The health care in Uganda is not as yet up to international standards:

The budget for health is minimal:

 

 

Written by Esiana Joselyn

 

Members of Parliament are visiting Namatala health centre in Sironko

 

Swayed by a notable public outcry over government's wobbly handling of the Covid-19 pandemic, the 11th parliament took an outsize interest in the country’s preparedness to contain the spread of infections in the second and anticipated third wave.

After weeks of on-the-ground visits to health facilities in the central, east, north and western Uganda, MPs have found a much unprepared, underfunded and frail healthcare system almost two years after the pandemic broke out.

Deputy Speaker of Parliament Anita Annet Among named about 40 MPs on a fact-finding mission to establish the readiness and capability of government to contain the raging second wave and anticipated third wave of Covid-19. The MPs monitored vaccination, case management and surveillance in facilities that get government funding.

On July 17, the minister of Health Jane Ruth Aceng gave a glowing national update on the containment of the second wave. She said the 42-day lockdown, which ended last week, was meant to achieve the following:

*Enhance measures to interrupt transmission of Covid among health workers and the general population;

*Enhance risk communication and community management;

*Streamline and strengthened home-based care for Covid-19;

*Increase capacity of our health facilities to optimally manage Covid cases; and

*Continue with vaccination depending on availability of vaccines and sustain continuity of essential health services.

Interviewed extensively about the fact-finding mission, the probe team MPs said the continued spread of the virus has shown how unprepared government and the ministry of Health are to help protect and treat thousands of Ugandans threatened by the disease.

Minister Aceng’s assertions on the containment of the virus during her public address on July 27, the MPs said, completely contradict what they found on the ground.

Dr. Michael Lulume-Bayiga (Buikwe South) and Charles Tebandeke (Bbale) told The Observer last Friday that the committee members engaged the ministers of Finance and Health and got a good grasp of the various expenditures made prior to the breakout of the second wave in April 2021, which has killed many people.

According to MPs, the taskforce got a good understanding of the appropriations and expenditures made and leaned on that information to make informed evaluations during the fact-finding mission.

The terms of reference included; establishing the readiness of various hospitals in managing many severe cases and critical cases of Covid-19. The MPs were tasked to find out whether hospitals have high dependence units, intensive care units (ICUs), human resource aligned to the treatment of patients, availability of medicines, requisite laboratory investigations, and x-ray.

They were also to establish the availability of CT scans and the human resource to run the scans including motivation of health workers in terms of risk allowances, availability of isolation centres, Covid-19 treatment units, testing kits, airtime for health workers and security personnel to enforce Covid-19 standard operating procedures.

The MPs on the fact-finding mission in the central region said they also visited border points fingered for the importation of the virus.

“We found porous borders as very important areas to watch since Covid-19 has been imported especially through Mutukula and Entebbe Airport,” Lulume said.

“We found that it is at those points where the ministry outsourced the testing and quality control to companies, which do the testing but don’t make it mandatory for anybody coming into Uganda to do a PCR test. So, its free entry for certain classes of people coming into Uganda especially from UK and USA. But it could be mandatory for Ugandans coming back home and ineffective in preventing Indians who have Ugandan passports coming back into the country,” he added.

“They imported the Covid-19 Delta variant into the country or even South Africa, which has the Beta variant. So, Uganda became a destination for these viruses because as they were coming in, there were no strict measures undertaken including mandatory PCR tests. As people come in, there’s nothing like quarantining those found positive. So laxity in that area is responsible for the Delta variant and the upsurge of the infection that we have in the second wave,” Lulume noted.

NON-UTILIZATION OF MONEY

According to Dr. Lulume, non-utilization of money appropriated by parliament is another reason health facilities cannot provide essentials in the management of Covid-19.

“Then the non-utilisation of the monies, which were meant for vaccines; you have been hearing the minister of Health talking about Shs 18.5bn, which was supposed to be paid to ensure that Uganda gets vaccines as part payment or an upfront payment... We have not benefited out of it. Instead, we got a donation and such money could not have been discovered if we had not probed the minister about it,” he said.

