Shortage of Medicines in Ugandan Hospitals & Health Centres

Shortage of Medicines in Hospitals and Health Centres retards Health Care

Despite government’s efforts to improve health service delivery, the facilities still grapple with inadequate and irregular drug supplies or no drugs at all sometimes. This has consequences on the whole health sector and its relevance to the citizens. In 2013/2014 financial year, the government under the health sector will focus on reducing morbidity and mortality from the major causes of ill health and premature death and to reduce the disparities in the provision of health services. To achieve this, a number of interventions have been proposed, some of which include; recruitment of key health personnel to ensure adequate staffing, provision of staff housing for health workers with special attention to under-served areas and all this works hand in hand with the adequate and regular supply of essential drugs in the hospitals and health centres around the country. The Health sector shares proportion of the national budget at 7.4% in the starting 2013/14 FY reducing from 7.8% in 2012/13, which is far below the Abuja declaration target of 15%.

Uganda Debt Network whose niche is in monitoring of Government Programmes to ensure prudent service delivery which is transparent reaching the intended beneficiaries in Uganda, visited some health centres as a sample and got alarming discoveries in relation to lack of or inadequate of drugs in Health centres which makes health service irrelevant to the wanainchi. Monitoring activities were carried out in Mulago Hospital – Kamuli District,  Namwendwa Health Centre (HC) IV, Kinawampere HC II, Kinu HC II, Bubago HC II, Nabilama HC II, Balawoli HC IV, Kasolwe HC II, Namaira HC II and Kibuye HC II. These health facilities had something in common which was lack of essential drugs retarding them to deliver optimally to the people.

In Mulago Hospital, Kamuli Town Council The hospital receives an average number of 400 patients per day from Monday to Friday. However, the delayed delivery of drugs to the hospital makes it hard to have services delivered adequately. The Anti-Retroviral Treatment Department has not received drugs since February although the Department is supposed to receive drugs every quarter. For instance 70 patients who were previously receiving “daption”, a drug that is given to those who are allergic to Septrin have become frustrated and no longer check whether the drug was received by the hospital for distribution apart from about 15 patients who constantly check. Instead the hospital has stocked more malaria drugs yet HIV/Aids prevalence is high in the district. HIV/Aids patients are therefore at risk of developing resistance to ARVs when the drugs are not taken regularly. This worsens their medical condition and response to further treatment.  In Balawoli HC IV in Balawoli Sub County there poor storage of drugs is on the rise. The drug store is too small creating high chances of drugs getting contaminated and turning them poisonous to patients. In Namaira HC II, there has been delayed delivery of drugs too. The HC has not received HIV /Aids prevention drugs, testing kits and other essential drugs like quinine since February 2013. The lack of operational materials/drugs could cause death of patients

It should be noted that inadequate or lack of essential drugs in Health Centres, has eventual consequences one of them being death and constant negligence of medical staff to deliver on their duties. Some health workers are reluctant and yet patients need their quick attention. A young lady of 19yrs (Nakirya Halima) from Butansi Sub County, Naluwoli Parish who had given birth to twins in April 2013 was not attended to and yet she was in a very critical condition. This happened even after Money, Jik and OMO which the medical staff asked for was provided by the care taker (mother – Nabirye). The mother of this lady was advised by other patients in the ward to use a local herb which she applied to save the life of her daughter. After 3days, they left the hospital without proper medical attention. Negligence by medical staff due to lack of drugs can lead to the death of a patient if not discouraged.

Nabirye applying herbs on Nakirya Halima after delivery of twins in Mulago Hospital, Kamuli district in April 2013. Medical staff neglected providing after birth services due to lack of medicine.

It’s the duty of the Districts in question to advocate for timely delivery of drugs by the Ministry of Health to the Health Centres. The district leadership together with the hospital administration should take this as a matter of urgency and set penalties for medical staff who neglect patients at all costs and there should be a reporting mechanism that can be shared with the Ministry of Health to ensure sufficient services are accessible and easily delivered to the intended beneficiaries.

