Of the 313 health centres II in the country, a total of 124 have been upgraded to health centres III. This follows the construction and rehabilitation works that commenced in 2018/2019.
Whereas Uganda has some of the finest healthcare professionals, there have always been lingering concerns over the health infrastructure in place.
“The population was smaller a decade ago. Perhaps, service delivery was slightly better because of the smaller population,” Eng. George Otim, the commissioner in charge of health services infrastructure in the health ministry, says.
Yet to deliver quality health care, there is need for proper infrastructure to match the population. This includes hospital buildings and support systems that comprise, among other hospital equipment, constant supply of electricity, water and sanitation.
So, how have the health infrastructure in the country been improved over the years in a bid to improve access to quality healthcare in Uganda?
BUILDINGS (CIVIL WORKS) HEALTH CENTRES II AND III
To streamline and strengthen healthcare delivery, plus referral in the country, of the 313 health centres II in the country, a total of 124 have been upgraded to health centres III. This follows the construction and rehabilitation works that commenced in 2018/2019.
Another 62 facilities are being upgraded and are expected to be completed by the end of December. In the financial year 2020/2021, another 64 health centres II will be upgraded to health centres III following the creation of new counties.
“We are phasing out the health centres II, to streamline and strengthen health care plus referral in the country,” Otim says.
The construction and equipping of 134 health centres III in subcounties without any health facility across the country will also be undertaken. All the work is funded by a $55m (about sh200b) World Bank loan for the health sector.
The money is earmarked for infrastructure development expenditure as directed by President Yoweri Museveni. The loan is under the Uganda Inter-Governmental Fiscal Transfer programme, which among other aims, is to restore adequacy in financing of local governments to deliver services to citizens.
HEALTH CENTRE IV
The upgrade of 67 health centres III to health centres IV is also being undertaken in the country.
“We have 137 districts. It will be too much to have a general hospital in very district,” Otim says. A general hospital is supposed to have a 100-bed capacity,” he adds.
But with the creation of new districts and a population, which has grown, the need to upgrade the hospitals arises. This is because some of them were constructed in the early 1960s.”
“We started rehabilitating one at a time. Kawolo General Hospital has been fully rehabilitated. Same for Kayunga Hospital, which has been revamped and fitted with all equipment and now functional. Yumbe Hospital’s construction is at 95%,” Otim says.
Last year, renovation works for Gombe General Hospital started. “We are going to rehabilitate all the general hospitals. Kisoro and Rukungiri general hospitals are next.” “When we rehabilitate, we draw a new master plan. Some of the old buildings are preserved and renovated, while others are replaced with new ones,” he says.
As far as staffing is concerned, general hospitals have been operating at about 57% across the country. However, all rehabilitated hospitals have recruited up to 100% because all the infrastructure is in place, including staff quarters.
There are 14 regional hospitals, but Mbarara Hospital is to be upgraded to a national referral hospital. “The state of infrastructure for regional hospitals is fair since they have been prioritised,” Otim says. “In terms of equipment, they are not up-to-date, but are not badly off either. They have been rehabilitated and renovated and we continue making them better,” Otim adds.
“By the end of the year, all regional hospitals will have hitech intensive care equipment,” he says.
There are four national hospitals. They include Kawempe, Kiruddu, Naguru and Butabika. In the wake of COVID-19, these hospitals were equipped with hi-tech medical equipment for the continuity of care for critical care patients as Mulago Hospital cared for COVID-19 patients, Otim says.
He adds that using all the hospitals to care for COVID-19 patients would have frustrated other patients in need of critical care since they were avoiding Mulago, the centre of treatment and opting for other hospitals.
“We have equipped Kawempe and Kiruddu hospitals. We have put 10 intensive care beds at Naguru Hospital, with monitors and ventilators, X-ray machines, and ultrasound to care for the critical patients,” he says.
Uganda has two specialised hospitals. The first is the Mulago Specialised Women and Neonatal Hospital. The Children’s Surgical Hospital that has been constructed in Entebbe, Wakiso district is the second and new specialised hospital. It should have opened in April, but was delayed due to the coronavirus outbreak.
“It has everything needed, the doctors, beds, equipment and drugs that had to be distributed to other hospitals due to delayed opening to avoid waste,” Otim says.
