By Flavia Nassaka
A lot achieved in health, a lot more needs to be done
The year 2015 ended badly for some of the staff at Abim Hospital located in the relatively new district of Abim in north eastern Uganda. The hospital which is one of the biggest and the oldest in the Karamoja region was constructed in the 1960s and opened by former President Idi Amin Dada in the early 1970s. Since then, it has been largely forgotten, left to fend for itself with derelict buildings, empty, bat-infested wards, a broken water and electricity system and lean and demoralised staff.
Working in Abim Hospital is a labour of love since the nurses sometimes have to provide their own uniforms and go for months without pay. The hospital has not had a doctor for years and was in 2010 the epicenter of an epidemic of suspected plague or yellow fever which killed 53 and infected over 224 in 10 surrounding districts.
So when on December 05, 2015 Santina Adong, the hospital’s most senior member of staff at the rank of Senior Nursing Officer, received an unexpected from one of the presidential candidates in the 2016 elections, Dr Kizza Besigye, she possibly thought it best to expose the rottenness of the hospital. She explained that the hospital has had not doctor for years and lacked even the most basic medical equipment. This election campaign time and politicians can be quite generous at this time, she might have thought.Big mistake.
Two days after Besigye’s tour, the nurse received a letter from Moses Kaziba Nandhala the Abim district Chief Administrative Officer (CAO), the top civil servant in the area. He accused Adong of breaching government standing orders, which bar public servants from revealing government information and ordered her to explain herself under threat of disciplinary action. Kaziba also warned two nursing assistants – Pasca Akello and Immaculate Owii, who were on duty at the time.
Kaziba is not new to the media and public. In June 2015, Kaziba was one of 50 accounting officers who the Permanent Secretary of Ministry of Finance, Keith Muhakanizi listed for dismissal for allegedly failing to answer accountability queries in audit reports. He stayed on the job, mainly because the sacking breached his terms of service.
Two months earlier, in April, Kaziba, had unleashed an unusual explanation to the Parliamentary Public Accounts Committee (PAC) on why he could not account for Shs900 million meant for health in Abim. The records had been eaten by termites, he said.
More controversy around Besigye’s visit was to come. Dr. Asuman Lukwago, the Health Ministry Permanent Secretary wrote to EC complaining about the “latest trend by candidates to visit health facilities”. He wrote that hospitals are private places supposed to give patients a good environment to recover where only relatives of the sick are allowed to visit not politicians. Though Lukwago’s reason may be valid, critics say this ban was meant to cover up for government by not exposing facilities that are in a sorry state especially following Besigye’s visit to Abim Hospital. The Electoral Commission (EC) in early January promptly issued a directive to all aspiring presidential candidates barring them from campaigning in hospitals, churches, mosques and schools.
On a good note, the Abim Hospital has now received Shs700 million to start on immediate rehabilitation. Although this money might not appear much to Ugandans since it cannot buy a small bungalow in a decent section of Kampala city, is way above the expectations of Abim’s planners. In the Financial Year 2014/15, they drew a budget of Shs137 million only. By the end of September, which is about midway the FY, they had received only Shs34 million – the equivalent of one-month pay for many CEOs in Kampala. It is, therefore, unclear how much the government hopes Abim can do with Shs700 million.
Eng. Dr. John Tumwesigye, the Head of Infrastructural Development at the Ministry of Health told the Independent on Jan. 07 that while they had not yet received a progress report from Abim district, they are aware some work is going on since 48% of the money had already been disbursed to the district.
Tumwesigye could not say what works exactly were being undertaken. He said that is the role of the district leadership which is headed by Kaziba aka `the termite man’. Together with his team, Kaziba is supposed to choose the priorities for renovation at the hospital and award contracts. The ministry of Health will come in to supervise.
According to media reports, the renovation contract was awarded to Pearl Globe Engineering Limited and the work is expected to be complete by June. Once complete and all the necessary equipment installed, the hospital will be able to handle more than 1000 out patients and 200 admissions for it serves five districts of Abim, Agago, Amuria, Otuke and Kotido.
The projects appear over optimistic, as Abim Hospital appears not to be the favourite of patients who, instead, prefer treatment at smaller but better run NGO facilities. In the 2014/15 FY, for example, the hospital budgeted to receive 33,000 outpatients but registered only 925 or 2% of its projection. Meanwhile, over the same period, the NGO facilities budgeted to receive 4500 outpatients and ended up with 2119; about 50% of their projection. In terms of maternal deliveries, Abim Hospital planned for 650 and ended up with only 175.