The Government too through Ministry of Health should ensure that there is timely delivery of essential drugs to Health Centres and Hospitals to reduce on the dangers that can come up as a result of insufficient drugs like death, especially in hard to reach areas. Through this, Government will be able to achieve its target for this financial year 2013/14 which focuses on reducing morbidity and mortality.

Young generation should stay away from the Devil - HIV/AIDS

Stay away from the “Devil” himself

When we were growing up, my grandmother used to gather us up every evening while on holiday to narrate stories and ask us how our day had been. Being the only girl in a bunch of male voices, most of the time I would just listen attentively to every single word. And like they say “listening is a virtue” and I learnt a lot. My mother watching from a distance, always made sure that the scripture and Bible stories were part of the package for this would make us grow in the fear of the Lord.

The most captivating story was about the “Devil himself”. Silence was an indication that everyone’s heart beat was racing due to fear the story inspired in us! The devil was described to have sharp long claws, long hands, black as charcoal, red eyes, and scary protruding teeth that will haunt and devour us if we don’t stop doing wrong. When in bed, the dreams of the scary creature would keep emerging and not to be associated to the devil’s child we always tried to do right at all times.

In this age and era, HIV/AIDS is worse than the devil himself. It’s sad that HIV prevalence is taking root in the young generation. Getting back to history, the first HIV/AIDS case was identified in the country along the shores of Lake Victoria in 1982. Superstitions and witchcraft characterized the initial response from communities amidst lack of clear government response to HIV/AIDS. Consequently, the epidemic progressed very fast to all parts of the country initially concentrating in urban and semi-urban centres. In Sub Saharan Africa, where Uganda lies, bears the heaviest burden of the epidemic accounting for 28.5 million children and adults (about 64%) of those living with HIV/AIDS globally while about 97% of the AIDS related deaths in 2005 alone occurred in this region.

As we speak, Uganda has the highest proportion of children orphaned by HIV/AIDS worldwide, and 7.2 percent of Uganda’s population is living with HIV. This amounts to an estimated 1.4 million people, which includes 190,000 children. An estimated 62,000 people died from AIDS in 2011 and 1.1 million children have been orphaned by Uganda's devastating epidemic. HIV prevalence has been rising since its lowest rate of 6.4 percent in 2006. New infections are diagnosed in 150,000 people a year, of whom 20,600 are children. Sadly, almost a quarter of people living with HIV in Uganda are part of the education system - like students. Only 39 percent of young people aged 15 to 24 know all the necessary facts about how HIV can be prevented, suggesting a lack of clear sex education in schools and hence having more HIV prevalence in women/girls at 5.4 percent, compared to 2.4 percent amongst men/boys.

Every minute that passes by, the devil keeps on spreading wings trying to get the young people and deny them a bright future by getting them involved in risky sexual behavior. The increased exposure of youth to pornographic materials has a direct impact of on their sexual behavior.

However, a lot more can be done to stop the long hands of the enemy. Like the fear the devil inspired in us, HIV/AIDS should scare the young people off all channels of the killer disease. There is need for effective Voluntary Counseling and Testing Centers (VCTs) which are not discriminatory not to hinder many young people seeking for counseling, getting tested and accessing treatment (including access to life saving ARVs). Behavioral change communication messages should be emphasized to involve the young people and conceptualize them towards a youth focused environment.

The ABC approach should be repackaged to emphasize “A” for abstinence considering it’s the only sure ticket to a free HIV generation. Comprehensive curriculum expansion of peer education activities including peer counseling, and mainstreaming HIV/AIDS into all youth

Programmes and activities should be considered. Youth-adult relationships need to be built firmly because young people need role models, people they can trust and relate to.

If we are to make significant advancements in the fight against HIV/AIDS in the young generation we must ensure that young people are included at the frontlines of the struggle. It’s time to stay away from the “devil himself”, get tested, know your status and live a healthy life, if positive, get counseling and live a healthy positive life.

The devil – HIV/AIDS is a living reality but together we can avoid it by living our lives responsibly, the future is in our hands as the young generation.

Teenage Pregnancy in Uganda.

