5 January 2014

Uganda: Time for a National Health Fund

In 1948, Great Britain was still recovering from the rough consequences of the Second World War.

But one of the best prizes ever bestowed on the people (irrespective of whether one is a citizen or visitor) in the United Kingdom in the aftermath of the war was the National Health Service (NHS) that ensures that every person accessed free medical care.

In Uganda, the aftermath of the guerilla campaign saw the leader of the then National Resistance Army (NRA) Yoweri Museveni capture state and eventually sworn in as the president of Uganda on January 29, 1986.

It was in his inaugural speech that Ugandans were informed that what they had just experienced was not a "mere change of guard but a fundamental change."

Indeed, many things that later followed were changed fundamentally. Uganda through the cajoling and tutoring of the International Monetary Fund (IMF) and World Bank (WB) became a full convert of the free-market economy and reduced government role in many services.

President Museveni became the best salesman ever for privatisation of government enterprises. He often said that government was a bad businessman. So, as government enterprises that were deemed not to be self-sustaining were privatized, the concept of cost sharing was introduced in public hospitals. That did it.

The hospitals' structures deteriorated to the extent that some resorted to using charcoal stove to sterilise surgery knives and other equipment. The doctors started minding more about money than attending to the patients and developing the field of medicine.

Many people abandoned going to hospitals because they thought it was better in their view, to remain at home, die from there than be wheeled to the hospital and later incur costs of transporting the body from the hospitals.

We have heard of cases where doctors abandon their patients for money. They cannot attend to pregnant mothers until the letter pay money. This was the case in Mbale hospital where a one Nambozo died because the doctor could not deliver her by caesaraen surgery until the husband paid Shs 300,000.

There are several cases of that kind that have happened throughout the country. By the way, the privatization of health services was not accompanied by the requisite standards. It is evident to all that even the president and a bulk of his officials don't have faith in the medical services offered in Uganda. He and his well-paid officials seek services from Kenya and other countries.

How sad that the head of state expects the governed to believe in the medical services which he himself does not trust?

Even in the so-called sophisticated private hospitals, one is not guaranteed of proper services. In some cases, some private hospitals have become money- minting fields. It appears the privatisation of medical services also meant that regulation to ensure proper standards went to the dogs.

Government attempted to introduce medical insurance for Ugandans but this scheme fell flat on its stomach. And the reason was that the people promoting it were doing it the wrong way. We don't need a medical insurance. We just need a portion of our tax allocated to our health. They made things more complicated than they should have been.

Again the problem was that this was not a home-grown idea. It was an idea that was imposed on them by some powers. Uganda created the Uganda Road Fund. This fund is supposed to mobilise money to ensure that at any one time the roads agency needs money for construction or otherwise, the money is there.

We can still have a national health fund. This fund can be serviced in the same way as the road fund. The Ugandans and other people resident in country should be able to make an annual contribution to the health fund.

This fund will ensure that the medical workers are paid commensurately with the kind of services they offer to Ugandans. Also the fund should ensure that the hospitals and health centres are equipped and Ugandans have free medical services.

I believe if the teachers are assured that when they or their children or dependants fall ill, there is an ambulance to deliver them to hospitals, they may not even clamour for a pay raise.

There is evidence that some public workers are paid well because of the risks that are associated with their work and also the skills they offer. The same can be extended to the medical workers.

It is strange that government cannot afford Shs 500,000 per month for the teachers but it can afford to pay about Shs 60m to a single individual who heads a public agency.

To me the problem does not seem to be that we don't have money to pay for the services, it is just that government has just failed to use our taxes well. The government doesn't have to build a thousand medical centres which are not even attended to.

The one present that this government can offer Ugandans this year is free medical services. We need accountability for our taxes, and one of the bare minimums we can ask for is a functional national health system.

Twitter: @piuskm

The author is the finance director, The Observer Media Ltd.

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