When disaster strikes, whether due to an accident or sudden illness, quick access to medical help can be the difference between life and death.
Yet, according to a new survey, Ugandans face significant challenges in responding to medical emergencies, from limited knowledge of emergency services to long wait times for treatment.
The Sauti za Wananchi survey, conducted by Twaweza in partnership with the Uganda National Bureau of Statistics (UBOS), explores Ugandans' experiences and perceptions of emergency medical services (EMS).
The findings highlight gaps in awareness, accessibility, and the quality of emergency care, despite the country's growing need for urgent medical intervention.
When it comes to responding to a medical emergency, many Ugandans rely on those closest to them. The survey reveals that in an emergency, 55% of respondents would turn to people nearby for help, while nearly 40% would head straight to a nearby hospital.
The survey also found that just 5% of people would call emergency response services, and an even smaller percentage would contact the police or other authorities for assistance.
Citizens in rural areas were particularly likely to seek help from nearby people, while those in urban centers, such as Greater Kampala, preferred to go directly to health facilities. The varied responses suggest regional differences in access to emergency services and the general public's understanding of how to act in a crisis.
One of the starkest findings of the survey was the widespread lack of awareness about emergency services. The survey found that an overwhelming 95% of citizens do not know the toll-free number for emergency medical services in Uganda. Only 3% of respondents knew that the number to call is 911, while 2% provided incorrect numbers.
This lack of knowledge is a serious concern, as the World Health Organization (WHO) has estimated that better emergency intervention could prevent half of the deaths caused by accidents or medical emergencies in low- and middle-income countries like Uganda.
"The fact that people don't know the emergency hotline is concerning," said Dr. Peter Ssebuguzi, an emergency medical professional in Kampala.
"In an emergency, every second counts, and if the public can't access immediate help, the consequences could be dire."
Approximately 15% of Ugandan households reported having experienced a medical emergency in the past six months.
While the number may seem small, it equates to more than one million households across the country, signaling a widespread need for urgent medical attention.
For those who sought care, the survey found that many experienced long wait times. On average, citizens had to wait 43 minutes at health facilities before being seen by medical professionals.
The wait time was longer in rural areas, with urban centers like Greater Kampala offering slightly quicker access to care. However, the wait was still significant, raising questions about the capacity and efficiency of Uganda's emergency medical infrastructure.
"Waiting for over 40 minutes in an emergency is unacceptable," said Joseph Taremwa, a 41-year-old father in Masaka who recently had to rush his daughter to the hospital after she fell seriously ill.
"In an emergency, you need immediate attention, not to sit around for over half an hour wondering if your loved one will make it."
Private Facilities Rated Higher Than Public Hospitals
Another key finding of the survey was the stark contrast in service quality between private and public health facilities. Citizens consistently rated private hospitals more favorably in terms of responsiveness and the quality of care, compared to their public counterparts. While private facilities were seen as more attentive to patients, public health services often received lower ratings, with many patients complaining of poor attitudes from healthcare workers and longer wait times.
"I've been to both private and public hospitals," said Irene Kasule, a 28-year-old woman from Kampala.
"At the private hospital, the workers are quicker to respond, and they seem more professional. In public hospitals, they don't treat you the same way, and the wait times are unbearable."
Despite these challenges, many citizens still rely on public healthcare services, which are often more accessible in terms of cost.
However, the disparity in service quality continues to highlight the pressing need for improvements in Uganda's public healthcare system.
The survey also explored Ugandans' knowledge of ambulance services. Only 20% of respondents knew of an ambulance service available in their area, and most of these services were either provided by local members of parliament (MPs) or private organizations.
Government-provided ambulances were far less well-known, further exacerbating the issue.
With limited ambulance access and public awareness, many citizens are left with no choice but to use alternative methods of transport, such as boda bodas (motorcycle taxis) or their own vehicles, to get to health facilities during an emergency.
Half of citizens rate emergency medical services as poor
Despite the vital role emergency medical services play, nearly half of all citizens surveyed rated Uganda's emergency response services as poor.
This includes the response time at emergency scenes, ambulance transport, and the quality of care at health facilities.
"The services are inadequate," said Jane Namara, a 50-year-old woman from Mbarara who had recently experienced an emergency. "We need more ambulances, better-trained staff, and quicker responses. The situation is critical."
In response to the survey findings, experts and public health officials have called for urgent reforms to Uganda's emergency medical system.
The survey recommends the establishment of regional call and dispatch centers to ensure quicker access to emergency services, improving public awareness campaigns to educate citizens about toll-free emergency numbers and available ambulance services, strengthening the capacity of health workers in emergency and critical care, and expanding first aid training programs to equip households and communities with basic emergency response skills.
The Ministry of Health estimates that Uganda needs 460 ambulances to support its healthcare system. However, the country currently only has 276 ambulances.
The Ministry of Health has since unveiled a 10 million Euro (about Shs38.7 billion) project for upgrading and renovating 30 health facilities.
Dr Diana Atwine, the permanent secretary at the ministry, said that the project targeting the Karamoja Sub-region will see many health facilities in the districts upgraded or renovated to improve service delivery.
The government has also unveiled a new reform in the health sector aimed at upgrading Health Centre IVs to community hospitals, announced Prime Minister Robinah Nabbanja during the parliamentary session last month.
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"Based on the Ministry of Health Draft National Health Policy 2024, Government has introduced a reform of upgrading the status of health centre IVs with 24-bed capacity to community hospitals with 60-bed capacity," Nabbanja said
"This will be undertaken in a phased manner, prioritising Health Centre IVs with high catchment populations and 135 constituencies without Health Centre IVs, based on geographical access, population coverage, and resource availability."
She noted that upgrading Health Centre IVs to community hospitals would save the country significant costs compared to constructing general hospitals in the 82 districts currently without one.
The estimated cost of constructing and equipping a general hospital stands at Shs 70 billion, while a community hospital requires Shs12 billion, according to the Prime Minister.
"Additionally, to fully operationalise a general hospital, the government would need recurrent costs, including wages, non-wage expenditures, medicines, and health supplies, estimated at Shs 12.238 billion per annum, whereas the annual recurrent cost for a community hospital is Shs 4 billion," Nabbanja added.
She also highlighted that since the 2018/2019 financial year, 381 Health Centre IIs have been upgraded to Health Centre III status, with 87% of sub-counties and town councils now having a functional Health Centre III.
Another 31 Health Centre IIIs are currently under construction, with Shs 4 billion required to address the needs of the remaining 488 sub-counties.
