The current tripartite crisis of food insecurity, climate change, and pandemic outbreaks like Covid-19 and Ebola underscores that Uganda needs a robust and resilient public health system now more than ever.
The 2016 Uganda Demographic and Health Survey shows that approximately 88 per cent of the population uses government healthcare facilities as the first point of care. Still, the 2021 National Service Delivery Survey indicates that 45 per cent of people do not access public health facilities because they are too far away. Likewise, 56 per cent of communities access healthcare within 3kms country-wide, with Lango having the lowest population proportion at 40 per cent, followed by Karamoja at 43 per cent.
Similarly, emergency rooms at public healthcare facilities are overcrowded, ambulances lack operational costs, health workers are on strike, and social determinants of health like education and social protection, to name a few, are worsening.
How many crises will it take to fix our public healthcare facilities? At what point does the government wake up?
In his recent State of the Nation address on the status of Ebola, Ugandan president Yoweri Museveni urged people to seek medical attention from the nearest health facility if they have Ebola symptoms.
What if the nearest government health center is too far away to walk to? What if the government health facility is out of reach due to transportation costs? What if the nearest government health center is understaffed and lacks essential drugs? Where should such a person go for medical attention?
In contrast, the private healthcare sector continues to capitalize on the unmet demand for healthcare caused by the overstretched public health system. Moreover, it fails to reach everyone given its profit maximization focus and prohibitive costs, particularly the poorest and most vulnerable.
The Initiative for Social and Economic Rights' report, 'Profiteering off the pandemic' underlines that even in the midst of a pandemic, private facilities will choose profit over lives.
In light of the foregoing, Dr Paul Farmer, a global health champion, rightly expressed, "if access to healthcare is considered a human right, who is considered human enough to have that right?"
It is, therefore, evident, that government must remain in control and it cannot abdicate its role to provide quality health care to the private sector. Considering high out-of-pocket health expenditure and government under-financing of the health sector, a publicly-funded and people-centric health care system is essential. First, it is inclusive of everyone regardless of socio-economic status.
Second, it lessens the financial burden on individuals. This is key to ensuring the country can withstand outbreaks such as Ebola or Covid-19. To build a robust public health system that will deliver universal health, it is critical to confront the resource question. As such, the government must ensure that the wealthy pay their fair share of taxes, curb corruption and illicit financial flows and reallocate resources from other sectors to the public health system.
As Ebola and Covid-19 have spotlighted, our health is interconnected, which means that creating meaningful alliances with communities can accelerate progress toward universal health. This calls for a fair redistribution of power across society by paying close attention to policy development and implementation processes.
Thus, it is our duty as advocates and policymakers to use our positionality and actively listen to community voices that have been long-gone unheard and neglected whilst decentering ourselves. Communities should shape the policy responses at the onset. Make no mistake, in an epidemic, the rich will not be insulated if the poor can't get healthcare.
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So, imagine a Uganda where everyone has access to affordable quality healthcare. Imagine a Uganda where the public health system is adequately funded. Imagine a Uganda where its people are empowered with the relevant knowledge to monitor and hold the government accountable.
Such a Uganda, in my opinion, is not only possible but also fair and just. Even though it will not happen overnight, it is important to progressively work toward investing in a public health system that is fit for purpose.
The author is the program officer, Right to Health Initiative for Social and Economic Rights