Theme: Teenage Pregnancy in Uganda.

Teenage pregnancy took the life of my childhood friend and Cousin Sister.

As statistics would have it, in Uganda, alarming rates of teenage pregnancies are becoming a major cause for worry to the women rights movement and a possible threat to national development. Pregnancy rates amongst teenage girls are quoted at 25% (Uganda Population Secretariat, 2011), making Uganda one of the countries with the highest rates of teenage pregnancies in Sub-Saharan Africa. At this age, it’s expected that any child should be acquiring an education which would brighten their future prospects; unfortunately, for many young women this is not the case.

The year 2003 will always be remembered as a year that snatched my only childhood friend and sister Ruth Ninyesiga out of this world. At a budding and fruitful age of 17 years she left a gap and a hole full of pain in my heart. Being born in a family of four with no sister to look up to, Ruth came in handy as a replacement. We grew up together, shared every little moment and smiles that kept me company even in the schools we attended together. My mother was glad I had found a reliable sister in Ruth. 

As fate would have it, Ruth became pregnant as she was about to sit for the senior four (UCE) exams. It was shocking and held me back for a while with tears in my eyes, Hard to believe as it were, it was real and in my face! She was asked to leave the school and my mother decided to get her another school to at least complete. Sadly Ruth was very disappointed with her-self and decided to have an abortion which took her life due to heavy bleeding!

My eyes are wet as I write this story because it’s vivid in my mind. Seeing my friend’s lifeless body gave me goose bumps. The picture is engraved in my head like a stamp. Ruth left me due to teenage pregnancy. However, some are lucky to go head and give birth to innocent children. As it were with Ruth, teenage mothers are often not able to complete secondary school which makes it difficult for them to find decent jobs to take care of themselves and their children. 

In Uganda, increased sexual abuse of children (at least 628 children are defiled per month) has become a major contribution to this evil. However, sometimes teenagers have consensual sex- (not protected) which can be blamed on the moral decay in the society and exposure to high level technology.

With Ruth’s experience I vowed to make her proud by achieving the dream that we had all vowed to get to. She wanted to be a lawyer and fight for rights of the needy and poor. Despite the sadness that will never leave my heart, I wear a smile for having managed to make her proud. I’m now a young lawyer working in an NGO Human Rights department ensuring that Ruth lives on through me. The story inspired me to be part of the young youth activists who inspire other young people not to be diverted and work hard to achieve their dreams they set out to achieve.

Uganda has put in place various policies to address teenage pregnancies but like many other policies, these have largely remained on paper and implementation has been very minimal. The National Adolescent Policy states that pregnant adolescent girls should be readmitted to school after they have delivered their children but this does not happen in most cases. Often, schools are not willing to re-admit a teenage mothers claiming that such students would set bad examples for the rest of the students. Teenage mothers face stigma, from their peers, families and even their teachers. 

The Government needs to ensure the policies in place are implemented; teenagers are sensitized about the dangers of teenage pregnancies, impact on their studies, future, families and communities they live in. Teenagers too have a role to play in ensuring that they are empowered and that their different potentials are not brought to a halt by getting involved in risky sexual behavior at a young tender age. Parents too should ensure that their children are educated on the evils of early pregnancies and not leave the job for the teachers. Teenage pregnancies are real; together we can fight for our uninterrupted future.  

If it wasn’t for the teenage pregnancy that took Ruth’s life at a tender age, am sure she would have been here to share the success that we all hoped to achieve. Through me, Ruth’s dream is ALIVE. 

Teenage Pregnancies are real. Together we can avoid them.

Written by: Adellah Agaba

adellah_agaba@yahoo.com

Mob: 0782/0702 - 171265.

