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Cause of poor health service misunderstood

By Morris D C Komakech

Failures are caused by structural deficiencies not individual lifestyle choices

The article, “Irresponsible lifestyles strain health sector” (The Independent Aug.10) by Dan Kimosho needs an urgent rebuttal. Kimosho argues fervently from a rather skewed perspective that Ugandans who get ill or those who find themselves in need of medical care, are the ones who strain the health care because of their irresponsible living. In his view, if Ugandans were to live a more carefully crafted lifestyle and were to take responsibility for their health situations, then the healthcare system would not be strained. He cites examples of rampant accidents and injuries secondary to road accidents and others.


I spent a number of years at the Mulago Nation Referral Hospital in Kampala, in the rehabilitation department as trainee. I must state categorically that from my own perspective as practitioner, the real causes of the rampant ill-health, accidents and reasons for seeking healthcare services in Uganda and elsewhere are associated with structural deficiencies at all levels of government.

I do not have to be technical in my analysis here. Take, for example, road accidents. I do not have current statistics on how many people die on Uganda’s roads or how many accidents occur in a year. But we all know that road accidents which are completely avoidable remain the top killer and cause of injuries as well as disabilities in Uganda. When we look at the statistics of accidents involving boda boda, either motor-bike or regular bicycles, the figures will stun you. Why?

There are many other situations that are inevitable and yet the ordinary Ugandan has no power to overcome, just by merely living responsibly. Let us look at hygiene among slum dwellers. The drainage systems and the facilities in slums around the urban centers all over Uganda are not adequate to contain the ever rising population. In fact, the UN has estimated an exponential rural to urban influx in most of Africa in the face of population explosion by 2030. It is even evident that most of the migrants end up in low accommodation areas that are quickly transformed into squalid slums. Are our urban planners taking heed of such significant policy matter?

Notwithstanding space limitation, both cases of increasing road accidents, disabilities, and the surge in urban population have profound public policy implications. These are areas that we have neglected, thus, the failures of structures and mechanisms to regulate opportunities for safe and responsible living.

We must agree that victim blaming is a very unfortunate and superficial way of diagnosing a social problem. Symptoms are not causes but manifestation. We must not forget this. The transportation infrastructure in Uganda is very poor, as such; people have tried to navigate the system despite its discrepancies to eke a living. Where public transits, buses, omnibuses or taxis cannot reach because of poor roads, Ugandans will devise means to reach, inevitably.

When we see people acquire avoidable waterborne diseases, or get disabled, we must think first that they did not choose such a destiny. As public servants, we should be critical and sensitive to causal factors to enable us remove such barriers. I contend that the healthcare system has not been expanded to meet the ever expanding and chaotic situation of human living in Uganda today. This is primarily due to two factors; lack of political will to strengthen the healthcare system and lack of healthy public policies on a wide variety of human discourses, including transportation, housing and accommodation, sanitation, equity and equality as well as culture and cultural practices.

Further, the health care system in Uganda is too biomedical and we must diversify to embrace alternative practices. I have advocated for investment in more upstream healthcare approaches where people are given skills to make healthy choices and decisions before they become ill. The Ugandan system still narrowly defines health as presence or absence of infirmity, this is very limiting.

The government should adopt health promotion strategies, principles and practices in all its policies. Every decision we make profoundly impacts on the health of individual or communities amidst us. When families or communities lose their bread winners in road accidents, such event redefines life experiences in such households and impacts negatively on the health status of the community. The existence of socially structured inequalities and inequities in society implies that the health of the population is thwarted. The real problem is with us, the technocrats. We must not blame the victims of our shortsightedness for their predicaments.

I contend that there has not been a systemic and critical study of the failures of our healthcare system in supporting its population. But healthcare systems that over rely on biomedical paradigms are failing world over. Therefore, paradigmatic shifts are inevitable.

Morris Komakech is a Public Health Advocate, Social and Political analyst based in Canada. Can contact via mordust_26@yahoo.ca

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