authored by Ddembe on 5. May 2007 at 15:
“4) In your posting you never examined the culpability of the administrators of medical services in Uganda. These are technocrats who come from all shades of political opinion! Have you bothered to examine their contribution to state of health in Uganda? What about the citizens themselves? Govt gets money to execute its functions from the citizenry. In Uganda about half of that money does not come from Uganda’s citizens but from foreigners after serious lobbying and begging by our politicians! Has it ever bothered you that we don’t collect enough money from the citizenry to pay for good social services like education and health? If we were to aspire towards the best health care system in the world, how much would it cost us? Probably US$10 billion! How much can we raise for the whole budget? US$1 billion. If we were to utilise all the money we collect on health services, how long would it take us? 10 years. Now imagine that Health takes a small fraction of the US$1 billion, how many years do you think we will take to upgrade our health systems? Suppose govt decided to increase the contributions which each member paid as tax, so as to improve the health services, would you accept? Probably NO!
You can say that wastage like buying MPs and Ministers cars should be avoided but you should ask yourself a very simple question: Does such an action enhance peace and stability in the country? Does it enhance motivation and efficiency? You should ask yourself why Ugandans of all shades love these privileges?
5) On the question of embezzled funds of the Global Fund, you should ask yourself whether there is anybody in this world who makes money with the aim of having it stolen?”
My friend, you keep running in the same spot but one fails to see where you are going!
We can talk about hospital administrators until we are blue in the face, but that is diversionary!
The relevant topic was political responsibility for our health services! Which is what you are trying very hard with the help of miles of verbiage to avoid!
Mayombo was failed in the hour of his death by a health system that does not work! despite the efforts of many individuals whose hard work is ill appreciated by your likes and the people who run this country! by trying to shift the blame to the individual cogs in the wheel you are trying to avoid the fact that the whole cogwheel does not work and we should be looking askance to the blacksmith who made or oversaw the making of that faulty piece of machinery!
The health system in Uganda overseen by the current government is in the doldrums and does not work! We have to look at the overall supervisors -the politicians, not the individuals!
All the miles of stuff you posted about individuals -doctors, nurses, technicians, bureaucrats only serves to demonstrate one thing -that there is an overall lack of direction and our health system is rudderless and unsupervised! That individual hospital administrators can get away with incompetence for decades without accountability if they hail from the right village or bury their faces deep into someones behind -of course someone with clout -a politician! That technicians can get away with incompetence for decades without sanction! That government can buy equipment over and over again without demanding accountability! that individual hospital administreators can purchase sensitive and expensive equipment on the basis os a whim while on a private jaunt overseas without going through some sort of centralised requisition and procurement procedure!!
A former Minister of Health while addressing the committee charged with investigating the Global fund saga stated that he could not allow a man who fought while the honourable judge was cowering under his bed to die -so he diverted the nearest funds available regardless of what they had been earmarked for! In circumstances very similar to those in which Mayombo died, Rukikaire was transferred to Nairobi -for dialysis at a cost to the taxpayer os 40 million!
I can name you all the places in Kampala that do haemodialysis or have the resources to -Mulago hospital through the ICU, Case clinic in Nakasero, Paragon hospital in Bugolobi and probably International hospital. Between all of them, they have at most 10 dialysis beds -less than a decent ICU in a big hospital! Three out of four are private and I am quite sure the equipment in Mulago was not paid for by the government! As a matter of fact, it is run on a private basis and the only free thing you get is the doctor and nurse -everything else you have to pay for! So if you ever make the mistake of going into kidney failure in Kampala, you will survive only as long as your money can last! While that 40 million spent on one man could if given to Mulago dialysis unit as a grant could have helped build the capacity to provide care for Mayombo and others!
As an aside, I can tell you for a fact that a significant number of the medical staff of Mulago hospital are unpaid -postgraduate students! And the other half, interns are underpaid! Mulago’s consultants relative to regional and international standards are significantly underpaid. Relative to you in Bank of Uganda who pays 2.5 million in taxes a month, they are lucky to take home a fraction of your pay! Relative to lowly lackeys in URA or young new graduates in the telecoms, they get peanuts. Yet while you work nine to five and have weekends off they are required to work long hours and travel to work at night to treat you -for no overtime pay or transport allowance! While this is not about pay, one has got to recognise that many of these people are doing a difficult job in a difficult environment! the mortality rate of Ugandan doctors from HIV is almost certainly higher than that for any other profession in Uganda -you may wish to look up a study in the Lancet addressing this! And it is not because doctors are more promiscuos than any other group. Another study looking at the mortality and rate of HIV among midwives and nurses demonstrated that midwives had a higher HIV rate -the only difference between the two being the number of needlestick accidents they get because midwives deal with blood and perform suturing while nurses do not!
The most recent summary of those events is that the honourable ministers usurped the powers of their finance departments and took charge of the disbursement of funds withing their ministeries -thereby becoming personally responsible if not for the funds for incompetence! Certainly if a Minister disburses several million dollars without documentation, one has got to conclude that they are either incompetent or criminally negligent or thieves -take your pick! That they may not have spent the money on themnselves is irrelevant! You work in the central bank and have been in government for long enough to know that the government has accountin rules and theoretically, one cannot simply divert funds from one fund to another without getting approval! In practice as documented clearly by the Global fund probe, the accounting rules are flaunted regularly in the health department and as a snapshot of what happens in government daily, it is appalling if not downright scary!
Mayombo died of natural causes. Those natural causes were contributed to by a derelict health system that failed him! The absence of adequate intensive care services or equipment was a major contributor to his death! The overall condition of the health services resulting in a lack of confidence in the major teaching hospital and national referral hospital led him to seek treatment in Kololo hospital (a clinic if you ask me) and International hospital -not a grade A hospital and certainly one that should not have better services than a tertiary and national hospital! This led them to take the risk of transferring him to Nairobi in the presidential jet which served as an adhoc air ambulance!
There is no saying if Mayombo would have survived had the relevant facilities been available in Kampala! But transferring him would almost certainly add to his risk of dying!
Mayombo was killed by the poor state of our hospitals -just like many Ugandans. And who better to blame than the people who have overseen our health system for the last twenty years!
the leaders of our country and the relevant ministers as well as the parliamentary committee on health and soical services should all take the blame for Mayombo’s death!
All that eulogising is out of shock and fear -the realisation that this could happen to any of them! Many of those in high places who have died before him have been older or had HIV or died violent deaths. As such they did not have as much of a shock factor. The realisation as well that wielding as much power as Mayombo did to the extent of having the presidential jet placed at his disposal did not save him, must have sent shock waves through many! Believe me if this happened to Kaguta at Rwakitura and it can, he would suffere the same fate!
No money or power is going to save them unless they fix our health system!