Kampala, Uganda — Kilembe Hospital which is the biggest medical facility near Kilembe town and serves the residents of the Rwenzori mountains sub-region beyond as a general hospital is on the verge of closure.
The 200-bed capacity hospital on the banks of River Nyamwamba and nestled in the valley surrounded by hanging mountain ranges has been running on a public private partnership spearheaded by the Catholic Church in Kasese and the Ministry of Health. It has been getting an annual allocation of about Shs354 million from the Government.
The hospital is the largest health facility in the area serving over eight sub-counties. The next largest hospital is Bwera Hospital which is in the extreme south of Kasese near the Mpondwe border post with the Democratic Republic of Congo, some 86km from Kilembe.
But it is on a drip after the Ministry of Health decided to cut off medical supplies and order staff that were paid by government to be transferred to other government health centres.
Resident and local leaders say the hospital which was established in 1951 serves a hard-to-reach community in the Rwenzori Mountains who often rarely access quality health services owing to the tough mountainous terrain. They oppose its closure.
The residents said their right of health has been denied as the hospital also served people from Busongora North with its 13 sub-counties and Busongora South with 10 sub-counties.
Florence Kabugho, the Kasese Woman Member of Parliament said it was unfortunate for the Ministry of Health to take such a serious decision without engaging local leaders from the district.
"You have seen the topography. People come from far and so when you cut off medicines, you declare death. Government is revamping other services after the floods - I hear they are looking for an investor to restore mining. Let them consider the hospital too," said MP Kabugho.
"It is wrong for government to leave thousands of residents of Kilembe and surrounding sub-counties with no hospital," says Eliphaz Muhindi, the Kasese District LCV Chairman, "Rukoki Health Centre IV which is being used as a nearest government health facility is far away and out of reach for people living in Kilembe Mountains."
He added: "We cannot put the lives of our people at risk like our mothers who used to come to deliver from Kilembe. I request that you stand with us, Kasese leaders, to ensure that the image of government is protected by having this hospital functional."
In the region, Kilembe Hospital had curved itself a niche of handling complicated bone treatment in western Uganda. Its orthopedic surgeon was one of the four orthopedic specialists in the country. Owing to the high incidence of traffic accidents, Kilembe Hospital had become a centre of reference for the whole of Western Uganda. Now that the hospital has closed, the community is at a disadvantage.
The government's action is the latest in a series of misfortunes to hit the hospital. The 2020 floods left its building and other the infrastructure seriously damaged. The flood torrents of River Nyamwamba swept boulders that crushed some hospital houses leaving the facility heavily destroyed.
In 2021 the hospital was temporarily relocated to Kasese town. By then the government of Uganda, Kasese Catholic Diocese and Kilembe Mines Limited had agreed to keep the hospital running with medicines and supplies, medical equipment and medical personnel.
However when this tripartite agreement expired in May 2022, there were no efforts to renew it.
The hospital was started by the copper and cobalt mining company to cater for its personnel in 1940s. In 1982, the copper mining activities were stopped but the hospital remained a community hospital. The mines which had just resumed operations after decades of closure were interrupted by flash floods.
Furthermore the Ministry of Health cut off the medicines supply line while the Kasese Catholic donors' taps stopped. The diocese decided to concentrate its efforts on St. Mary's Hospital in Kasese town. With these developments, Kilembe Hospital administration was left hanging dry with not alternative source of medicines, an essential service a hospital provides.
By November 2022, the hospital was undergoing a rough patch as it went without essential medicines for 6 months after it was relocated to Kilembe from Kasese town. Patients began fleeing and avoiding the hospital. Pleas from the locals and areas leaders to government to support the hospital went unheeded.
Patients say they are being turned away and referred to other health centers in town for medical examination and treatment due to a lack of essential medical equipment and drugs.
Dr. Bernard Balyana, the medical superintendent says that the hospital lacks anti-malarial drugs, antibiotics, vaccines, medical equipment such as x-ray, ultrasound machines, and medical supplies such as syringes, gloves, and gauze among others. He said that since they shifted back to Kilembe, they have also been struggling to make referrals due to the lack of an ambulance.
On December 2, last year, the Permanent Secretary of Ministry of Health wrote to the hospital and Kasese District leadership that the ministry was deactivating Kilembe Mines Hospital's credit line of essential medicines and medical supplies.
The PS argued that the hospital had failed to utilise funds for essential medicines and health supplies during the first quarter of the financial year 2022/23 covering the period between July and September 2022. This was not well received by the community and the leaders.
The area MPs and local leaders petitioned the Ministry, Parliament and the Prime Minister to have the Ministry of Health's decision rescinded but in vain. On Jan.09, the Police foiled a demonstration by residents of Bulembia division and surrounding areas in Kasese municipality who were protesting the decision of not supplying medicines to Kilembe Hospital.
Under pressure, the Ministry of Health defended its decision arguing that the tripartite agreement between the Ministry of Health, Kilembe Mines Hospital, and Uganda Catholic Medical bureau-UCMB expired in May 2022 and it had not yet been renewed, so the ministry did not have any financial obligation to the hospital.
However, the Ministry of Health's spokesman, Emmanuel Ainebyoona noted that the Ministry is planning to construct a public health center IV in Bulembia division to ensure access to health care in that catchment area. He did not indicate when this would be implemented. So the people who were getting services from Kilembe Hospital will wait longer or try elsewhere.
Closure activity continues
Even when Parliament's Health Committee recommended that the Ministry of Health should reinstate Kilembe Mines Hospital on the list of facilities that qualify for essential medicines and health supplies, the Minister of Health, Dr. Jane Aceng, had said she cannot commit drugs to a hospital that will be swept away by floods any time.
For now the hospital is relying on the support of the Belgian non-profit organisation, Daktari Project, but this can only do much.
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Elisa Rutahigwa, a member of the Health Committee said that whereas government plans to establish another facility in the area that should not stop the supply of drugs to the existing one, which is handling patients. He however said local leadership should stop politicising the issues of Kilembe Mines Hospital and focus on the greater goal of providing better health services to their community.
The former Kasese woman MP and member of the Kilembe Mines Limited board Loyce Biira Bwambale said the pull and push over the hospital was a result of a poorly done transition process after the end of the tripartite agreement between the government, Kilembe Mines limited and Catholic Diocese last year.
The Kasese municipality Member of Parliament Ferigo Kambale told the committee that the existence of structures offered by Kilembe Mines Limited to host the hospital is a clear indication that both the company and the community appreciate the value of such a big facility in their area.
Kasese District CAO, Elias Byamungu, said that he was hesitant to recommend the construction of a hospital in the valley because of the high risk of flooding which would destroy the buildings. On Feb. 3, the CAO wrote to the medical Superintendent of Kilembe Hospital to get the hospital staff, equipment ready for the transition to Rukoki Health Centre IV.
"Stop requisitioning for any more funds. Take stock of all equipment with assistance of Kasese District or Municipal Council Auditor for handover within the next two weeks, ensuring nothing is looted. Get the police to guard the hospital premise on a 24-hour basis until all equipment is transferred to the new cost centre -Rukoki Health Centre IV," reads part of CAO's letter.
