Uganda’s health services -why your politicians seek their healthcare abroad!

Posted on June 5, 2011

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authored by Ddembe on 2. January 2010 at 20:03
 
There’s also an element of information, communication and education required for the general public, but this is contingent on funds. What also makes things worse is the lack of adequate human resource for healthcare, and health units, if there were enough health units equitably dispersed across the country, then it would provide health clients with a viable alternative to unqualified, or unscrupulous health providers, but alas, FUNDS are in the lacking.
 
I can hear what you are saying.
 
However, I believe we place too much emphasis on money and funds!
 
There are certain things that are simple.
 
Take an example of drug stores. Licenced to unqualified people, for the purpose of selling “over the counter drugs” (OTC’s) and non prescription rememdies, they function as unlicenced and unsupervised pharmacies! To add to the confusion, they are allowed by the MOH to stock prescription items such as antimalarials which they are allowed to dispense without prescription against a range of non specific and non diagnostic symptoms as part of the national anti malarial campaign!
 
While one could argue that this is warranted given our resource poor setting where pharmacists are in such short supply they are allowed to cover several pharmacies even when it is obvious they cannot possibly supervise them given they cannot be in more than one place at the same time, particularly given the same pharmacists usually have a full time day job in industry, academia, government (administration or clinical) or marketing (big pharma)! One would have thought that if we believed that our setting demanded that we accept a lower cadre of dispensers with poorer qualifications functioning as pharmacists or dispensers, we would at least have some sort of certifcation requirement for people who own run or operate drug stores! We dont. I can give you an example of one I knew many years ago owned by a secretary who was the “musawo” after work and run by her nephew who was a primary school dropout during the day! Once my grandmothers heart pills needed dispensing against a doctors prescription. The idiot substituted digoxin for lasix because they were both “heart pills” and he had no stock of lasix! He thought it was logical! Fortunately I happened to be around and picked up the error. I suspect when she died later, there was a drug error involved!
 
It is not impossible to verify the drugs sold by these “drug stores”. one only has to visit the nearest corner. Coupled with some high profile publication of legal action against culprits and long custodial sentences, there would be little incentive for drug stores continuing to flount the rules and functioning as illegal pharmacies right under the noses of regulatory agencies! But this is the story of Uganda and government agencies! You do not have to jail everyone to get the message across! You just have to jail a few high profile cases for a sufficiently long time for people to decide that the consequences are too high. But given our record as a country in the ‘war against corruption” where no one of any consequence has ever been convicted, what do you expect?
 
One should talk about clinics. Most “clinics” around Kampala and upcountry are run by unqualified staff from sweepers to relatives from the village to enrolled nurses and medical assistants. They however are registered to a medical doctor whose only role is to provide his name for the licence for a fee -just like the pharmacists with the pharmacies!! Theoretically the clinics are under his or her supervision something that is usually geographically impossible given he is usually busy with his own day job or his own private practice! the licensing bodies know this and are a part of the racket! these clinics do everything like offer quack treatments to abortion services (officially illegal in Uganda)! i spoke to one this week at the request of my mother who had been offered the third course of antibiotics for what was clearly a viral bronchitis! She declined the antibiotics as she rightly should. The “doctor” explained to me that given her cough had not responded to “powerfull antibiotics” before including injections, she needed even more powerfull antibiotics which frankly was horse manure! I said no thanks! She is doing fine without the antibiotcs! These “doctors” do not like to reveal their names or their specialties. Clients are just supposed to take it on faith that they are doctors! In one where i asked for the name and specialty of the doctor ( I wanted a paediatrician) the receptionist cum practice nurse asked whether I would know all of their doctors and refused! “Ye no ono alowooza abasaawo baffe bonna anabamaanya?” She assumed I didnt speak luganda!!! I spoke to her boss (in luganda right in front of her to her astonishment), a paediatrician on my mobile made an appointment, left, and came back later the same day to see a proper paediatrician! Many Ugandans are afraid to ask simple questions like who the doctor is, what they are suffering from and what treatment they are being offered and why! I insist that my parents ask these questions!
 
You mentioned health inspectors! Anyone who has ever had anything to do with health inspectors from KCC to distric level knows that health inspectors are some of the most corrupt civil servants in Uganda even though they do not appear in the corruption report! Again this does not require muc research! Take a walk around Kampala and surrounding surburbs. Every illegal building and they are everywhere has got a building permit which includes a health inspectors report! All are signed off. It is a lucrative market given the amount of construction in Kampala. BUT as you would see from your walk around, there is no service given for money! A carefully planned sting with a well publicised trial and a long custodial senetnce would go a long way towards controlling some of these wayward officials.
 
The bottomline is that there are many things wrong with our health system that need more than money to fix! the absence of money has simply become an excuse to continue incompetence! Our medical training is stuck in 1970 with little specialist training beyond general surgery, othopaedics, paediatrics, Obs/gyn, General or internal medicine and public health. As a matter of fact, the bulk of physician emigration in Uganda is not to South Africa, Rwanda or Europe, -it is out of the clinical ranks into the administrative ranks (MOH, WHO, and various HIV NGO’s and reearch organisations) mainly through public health which is the only recipient of donor support through scholarships. There is no requirement for elective research or overseas training as part of speicalty training leading to a generation of “inbred” doctors whose only experience of medicine and surgery is what is done in Mulago!

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