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COMMENT: Ethics of healthcare

The result of this ethical dilemma has been uncertainty and creation of panic for those delivering healthcare. Currently there is panic over whether supply of key treatment such as ARTs will be stable. This has also led to gaps in the overall organic health systems strengthening and deplorable conditions of health facilities across the country.

The human resource challenge continues to dominate healthcare delivery and overload for the existing human resources is relatively common.

Options such as task shifting are vigorously happening but in a highly unregulated manner and in complete disregard of the professional codes and laws in place. Clinical officers are, for instance, undertaking roles of doctors without any clear instrument and in contravention of sections of the Medical and Dental Practioner’s Act. This is unethical and in bold terms illegal.

Uganda continues to have an unacceptably high out of pocket expenditure at the level of approximately above 50% of the total health expenditure – with the government spending only 16% and no mentionable social health insurance program. The efforts to establish the National Health Insurance Scheme have been devastatingly slow and not prioritised. In the alternative, we have continued to read about the high government expenditure on treatment abroad for selected government officials. This is not only unethical on the part of the government; it also violates the core thinking around Universal Health Care Coverage which seeks to reallocate resources from those that have to those without.

The poor state of health facilities particularly psychiatric facilities irritated Mungherera in several of discussions. The colonial model of constructing these facilities with concrete beds and the inhuman and degrading seclusion room designs explain the state of unethical environments for health professionals. This combined with unthinkable and unregulated commercialisation of essential services; such as water and electricity supply to public health facilities, have all made delivery of ethical healthcare difficult.

In conclusion, these are just a few examples on how our unethical environment can make ethical delivery of healthcare complex for our health professionals. My views do not in any way condone individual unethical practices that the health professional bodies continue to fight. This is rather a call for a deeper reflection on the contribution of the overall environment towards achieving ethical practice for our health professionals at all levels.

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Moses MULUMBA is a lawyer practicing Health Law and Policy – Center for Health, Human Rights and Development (CEHURD)

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