of these people continue to suffer without the necessary medicines (ARVs) because of theft of the money supposed to buy the medicines, and because the health care system is not able to provide the care and monitor the patients. The Health Centres which have been baptised hospitals lack doctors and equipment. The present number of health staff including those in the private sector, amount to about 40,000. This is far below the recommended WHO minimum standard, which considers countries with less than 1 doctor, nurse or midwife per 439 people, in critical shortage of health workers. Uganda’s population is 86per cent rural. But the positions which are mostly vacant, and where the bulk of the health problems are, are in precisely those same places. The poor health outcomes are predictable.

The IPC government is committed to delivering a health care system that works. Dr Kizza Besigye’s government will recruit and motivate the workforce, and equip the health facilities. The IPC government will construct and equip four more regional hospitals, and will revamp the infrastructure in existing hospitals at all levels.

The professionals working in relevant authorities and agencies have been unable to assure Ugandans of the quantities and quality of medicines in the country. The IPC government will, as part of the zero tolerance to corruption, let competent professionals implement the National Drug Policy, in order to ensure that health facilities across the country have essential medicines at all times.

Households spend about 9per cent of their consumption expenditure on health although no user fees are paid in lower level government health units. 28per cent of the households in Uganda are experiencing catastrophic health payments; many are kept under the poverty line by these medical bills. Private health insurance, which is largely subsidised by employers on behalf of employees, is for a few. Government’s allocation to health is between 8.3per cent and 9.6per cent of the national budget. The IPC government is committed to achieving the recommended 15per cent Abuja target over the next 5 years.

Ms Margaret Wokuri, director for communication and publicity at the IPC campaign bureau wrote this article in consultation with her organisation’s leadership.

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