“So, the ministry has been really weak, lackadaisical, lazy, laissez-faire in procurement and distribution of vaccines, which should have helped to cut back on infections as well as ensure that the population is safe and is participating in the building of the economy...,” Lulume said.

“We found some oxygen plants available in some regional hospitals...with capacity to produce at least 40 cylinders of oxygen per day but some lacked backup generators. With power cuts, these oxygen plants get disarranged and their repairs are costly.

In many times, production of oxygen stalls,” he added. The MPs said that much as some companies volunteered to supply free oxygen, some hospitals couldn’t pick it because transportation was too costly.

“To come from Masaka to Namanve to collect oxygen, it would be very expensive. And with the limited number of oxygen cylinders available, it would be difficult and expensive especially for private, not-for-profit private facilities to access oxygen, which is needed. Even regional referral hospitals with oxygen plants producing a maximum 40 cans per 24 hours cannot cope with many hospitalizations where each person requires more than four cylinders per 24 hours. So, in the event of an upsurge in the number of patients, then very many people would be dead and so we found it would be a catastrophe if we get another wave,” he said.

“Because we are not ready, we don’t even have requisite numbers of trained human resource to manage the high dependency units and ICUs in Uganda and requisite medicines that treat drug-resistant bacteria,” the MP said.

HEALTH EDUCATION

Both MPs Lulume and Tebandeke said health education is suboptimal because the only radios, which volunteer free airtime offer awkward hours, when the would-be listeners are asleep.

“RDCs [Resident District Commissioners] are more focused on implementation of lockdown measures and have not assisted district health officials in sensitizing the masses.

Whenever they go on radio and TV, they communicate strictness to observation of lockdown measures instead of giving a chance to medics to talk about Covid-19 issues,” Tebandeke said.

Lulume said RDCs get one hour a week on radio, which is not enough to teach people how Covid is transmitted and how home based-care is done.

According to Dr Lulume, the much-hyped home-based care is not well developed because Village Health Teams (VHTs) have not been trained to look after Covid-19 patients. The teams are not vaccinated as well, he said.

“So, it makes it difficult for them to look after people on home-based care management. It also has a limitation of space where people sleep nine in a small house. Doing home-based care would push somebody out maybe in a latrine or to camp outside the room in order to save others, which is not quite practical and it is very difficult to monitor... So, it is hyped but very complex yet it is a necessary pre-requisite for people managing patients outside hospitals,” Lulume said.

“Because of community transmission taking place, government is overwhelmed. We can no longer run isolation centres because there is community transmission. We can no longer admit moderate and severe cases. We send them back home again to transmit and get the disease,” Lulume added.

The worn out sign post in the Northern Province of Uganda

 

TESTING

According to the MPs, testing kits supplied are limited.

“Few health facilities can test and they are limited by security forces implementing the stay home Covid guidelines. So, boda bodas transporting people are curtailed by security forces preventing them from taking people to testing centres,” Lulume said.

“So, it is very easy to note that fewer people are being captured positive yet very many people remain home unable to access testing centres. So, the numbers which are thrown around don’t give us a true picture of the transmissions. The situation continues to be bleak because we cannot prove that these are the real numbers because we don’t have mass testing,” Lulume noted.

“We don’t have a robust surveillance system in order to know all the patterns of distribution of the transmission of the disease. The only people who are captured are those who come to the health facilities. Those kind of numbers do not give us a true picture...”.

HOSPITALS NOT TREATING COVID-19

The MPs noted that general hospitals are not allowed to treat Covid patients; they are supposed to test mild cases and refer them to home-based care.

Yet they should have been able to treat them if they had supplies of oxygen, and prerequisite personal protection equipment including medicines. Some hospitals lack space.