This is not surprising to observers since the same facility was a few years ago the scene of a major riot by expectant mothers protesting against is poor service.
Past intervention failed
Despite the very poor state, this is not the first time Abim general hospital is being renovated. Dr. Medard Bitekyerezo, the chairman of the Health Committee in parliament told the Independent on Jan. 09 that when his committee visited the hospital in January 2014, it had been renovated a few years earlier by one company called Excel Construction Limited. Then, government had allocated Shs2.8 billion for the work. But, the legislator says in a few years, the condition “was already pathetic”.
Bitekyerezo said that the hospital lacked easily available yet crucial things like furniture. He recalls a scene that he witnessed when they visited one of the consultation rooms.
“We found a patient squatting while consulting a medical worker who was standing because there were no chairs,” he recalls.
Rukia Nakamatte, the Public Relations officer at the Ministry of Health says the hospital has, in the past, received maternity beds, mattresses, and incubators as part of a programme called the Uganda Health System strengthening Project (UHSSP). Nakamatte told The Independent that when she saw pictures taken of the hospital during Besigye’s visit, she had a million questions running through her head. Where had the equipment handed to the hospital gone? Abim Hospital also receives Shs 140 million annually as a standard allocation to each district hospital. Where do the Abim district officials use this money for?
Why has Abim remained dilapidated?
Bitekyerezo says Abim Hospital’s problem might not be about lack of resources.
“It is purely administrative since the government has played its role as far as availing funds to the district is concerned,” he says.
He recalls that when he and fellow MPs toured the hospital, Nandhala the CAO had hijacked the premises reserved for doctors and was occupying them. He says they also received complaints from the people that the nurses at the hospital buy their own uniforms and other work tools meant to be provided by government.
They also found that the district health officer, who is supposed to work with other administrators to better the health situation, serves in two districts of Abim and Aleptong, something Bitekyerezo says does not give her time to concentrate on one district.
Bitekyerezo who says he later reported this to the Minister for Local Government, Adolf Mwesigye, expecting immediate action to be taken wonders why nothing has ever been done about it.
“I don’t know why they have failed to get rid of the administrators. Most people we talked to were complaining about the CAO. Unless administration is changed, don’t expect the hospital to change”.
His view is shared by Juliana Auma, the Abim woman MP who says there is no way government can fail to hire fumigation services to rid the hospital of bats. She blames the administration for failing to carry out its supervisory role.
“Currently, Abim hospital doesn’t qualify to be called a district hospital because a well-managed health center IV beats it,” he says, “Why should it continue to exist when it can’t be well run to offer patients the hope of recovery?” says Bitekyerezo.
In his view, the hospital needs “a serious overhaul rather than minor renovations”.
However, Bitekyerezo says although Abim hospital has become the centre of negative publicity, many general hospitals across the country are in the same state. He cites Kitagata and Kambuga in western Uganda where his constituency is located. To him, district hospitals can only function well if they are taken over by the central government.
“It’s clear that local government can’t handle them,” he says.
Abim is not the worst
But in a case of the blind men and the elephant, Bitekyerezo might be basing his generalisation on limited knowledge of the extent of renovation of hospitals, construction of new ones, and other medical facilities.
President Yoweri Museveni devotes up to 17 pages of his campaign manifesto to showing the achievement in the health sector. They include numerous hospitals that have been built, renovated, and equipped with staff and machines. He lists staff quarters that have been built, ambulances supplied, and drugs and vaccines supplied. He says the measure of the success in the health is the rise in life of Ugandans from 51 years in 2009 to 58 years today, the reduction in maternal and child deaths, and the improved accessibility.
Despite, all this Museveni writes: “Much better health could have been achieved if only the concerned authorizes (health, local government, etc) paid attention to hygiene, nutrition, behavior change and lifestyle.
President Museveni is right. A lot still needs to be done.
Although Abim is under the spotlight, it is not the worst hospital in Uganda basing on the Uganda District League Table (DLT) which compares the performance of medical facilities by district, and determines good and poor performers with a view of learning best practices.
Under this assessment, Abim is midway the scale with Kampala and Gulu district hospitals at the top, and those in Amudat and Bulambuli. Up to four of the six worst district are from the same north east area as Abim. This area has Moroto referral Hospital as the main medical facility, and covers Napak, Kaabong, Amuru, Pader, Kotido, and Kitgum. If Abim Hospital is not the worst district hospital in these districts, it is worrying to imagine what the main hospital in the worst district, Amudat, looks like.