The problem with Uganda’s healthcare is affordability...

Uganda's national referral, Mulago Hospital. Health services in the country are costly. PHOTO | MORGAN MBABAZI 

In Summary

• A hardworking and diligent person who had hitherto stood on his own two feet had nearly been reduced to destitution by a treatable ailment and health services that are either too costly for an ordinary person, too distant to be reached easily, or dysfunctional enough to be of no use when health crises hit the not-so-well-off.

By FREDRICK GOLOOBA-MUTEBI
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The current standoff between the Government of Uganda and the medical fraternity offers Ugandans much food for thought and also an opportunity to reflect on health services in the country in general.

The standoff began on May 1 when, while presiding over Labour Day celebrations, if ‘celebration’ is indeed the right word in the circumstances, the President seized the opportunity to lambast doctors for among other things, their uncaring attitude towards their patients.

Museveni was smarting from encounters he has had with doctors who in recent times have been rather vocal in voicing their dissatisfaction with their conditions of service, stretching from their salaries which they argue are inadequate, to constant lack of supplies and equipment that would enable them to provide decent services to their compatriots in ill-health.

It seems like merely talking about these things does not impress the government or the president sufficiently for them to take the necessary action. As a result, doctors have taken extreme measures and downed their tools, throwing an already chaotic and dysfunctional system into further chaos.

Whatever Museveni thinks or says about the lack of supplies and equipment is unknown. He is not in the habit of making public statements about the issue. However, on salaries, he has been emphatic.

He has been ‘advising’ doctors and other public servants not to clamour for bigger salaries because he and the government have higher priorities to attend to, to lay the foundation for a thriving economy that will, in the course of time, enable the government to be more generous.

However, like other public servants, doctors have been uncompromising on this. So, recently the government decided to raise their pay.

But the President has been unforgiving, thus his recent diatribe. And now he wants to take measures to ensure that doctors do not ‘hold the government hostage’ again.

One such measure is to import Cuban doctors presumably to ensure that should Ugandan medics go on strike again, services do not come to a complete halt. Many questions arise, but I won’t go into that today. Suffice it to say, though, that the medics’ demands for more money in their pockets are legitimate.

Healthcare costs

There is another issue, though, which this standoff is not bringing to light, and that is how Ugandans experience health services when they need them.

A recent experience gave me pause for thought. A young man I know has a problem. For the last three months he has been forced to take time off work by severe back pain. Through no fault of his own, he never went to school and has been fending for himself since his early teens.

For the past two decades or so, he has been carrying heavy loads, earning his wages daily. So ever since he stopped working he has had no income.

During that time, he has been to many health facilities, public and private, and even to a ‘traditional healer’. In each instance he has been told a different story.

At a government clinic he was ‘checked’ by a medical assistant and told he had kidney disease. Then an aunt told him that he was suffering because he had fathered twins and not gone through the necessary traditional rituals.

The kidney disease claims forced him to visit a large upmarket private hospital where he was checked and told that his internal organs were all healthy.

However, the fees were so high he could not proceed with the recommended treatment for his back. The story of the neglected rituals then forced him to seek the services of a ‘musawo’ (healer). His recommendations were too ridiculous to narrate here. But he, too, charged handsomely for his services.

A well-educated relative then recommended the services of a physiotherapist. After a single trip to the physiotherapist, he ran out of money and couldn’t go back. He then tried a public referral hospital.

There he was examined and referred to a private facility to have his back x-rayed after which he should bring back the images. The fees were too high. He gave up.

Then his one-year old twins developed health problems. With no money to pay for their transportation to the nearest government clinic several kilometres away, buy medicine from a nearby drug shop or even feed his young family, the young man could see no way out of his predicament.

Meanwhile his third child could no longer attend kindergarten because he could no longer pay the rather modest fees.

Only when a better-off relative came to his rescue by giving him money to feed his family, procure treatment for the twins and return to physiotherapy, did the young man get some relief.

A hardworking and diligent person who had hitherto stood on his own two feet had nearly been reduced to destitution by a treatable ailment and health services that are either too costly for an ordinary person, too distant to be reached easily, or dysfunctional enough to be of no use when health crises hit the not-so-well-off.

As we contemplate the row about doctors’ working conditions and what lasting solutions the Cubans may or may not bring, it would be good to spare a thought for those who cannot speak for themselves but whose experiences get no publicity.

Frederick Golooba-Mutebi is a Kampala- and Kigali-based researcher and writer on politics and public affairs. E-mail: fgmutebi@yahoo.com