Access to Health Services Remains a Dream for Most Ugandans

Access to health services remains a big challenge for residents of Ntoroko in western Uganda

Access to health services remains a big challenge for residents of Ntoroko in western Uganda

By Betty Mujungu

Kampala-Monday, July 14 2014- For most people in Uganda accessing health services remains a nightmare despite the efforts the Government has put in place to achieve the Millennium Development Goals-MDGs.

The worst affected areas are the new districts where accessing health services, is more of a myth than a reality.

Ntoroko district of the Rwenzori region in western Uganda is one of the worst affected in terms of Primary Health Care-PHC delivery. Four years since it was curved out of Bundibugyo.

Like any other newly created district in the country, the justification for the split was to bring services closer to the people. However this justification remains a myth in Ntoroko where the health service is marred by inadequate health facilities, Shortage of health workers and drugs.

The district has a population of at least 100,000 people but there is only one health centre IV, two health centre IIIs and two health centre IIs contrary to the government’s health policy which provides that every county must have a health centre three with about 18 staff led by senior clinical officer with.

The policy also stipulates that each County is to have an Out Patient Department-OPD and maternity ward and a functioning laboratory.

Mulango is one of the five islands in Kanara sub-county on the shores of Lake Albert where there is no single health facility putting the lives of more than 3000 residents at high risk. Residents are forced to use facilities at Ntoroko health centre III or Rwebisengo health centre III.  The means of transport to the health facilities is by use of a boat which costs 100.000 ugandan shillings for a two hour boat ride.

At the island you see a big number of seemingly busy and excited people of all age, men, women and children and a minimum of 100 small mud and wattle houses where they live and operate small bars and shops.  The houses are just 3-4 meters from the lake where the boats are packed after the day’s transport and fishing.

Joel Zile, who has lived at the island for 6years, describes the situation as appalling. He says that it’s difficult to take a pregnant woman to Ntoroko health centre III for delivery.

‘It is expensive to hire a boat at one hundred thousand shillings. It also takes four hours to cross the lake’, Zile laments.  He wants the government to construct a health facility at the landing site.

The lack of adequate health facilities and workers has opened room for the operations of the village health teams (VHTs) in Ntoroko.  Village Health Teams, the equivalent of a low-level health centre are meant to serve as the primary, village-level health contact for all villages in Uganda,

Mumbere Natukunda, a VHT member set up a makeshift house that works as a health facility. However, it lacks the standard of the least functional health facility. There no drugs, women deliver on the floor by the help of the Village health team member.

“There are no drugs in the store and yet there are outbreaks of Dysentery and cholera. It gets even hard when a pregnant mother needs to deliver; u can use 300,000 which is so expensive for us, he said.

Being an island, Mulango is increasingly becoming a breeding ground for the HIV virus that causes AIDS. There are no condoms and testing services. Natukunda says that the government should give a helping hand and renovate the ‘facility ‘and equip it so that women can deliver comfortably.

At Ntoroko health centre III which serves a population of at least twelve thousand people there is only one Clinical officer who at the same time is the in charge, the maternity ward is also a general ward where all patients ranging from children, women and men are admitted.

‘‘The facility serves the town council, the five islands, neighbouring Kibale district and some parts of congo. We have staffing challenges am a junior clinical officer, who is at the same time in charge, so when am for administration work, the patients themselves feel the gap of the clinical officer.   There is only one word where all cases are admitted. Its actually a multipurpose ward’’ says Simon Nyakahuma the in charge.

He says there is only one mid wife who is over whelmed by the work and when she is off duty there is no service offered prompting other patients to help the delivering mothers.

‘‘When we get emergency cases, there are no equipments, the nearest ambulance is 50km away which we need to call  and its only for a few who can afford to pay for  fuel, So people end up losing lives.’’

‘‘I wish there is another health centre III nearer to help make the health service abit easier for the people.’’ He said.

Simon also says the rate of HIV/Aids here is high. They receive 30 newly HIV positive cases per month, yet there is no CD4 count machine. Blood samples are instead sent to Fort portal regional referral hospital where the patients have to wait for more than 2 months to know their CD4 results.

Atugonza Jennifer an HIV/Aids patient who has been seated for 6 hours waiting to see the Doctor says the problems of this health centre begin with the poor ward which accommodates patients suffering from all ailments like HIV/AIDS, TB, and Cholera among others.

‘‘There is only one ward where all patients are admitted. Some of us who are HIV/aids positive find a lot of complications with getting drugs here, there is no specific place, we queue up with other patients and yet some times we do not want noise and need some privacy.’’


