Yes, the health system is awful and we need concerted efforts to improve it

Health officials tour Kawolo Hospital recently. The health sector is facing poor infrastructure and inadequate funding among other shortcomings. In the picture below are patients waiting for services at the same hospital. Photo by Stephen Otage 

By Dr Okara J. Wanyama

In Summary

Distorted thinking. We seem to have lost our collective rationality and completely distorted our mindset to think that sharing the national cake is the most important national agenda regardless of the poor results it has produced over the years.

I refer to Mr David F.K, Mpanga’s article of September 1, 2012 titled “To call a spade a spade, the health system in Uganda is absolutely awful!”




This fascinating piece of writing on the state of health care in Uganda deserves some attention. I hope this conversation can inform our health policy formulation.

Allow me add that any nation’s health system is very much reflective of its ability to mobilise and generate resources required to meet its health system functions.

Whereas it is well known that increased resources available to the health system does not necessarily translate into better health outcomes for all citizens, there is consensus that delivering equitable and quality health care, whether publicly and or privately organised, requires considerable resources which can only be achieved with strong citizen participation.

Unfortunately the so-called free health care has become a disincentive to citizen participation in the growth of our health system. Luckily, the ordinary citizens, the actual consumers of health services, now perceive the performance of our health system as miserable and maybe it is time we did something about it.

Whether true or not, the legitimacy of this perception cannot be wished away, for the consumers of public health care are the most qualified to assess its quality. The leadership can point to a few indicators such as the overall national reduction in maternal mortality and under-five mortality and say we are doing well, but whether that improvement can be attributed to the public system is a debate for another day.

Anyway, the verdict is out and I agree that our public health care is awful. I also agree that this appalling state of our care delivery has nothing to do with the lack of resources or competence of the actors within the system itself. Its crippling problems are mostly self inflicted; reflective of broader structural problems in our politics and how resources are generated and allocated to various national priorities.

This brings me to the widely coveted and perhaps the most invasive political concept of our time in this country; “sharing of the national cake”.



Whereas, it is logical that sharing of the national cake would be at the heart of every politically organised society, this concept meant to be a solution to our problems has turned out to be single biggest contributor to the poor state of social services delivery.

We seem to have lost our collective rationality and completely distorted our mindset to think that sharing the national cake is the most important national agenda regardless of the poor results it has produced over the years. We, the citizens and our leadership, collectively, whether knowingly or not, have allowed the sharing, rather than the creation of national wealth, as it should be in a modern market economy, to drive and permeate our policies at all levels.

This skewed thinking is the cause of lack of interest in what and how the health facilities countrywide should acquire capacity to deliver quality health services. For we construct health facilities not necessarily to yield health benefits, but because our intention is to show how we are sharing the national cake. A bad intention cannot produce good results. Therefore we have many health facilities, including even referral hospitals, functioning at frustratingly sub-optimal levels.

 

Again I agree that we are desperate for ideas including to learn from others who have asked their citizens to contribute to a pool of funds to run their public health system.

Despite the thinking that such a system will be anti-poor, evidence shows otherwise; such a system, if well implemented will result in increased availability of quality health services even to the poorest of the poor.




What our leaders are not telling us is that, our health system, the way it is, is more devastating to the poor than the rich who can procure services from the private providers. So, we cannot continue saying the system is pro-poor. Those who have ever sought health care from public facilities will agree with me on this.

It is high time we revived the discussion of a health insurance scheme that started two to three years ago and regulate the interaction between political with technical processes to achieve good results we seek.

Otherwise there is no way in the foreseeable future, considering our tax base, even without corruption by the way, ( even the oil money won’t do it in the short term) that this country will be able to offer its 35 plus million people with high quality health care, without some form of citizen contribution. We need to be told these hard facts and our politicians and leaders “must stop” pretending.

Dr Okara J. Wanyama,
Public Health Consultant