According to the Ugandan government’s national health policy, every parish is supposed to have a health centre II, III, IV and Hospital. Health Centre II facilities should serve a few thousand people and treat common diseases like malaria. It is supposed to be led by an enrolled nurse, working with a midwife, two nursing assistants and a health assistant. It also runs an out-patient clinic treating common diseases and offering antenatal care.
Health centre III should be found in every sub-county in Uganda. Theses centres should have about 18 staff, led by a senior clinical officer who runs a general out-patient clinic, a maternity ward and a functioning laboratory.
Health centre IV is a health facility that serves a country or a parliamentary constituency. It is a mini hospital, which should have the kind of services found at health centre III, but it should have wards for men, women and children and be able to admit patients. They should have a senior medical officer and another doctor as well as a theatre for carrying out emergency operations.
Each district is supposed to have a hospital, which should have all the services offered at a health centre IV, plus specialized clinics such as those for mental health, dentistry and
consultant physicians.
At the top of the health care chain is the National Referral Hospital located at Mulago in the capital Kampala. This is where some of the best medical brains in the country are found.
But after getting the pictures of these health centres look like and should provide, most health centres in Uganda have similar problems.
Poor sanitation in the general health centres is terrifying and put the lives of the patients at risk because they come to get treatment but end up getting new infections.
Centres are given less drugs and sometimes expired drugs from National Medical stores instead of what they request.
Lack of staffing is a big issue, some centres have no doctors. For example Bwizibwera health centre IV had only one doctor who left three months ago. Nurses act as doctors and midwives.
Some patients claim that nurses beat up women who go for delivery, in most health centres but more commonly in rural areas.
The bed capacity is less and cannot accommodate the overwhelming number of patients the centres get from more than six sub counties. For example at Kawempe health centre IV patients were laid down on the floor.
Most of these health centres have no fridge to keep blood and they are forced to refer patients. Transport is a problem because of long distances from the health centres to the main hospital which leads to complications in child birth and death on the way.
The issue of charging money from patients in order to treat them is another problem in these health centers. The government provides equipment which is not enough to facilitate overwhelming number of patients.
This is also a difficulty for a poor rural people and frustrates the government’s program of health for all.
Recently civil society organisations (CSOs) asked Members of Parliament to correct a crisis in the health sector by recruiting 5,000 health workers and increase their allowance in financial year 2011-2012, in order to motivate them to keep at work. CSOs believe that if health workers are paid well then this would save the lives of mothers and children.
People are given drugs without diagnosing them this increases chances of drug resistance due to treating wrong sickness.
Maternal health issues have highlighted many cases of Ugandan women in rural areas dying while giving a life, such as the case of Sylvia Nalubowa of Mityana district who died while giving birth to a second twin due to the neglect of health workers in 2009. Events like these have angered CSOs and sparked off the campaign against the government’s neglect in facilitating these community-based health centres, which leads to the death of 16 women every day in Uganda while giving birth.
Government officials have raised concerns about this especially CSOs but nothing has yet changed. Women continue dying and petition 16 on maternal health is still pending because judges continue adjourning whenever they sit.
Recently (September 2011) doctors in Mbale were arrested over the death of woman in labour. She was allegedly brought to the main Government hospital in the district around 6am but the medics demanded 300,000 shillings to attend to her. She wasn’t able to raise it and later died at 8pm after failing to push the baby.
The government has made remarkable changes by transferring doctors and nurses from different health centres to others but that cannot solve the problem of poor working conditions. Solutions to this problem, and increasing salaries, could motivate medical staff to remain working.
“In Uganda nobody wants to see anybody dying even it is one woman and if they are dying they should not die of things which are preventable and manageable,” said Resident District Commissioner Clement Kandole.