Edward Bwambale, the Town Clerk Kanara attributes the poor health system to the remoteness of the district, which is a hard to reach area, hence keeping the health workers away. He says that there is no decent accommodation for the health workers, and since the area isn’t a food growing district, the cost of living is high since the food is purchased from neighbouring fort portal.

At Karugutu health Centre IV the biggest healthy facility in the district, in Karugutu town council, the situation isn’t any different from the rural health facility.  The one ward facility whose roof was blown off a year ago by wind, renovation has never been completed.

The patients are admitted in tents that were donated to the health facility by UNICEF after the storm. There is one ward where children, female patients and pregnant women are all crammed.

The ward also serves as a mortuary.  When i visited there was a corpse that had been in the ward from 3am to 3pm. Most patients were in sombre as the relatives of the deceased were sobbing and stranded on how to transport the body to Congo.

William Tinkasimire, the In-charge says that as a result of the congestion some patients with complicated cases are referred to Fort Portal referral hospital due to lack of adequate space and man power.

 ‘‘The tents are very hot during the day, but we have no option since they are the only option for now, thanks to UNICEF’’said William.

Simon Kaddu Kaggwa, the Ntoroko District Health Officer says that the health facilities are not enough to serve the entire population. The district has a single health centre IV, two health centre III and two health centre II.

“Majority of the residents stay more than ten kilometres away from the facilities, making it difficult to access treatment,” Kagawa explains.

Kagawa says that the inadequate health facilities coupled with shortage of staff and the poor road network has affected the district’s health performance at the national level.

‘‘Currently Noroko stands at DPT3 coverage of around 55% lower than the national level that stands at 85%.  other indicators like ANC services, attendances is abit high  but deliveries are at 14.5  very low compared to national standards at 41%.’’

‘‘The district cannot meet the Millennium development goals because you realise that the most vulnerable people in the society like women and children lack basic health services.  The health centre IIIs are supposed to be first point of contact and first reach for maternity services but they are  lacking.’’ Says Dr.kaddu.

Despite the few health facilities, not all is gloomy. Kagawa says that in 2010 when the district started the staff percentage was at 36% but today it is at72%, following interventions by the village health teams, UNICEF, Baylor, and World Vision among others.

He also says that they have started prioritising accommodation for the health workers which will prevent them from abandoning the health facilities.

The Chief Administrative officer  Ashaba Allan says the district is doing poorly in critical staff cadres where there is only one doctor who is the DHO doing administrative work and only one doing clinical work recruited by Baylor, but lucking other 2 doctors.

He also attributes the poor health service to dispersed population where people have to travel long distances for health services citing sub-counties like butungama and itojo where there is no single health facility yet they are some of the hard to reach areas in the district.

‘‘The district gets 119million per year for development which can’t even build a full ward; per ministry of health award is 350millin. So we need 3 years to build a ward which is very challenging. We need a lot of support in terms of funding. We are lagging behind in most of the development aspects because of poor funding.’’

A report compiled by the coalition of Civil Society Organisations on health in the Rwenzori region, indicates that the unqualified health workers operate in major health facilities in the district. The report follows complaints received by the CSOs from residents who accused some of the health centres of not providing adequate treatment.

The report also reveals that relatives of some medical workers and casual labourers in the district have also taken to administering treatment to patients in health facilities in the district. According to the report, some of the health centre workers are not trained to treat people and have no idea about the medicine they prescribe to patients.

Under the Local Government Act, districts and municipal councils are responsible for medical and health services  including: Hospitals except regional referral hospitals; all health centres; maternal and child health services; communicable disease control, ambulance services; vector control; environmental sanitation; health education; quality monitoring of water supplies; supervision and monitoring of private sector health services; immunization campaigns; health promotion; reproductive health including  family planning among others.

Despite the huge health mandate vested with local governments, only 27% of the health sector budget equivalent to UGX 41.185 Billion is appropriated to 137 local governments, 56 general hospitals, 61 PNFP hospitals and 4,205 lower level health units. 40 percent of the health budget is spent at the Centre.

For the last 10 years, Uganda Parliament and civil society organisations have consistently advocated for an increase in the budget allocated to the health sector for better health care delivery. Uganda is a signatory to the 2003 African Union Maputo Declaration, where all member countries agreed to commit at least 15 per cent of their annual national budgets to the health sector.

The Committee of parliament on health recommends that more funds and energy be expended in primary health care to facilitate the local governments and lower health facilities including PNFPs to deliver on their health-related mandate.


































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