October 18

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John and Dayna in Uganda – Hospitals

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After visiting some hospitals located locally here in Kampala as well as some rural facilities it seemed that it would be interesting to do some research on how these healthcare institutions are structured, staffed and funded.

As it turns out, hospitals in Uganda face several challenges. It was mentioned by many people we spoke with that hospitals suffer greatly from a deficiency of skilled healthcare workers. One hospital administrator we spoke with complained that most of his staff would leave the facility for other opportunities after costly training was complete. Many are simply chronically short staffed.

There are often a lack of medications and supplies to treat patients. In some areas, due to reduced government funding, many sick patients go private hospitals or abroad if they can afford it.

The distribution of services tends to mean rural areas are underserved and lower-income households in urban areas are underserved as for-profit outlets and crowded government hospitals are concentrated in the towns.

Infrastructure and Healthcare Workers:
Some quick internet searches revealed that health delivery in Uganda is shared between government-funded facilities (typically large hospitals), private not-for-profit facilities which include church-supported hospitals, medium-sized clinics, private for-profit or commercial health units and self-employed physicians. The share is 30% government (Ministry of Health), 45% not-for-profit (NGOs) and 25% for-profit (private).

Public (regional) hospitals in particular are feeling the healthcare worker shortage. Just like in the U.S., health workers who choose to practice in the public sector get paid less than the private sector. To make matters worse, public sector health workers receive their pay late in some cases.

The effect of this staff shortage on efficient and quality care is notable in the delays in receiving health services, which may contribute to avoidable morbidity and mortality. This scenario is common in all the regional referral hospitals. Specialists are few or not available. The absence of key health services at hospitals outside of the larger cities in Uganda compounds the situation by incurring costs for transporting patients to the national referral hospitals in larger cities (i.e. Kampala).

Many hospitals still seem to rely primarily on manual record keeping. Having supplies and medications on a regular basis continues to be an ongoing problem.

Government Support and Healthcare Development Partners
It turns out that the current levels of government funding fall short of estimated requirements and the funding gap is on increase year after year.

However, the health sector also enjoys great support from development partners who supplement the patient care services and provision of infrastructure.

A visit to the largest state-owned hospital in Uganda (Mulago Hospital, built in Kampala 1962, with around 1,500 beds) was very interesting. We met with the OBGYN department and learned how they function, and spending time with the inpatient pharmacy was a bit overwhelming in that the way that they procure products is somewhat complex.

There are many NGOs operating charitable hospitals now around the country, especially in rural areas. For example, CURE Children’s Hospital of Uganda (CURE Uganda) is a specialty teaching hospital that treats the neurosurgical needs of children, with an emphasis on hydrocephalus, neural tube defects, spina bifida, epilepsy and brain tumors. To extend its reach beyond its central location, the hospital regularly sends out mobile clinics to remote areas of Uganda for follow-up care and to identify additional children for treatment.

We learned that the combination of a high fertility rate and low access to quality maternal care continues to put Ugandan women at risk of pregnancy-related death and disability. The maternal injury with perhaps the most devastating aftermath is obstetric fistula. A fistula is a hole, or abnormal opening, in the birth canal, that results in chronic leakage. Obstetric fistula due to obstructed labor is by far the most common form of fistula in East African countries. USAID-supported fistula services in Uganda began in October 2004, and in addition to seven prevention only sites, Fistula Care has been working with two private, faith-based hospitals to prevent and repair fistula.

International Hospital Kampala (IHK) is near our home here. It is a 200-bed private hospital, the first ISO-certified hospital in the country. IHK has encouraged companies in Kampala to sponsor a ward of beds to enable subsidized care of serious cases among lower-income households.

These exciting developments show what can be accomplished when private and public entities come together with not-for-profit institutions. Hopefully in the near future the Ministry of Health in Uganda can address their funding and delivery issues, and hospitals can get the staffing and supplies that they require.