“Kawolo, Kalisizo, Kakuuto, Kyotera have no space for isolation. So, laboratory facilities are still wanting. Many of them have no blood count machines; or blood chemistry machines, therefore, you cannot know how the kidney and liver function. You don’t know your complete blood picture at hospital,” Lulume said.

“The only tests done are those that aid some kind of research on TB and HIV. In regard to knowing the functionality of a human body, there is still a lot to be done not because officers to do that are not there but because government has not cared to have complete blood count machines, chemistry machines, culture and sensitivity machines so that we know exactly what is taking place in somebody’s body system and then we get the necessary drugs to treat them,” Lulume said.

“That explains why doctors are bombarding patients with very many types of medicines to catch a small infection... Now you have to give a barrage of antibiotics in order to capture one bacterium. So, laboratories are very important but are given very little attention.”

MPs, however, said it was still hard for them to establish the variations in charges for testing for Covid- 19 by Test and Fly, Safari and Case hospital laboratories sourced by the Health ministry to do tests.

The charges range between Shs 300,000 at Entebbe Airport and Shs 150, 000 to 180,000 at Mutukula border.

“Besides, they don’t even have a quality control laboratory. Their results are final. Who does quality control for them; it’s themselves. Who can superintend upon them? The ministry of Health, which outsourced them in the first place, has no capacity to retest what they have already tested. So, that explains why people come in with fake results, which cannot be verified,” Lulume noted.

“How they were sourced we don’t know. Did they go through normal contractual obligations according to PPDA; nobody knows. They too don’t know and parliament needs to investigate that area very well. Can their results be relied upon, maybe, maybe not because we don’t have verification machines,” he added.

Interviewed, two other members of the taskforce; Faith Nakut Loru (NRM-Napak Woman MP) and Hope Grania Nakazibwe (NRM-Mubende Woman MP) concurred with Dr. Lulume and Tebandeke. Nakut was part of the Northern region Covid-19 parliamentary taskforce while Nakazibwe was on the central region one.

Nakut told The Observer that almost all health facilities are grappling with issues, which Covid-19 made worse.

“When you add on the Covid-19 burden, you find its too much. And one of those issues is staffing. Staff are few and with Covid-19, you need more health workers who cannot be recruited immediately because of the staffing norms,” Nakut said.

“Then there’s the issue of over-crowded wards. They are taken up by other ailments and so some hospitals have had to cut back on admissions of other diseases in preference for Covid-19. They have had to sacrifice mental health units. That means mental health care work is being compromised....”

Mubende Woman MP Hope Grania Nakazibwe said what is available is not sufficient to slow Covid-19.

“...We need to equip health facilities because we have facilities which have been designated to cater for Covid-19 patients, but the challenge is equip- ping these facilities,” Nakazibwe said in an interview last Thursday.

“Kayunga has been identified as one of those hospitals with enough space to cater for Covid-19 patients but it’s not equipped. So, there is work required to be done in order to prepare these facilities to manage Covid-19...,” Nakazibwe added.

Nakazibwe, however, noted that most regional hospitals have oxygen plants but the challenge remains a lack of electricity.

“Sometimes power goes off and sometimes it’s too low to power the machines. So, we realize there are a number of things that need to be worked on and others that need improvement as we prepare for wave three or any other outbreaks,” Nakazibwe said.

“The other thing which may stand out is the PPEs like gloves, sanitizers and cover rolls, among other things. We need to protect our frontline workers and we need PPEs to be supplied on time and in sufficient quantities...,” Nakazibwe added.

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The hospital is a universal entity. We all get sick in many ways and our relatives and friends.

The government and its majority parliament are well aware of the mess in the healthcare since 1986 when they captured power.

Now that they have been in power for 36 years and counting, why are they saying that this problem of health care mismanagement has only been discovered when the pandemic of COVID19 Delta hit Uganda and the world as a whole!

Who exactly is fooling who of all people? If you cannot correct the problem for the last 36 years how many more years do you need to sort it out?