The 2013/14 National budget falls short of promoting access to health facilities by the poor

The 2013/14 National budget falls short of promoting access to health facilities by the poor

Investment in the health sector is considered to be key for a country’s economic development. In 2013/2014 financial year, the government under the health sector will focus on reducing morbidity and mortality from the major causes of ill health and premature death and to reduce the disparities in the provision of health services. To achieve this, a number of interventions have been proposed, some of which include; recruitment of key health personnel to ensure adequate staffing, provision of staff housing for health workers with special attention to under-served areas, and improving the governance and efficiency in health service delivery through joint supervision and monitoring in collaboration with non-Governmental health institutions among others.
In the next financial year, the budget for the health sector is projected to rise from Ushs 852.2billion in FY 2012/13 to 940.4 billion in FY 2013/14, implying an increment of Ushs 88.2billion in nominal terms. Despite the nominal increment, the health sector share proportion of the national budget is projected to decline from 7.8% in 2012/13 to 7.4% next financial year, which is far below the Abuja declaration target of 15%. The increment in the sector budget is largely due to the increase in the recurrent budget which is projected to increase by about Ushs 45.6 billion. This increase is projected to consume over 63% of the sector budget, implying that the administrative costs remain high as a proportion of the sector budget, which is a major concern for the much needed investment required in the sector infrastructure, since less of these resources will be spent on actual service delivery. This perhaps explains why some health indicators are still poor. For instance, deliveries in health centres currently stand at about 40%, still below the 50% HSSIP target for 2011/12, infant and  maternal mortality are still high in the country among others.

With new tax proposals announced by the Finance Minster, the situation in the health sector is likely to worsen especially for those living in rural areas. The proposals to increase excise duty on petrol and diesel by 50/= and the increase in motorcycle registration fees by 70,000/= will affect access to health facilities by rural poor households since it will translate into an increase in bodaboda fares as the tax will be transferred to the final customer. Since boda bodas are the most common means of transport used in most rural areas to transport patients and expectant mothers to health facilities, this will affect access to health facilities by the poor households. Hence, the 88.2billion increment in the health sector is virtually meaningless to communities if they cannot access health facilities.

Government should invest more in Referral Hospitals FY 2013/14

Government should invest more in Referral Hospitals FY 2013/14

By Adellah Agaba

The National Health Policy is driven by the National Development Plan (NDP) which provides thematic areas of development including health, education, water and sanitation, agricultural production and human resources development and management.

The mission of the health sector is to attain a good standard of health for all people in Uganda. Sadly, geographical access to health care has been limited to about 49% of the population.

As a strategy to bring health services closer to the people, decentralization of health services was encouraged with an aim of taking services closer to the people and improve geographical access, particularly to the rural poor. The aim was further to lead to improved options for target group oriented health service delivery, and more transparency and accountability through closer responsibilities by the poor in rural areas.

However, the poor health facilities in health centres have left patients with no alternative but to go to referral hospitals leading to overcrowding and easy spread of disease. On a daily Mulago referral hospital among others receive an overwhelming number of patients’ per-day most of them from rural areas. This has taken a heavy toll on health service delivery at referral hospitals in Uganda. Any hospital, including a district hospital, will receive referrals from lower levels of care.  Referral hospitals come into play where health care providers at lower levels of the health system, lack the skills, the facilities, or both to manage a given clinical condition hence seek the assistance of providers at the referral hospitals.

Shockingly with the day to day increasing number of patients in the referral hospitals in Uganda, working conditions of health workers have become very difficult, characterized by poor infrastructure, lack of staff accommodation, inadequate equipment and supplies, work overload and inadequate remuneration. These poor working conditions do not attract staff nor motivate them to stay making it hard to have services adequately delivered to the intended beneficiaries in the hospitals.

It should be remembered that health is a key element of social and economic growth and its one of the major sectors that can directly impact on poverty eradication. With the budget for the health sector projected to rise from Ushs 852.2billion in FY 2012/13 to 940.4 billion in FY 2013/14, a lot of expectations from the citizens will have to be put into consideration. The health sector share proportion of the national budget is projected to decline from 7.8% in 2012/13 to 7.4% next financial year, and is far below the threshold of 15% agreed upon by African leaders in the Abuja declaration of 2001.

In Financial Year 2013/14, Government should invest more in referral hospitals and equip them with the basic drugs and facilities and ensure services are easily accessible to all citizens.