“Shs. 63,000 per person for annual medical care is low”

Around 2,000 women, children and men brave the scorching sun and long lines in the Kampala suburb of Bukoto, waiting for free health care at a medical camp.

It’s August 12, the last day of a two-week camp organized by supporters for destitute people who cannot access care in hospitals due to high costs and other factors.

“People are broke and they cannot afford the cost of medical services in hospitals, especially in these times. We see 4,000 patients a day,” says Dr. Ezra Kibirango, the camp’s chief medical officer.

Dr. Kibirango adds that more than 60% of patients sought more than one service, including dental, eye and reproductive health services. This signals serious gaps in access to health services, he adds.

This confirms the Multidimensional Poverty Index (MPI) report released by the government in July. The index, among other things, indicates that up to 18 million Ugandans (42% of the population) face some form of deprivation in access to health care and other social services.

Specifically for health care, the MPI report showed that 14% of Ugandans (six million) are deprived, a figure that some researchers say does not reflect the entire deprivation.

The Uganda Bureau of Statistics (Ubos) in the MPI measured the effective utilization of health services and considered access to health care in terms of distance to a health facility, cost of accessing care and quality of care. This involved assessing the availability of qualified staff, the attitude of staff and the availability of drugs.

Ubos considered a disadvantaged household if at least one member of the household was sick in the 30 days preceding the survey and did not seek care for various reasons. A household was also considered destitute if a member who fell ill in the last 30 days consulted a health care worker, but the first place of consultation was outside the household’s five-kilometre radius.

The report clearly indicates that “the greatest deprivations relate to access to improved toilets (76%), construction materials (65%) and electricity (65%)”, which are important factors determining the health of family or community members.

Mr. Vincent Ssenono, Senior Statistician of Ubos, noted that the lack of toilets predisposes the family to a number of increasing diseases, which drain the limited resources of the family and affect productivity.

“The inability to access electricity and its high cost force people to use charcoal, which affects the environment and increases the risk of respiratory diseases,” he said.

Mr. Richard Ssewakiryanga, senior researcher at the Center for Basic Research, believes that the choice of health indicators should be improved to capture the true extent of deprivation.

“Households can do very well on some of the measures that we have put in place, but then they have other elements in the household that we have to think about,” he said, citing, for example, “ whether a household has a disabled person or a mentally ill or bedridden person.This, he added, “may not be taken into account in our measurements”.

Mr. Ronald Ocira, 43, a resident of Mutungo-Bbiina in Kampala, told this reporter from the August 12 medical camp that lack of money prevented him from accessing specialist services. He traveled 10 km. “I suffer from intestinal problems, but I received the medicine and I am convinced that I will recover,” he revealed.

In Kampala, medical consultations cost between Shs 50,000 and more for complicated conditions. This is usually before one receives medication or other forms of medical care.

The situation is no better outside the central region. Mr Bonny Opio, 27, from Lira City, told the Saturday Monitor he had not been to hospital four months after he started having haemorrhoids.
“I don’t have money for surgery right now. I’m still living with the disease, but I hope it will go away [on its own],” he said.

According to medical experts, when you experience persistent discomfort, pain or itching for a week due to hemorrhoids, a visit to the doctor is enough. The disease can be managed with medication or surgery, depending on the stage and severity.

A 2017 report by the Center for Economic Policy Research on Universal Health Care (UHC) coverage in Uganda indicated that there are fundamental challenges with the health infrastructure in Uganda.

During the working week leading up to the August 12 health camp, Dr Jane Ruth Aceng, Minister of Health, told the Parliamentary Health Committee that the government was fast-tracking the national health insurance scheme to improve the CSU. She added that they want the law in place this year.

Dr Aceng also told the same committee that the government is constrained by 10 shortcomings, including insufficient funding, a shortage of specialists and inadequate equipment.

Information from the Ministry of Health indicates that up to 74 districts in the country lack government general hospitals, which means that people have to cross districts or travel to Kampala for medical treatment.

“The estimated cost of construction and equipment is 70 billion shillings per hospital and the total cost for 74 hospitals is 5.1 trillion shillings,” Dr Aceng revealed, adding that the creation of new districts does not correspond to the need for additional funds for the establishment. health facilities and the provision of services to the population.

She said the government allocates each Ugandan only Shs 62,900 per person per year for medical care. This, Dr Aceng added, is well below the minimum requirement of Shs 125,800 to receive essential health care.
The 62,900 Shs can only treat one episode of malaria attack at low level clinics in Kampala where people are charged between 60,000 Shs and 100,000 Shs for treatment depending on the severity of the disease.

Dr Aceng said most of the funding for the supply of essential drugs comes from development partners.

“Public funding available for essential drugs and health supplies is Shs 9,285 per capita [of which 36 percent is for antiretrovirals or ARVs],” she says.
She added: “It is well below the recommended 44,000 shillings per capita. Development partners contribute up to 64% of drug financing, primarily for ARVs, HIV test kits, TB drugs, malaria and reproductive health commodities.

She said the projected funding gap for essential medicines and health supplies over the period 2020 to 2025 is 5.7 trillion shillings. This essentially means “there is an urgent need to increase public funding for drugs and medical supplies”.

Dr Kibirango agrees, adding that there must be a deliberate policy to increase funds channeled into health care.

About Antoine L. Cassell

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