“Specialised doctors are expected to come from Europe to train and work with Ugandan doctors,” he adds.
The hospital will treat only children up to eighteen years of age free of charge. Children with heart diseases, kidney problems, liver and other complications that need lifesaving operation will go to Entebbe instead of India. Private donors from Italy funded the construction and equipping of the hospital.
They will operate it for one year then later hand it over to the Government who will contribute to the payment of staff. They will then continue supporting the Government-run hospital for eight years.
For every 1,000 people you need a hospital bed as per World Health Organisation recommendation Otim says Uganda needs 45,000 beds for her 45 million people.
“Unfortunately, Uganda has a total of 13,000 beds,” he says. “If we combined the beds in all government hospitals with those in the private health facilities across the country(7,000), we may have 20,000 beds. There is still a big gap to fill,” Otim says.
For example, a secondary school with 2,000 students may have no admission bed, but it needs at least five so that a child admitted can wait from there to be moved to another facility.
“We have been importing hospital beds from china with a maximum load of 180kg, but as health ministry, we designed beds and asked local factories to make samples, which experts approved. We do not encourage patient visitors to sit on the bed, but you cannot stop them. Therefore, we designed a bed that can carry 500kg,” Otim says.
He adds that: “We are going to manufacture hospital beds locally, we are not importing them anymore. But we will upgrade to all other simple hospital beds, then delivery beds, examination beds, ICU beds. We will create employment for Ugandans, use local materials and develop skills and hopefully, they will start exporting them to the region,” Otim says.
He says 4,600 beds are being manufactured for the start. They are going to regional referral hospitals to take care of COVID-19 patients.
“By starting with simple equipments, such as beds, we can grow to other major medical equipment. Medical equipment is very expensive,” he says.
WASTE MANAGEMENT SYSTEM
We are constructing a big medical waste management plant in Mbarara district, to serve western Uganda, Otim says. “We constructed several regional plants, but when they broke down, there was no budget for their maintenance or fuel,” he adds. “We are now developing a national waste management system and will have a plant in every region. There will be trucks that will collect waste from the health centres for proper disposal,” Otim says.
“We will construct a storage in Kabale where trucks will pick the waste and bring it to Mbarara for proper disposal and later build a plant for the greater Kigezi region,” he says.
For instance, the x- ray machines cost sh1b, Otim says. “Some CT scans and MRI scans cost as much as sh5b. There are also operational costs, but we are getting there steadily.” “One of the problems we face in Uganda is that we cannot accurately diagnose. We are moving towards improving this gap, but acquiring better medical equipment will provide holistic diagnosis.” “A healthy population is a productive population that contributes to economic development of the country. When the health ministry of health injects a lot of money in people, it means that we are investing in them because when one falls sick, they cannot work,” he says.
But amid all efforts to develop the health infrastructure further, Otim underscored the need to improve pimary health care.
“About 80% of illnesses can be avoided with proper hygiene in homes and communities,” he says.
However, the budget allocation for primary health care is the smallest. “If it increased to 25 % of the health budget, in a few years, the whole health sector budget will come down because we may not need the money.”
He also says there is a need for people to change attitude and be receptive towards health care provided in public health facilities.
“Some People go out of the country for medical treatment. Now, with COVID-19 all stakeholders have come to terms that the place we should invest in first is health because you may not get an opportunity to be flown out.” “Some of these treatments can be done locally by our qualified specialists. Sometimes, it is only infrastructure and tools lacking,” Otim says.
He adds that with the infrastructure and tools, some of the complicated procedures can be done in Uganda because we have the specialists.
The president of the Uganda Medical Association, Dr Richard Idro, says in 2016/17 about sh125b is what went out of the country from people seeking medical treatment in India.
“That money would have put up another women hospital. We have created another eight cities that money within eight years would have built a hospital like that in each of the major cities,” he says. “This means that not everybody has to travel to Mulago. This is because there is qualified personnel,” he says.
Idro says Uganda each year is producing 150 specialists. “We have 16 regional hospitals, which means that each regional referral hospital can get 10 specialists every year,” he adds. “If we are to distribute them to the new cities, each city would get 20 from what we are producing already,” Idro says.
“The investment supports the lower health units so that we are able to refer people properly and those people do not have to go far,” he adds.
Originally Posted On NewVision.Co.Ug