Private Clinics A Disaster Back Home For Patients & Taxpayers

Sunday, November 14, 2010
By ugandansabroad

By D. A.

KAMPALA, Uganda (Ugandans Abroad)— Millions of taxpayers dollars are most likely squandered every year in public-private healthcare units in Uganda.

Have you ever gotten free medicine from a private clinic back home, or have your family and friends? Most likely, you have never had the opportunity.  But for over a decade, the government has been sending cash and essential drugs to private clinics, under the mission of reaching people far away from government healthcare units.

Last financial year, the government spent sh222 billion, or $100.9 million, of taxpayer’s resources on nonprofit but private hospitals, primary healthcare centers, and lower-level health units.  But very few of these entities actually provide free medication.

In Uganda, sick children have to look to sources as unlikely as the U.S. army to receive free medicine. Photograph by Edward Echwalu.

The money for free, essential drugs comes from the national shared programme, as well as the health sector support programme II project.  The essential drugs supplement other drugs that are procured with money for districts and referral hospitals.

The nonprofit health units also get money from the Joint Medical Stores for immunisation, and receive free ARVs and anti-malarial drugs.

An additional 119 nonprofit doctors are given financial support in 25 districts, paid according to the government scales and levels, including an allowance for lunch.

For example, in the rural distract of Kibaale in Western Uganda, government-supported healthworkers form 48 percent of major professional staff in private, not-for-profit health services.

Despite this, you might never know that the government subsidizes these clinics at all.  At the Nagawa Memorial Nursing Home, a nonprofit clinic in the city suburb of Namugongo, patients still have to buy essential drugs like Coartem.

Despite government support for such nonprofit clinics, the clinic is headed by Willy Bukenya, a senior four drop-out.  Bukenya prescribes drugs, a job better handled by licensed pharmacists.  This is not a problem for the district health officer, whose job it is to ensure high-quality service delivery.  After all, Bukenya is his brother.

The clinic does not have the proper authority to admit patients, but it still admits several, who a midwife takes care of.  Its laboratory is appaling– not only is it congested and filthy, but some of its drug containers are weaved in cobwebs.

Despite government funding for free and subsidized essential services throughout Uganda, many back home find it difficult to access basic drugs. Photograph by Edward Echwalu.

Nagawa Memorial Clinic is not alone.  In fact, it is largely a mirror image of hundreds of nonprofit health clinics throughout Uganda, all receiving government funds on an annual basis.

One employee of Jinja district’s health services, speaking on conditions of anonymity, told Ugandans Abroad that “some of the NGO clinics were dens of criminals, as many of them are owned by local, influential people.”

Ugandans Abroad spoke to Diana Atwine, who heads the government’s recently-created Drugs Inspection Unit.  She says the greatest challenge surrounding governmental support of these private clinics is that “most people are not aware that they can get free or subsidized treatment in such health clinics.”  And the clinics are in no rush to inform their patients.

Government support alone raises a number of managerial and human resource challenges.  Private, nonprofit managers must supervise workers they do not have full authority and control over.  The government-supported workers report to both the Ministry of Health and the nonprofit healthcare unit managers.

These issues pale when you compare such clinics to phantom clinics, which you don’t even exist at all.  Several local government officials are in the lucrative business of creating ‘ghost clinics,’ which might not exist but are funded by Ugandan taxpayers.

How does the government select which private, nonprofit clinics to support? Some formal factors are population, accessibility of health services in communities, and the history of the clinic seeking support, among others.  The district’s local government and the private units’ have to form an agreement on the clinics’ activities.

Despite public support, these private clinics are largely the preserve of the few.  The majority of poor Ugandans cannot afford to pay for these clinics’ services, and the situation has exacerbated impoverished households in rural communities.

Government support of private, nonprofit clinics is supposed to help people in remote communities access healthcare. Edward Echwalu.

Ugandans Abroad reported that urban and rural-area patients do everything possible to access these services, which are supposed to be free or subsidized.  They even sell major assets like their land to receive treatment.

Paying for services at private, nonprofit clinics was even found to be a potential source of further impoverishment of households around Uganda.

Dr. Atwine’s team has begun to tackle the situation through random checks on various nonprofit clinics supported by the government.  These investigations have been alarmingly complicated by distinguishing which drugs are provided by the government, and which have been stolen.

“The doctors and other health personnel steal the drugs, and sell it in their private clinics,” she said.  ”It is hard to tell what are government drugs, because they are not labeled.”  The government is now working to carefully label its drugs to deter outright theft.

Director General of Health Services, Dr. Sam Zaramba, says that all government-supported clinics that don’t follow health service delivery guidelines are gradually being scrapped off the list for support.

“These are public funds,” he told Ugandans Abroad.  ”We cannot allow this mess to go on.  We shall scrap off all such clinics that are not up to the standard.”

Some in the diaspora go home regularly, others may not have been home in years.  But the Ugandan health system is a pluralistic system, combining many different agents.  There are public government-owned and managed health services, faith-based facilities, private nonprofit services, and private for-profit health providers.  There are also traditional medicine practitioners, whom many Ugandans consult.

Some of these categories overlap.  Faith-based nonprofits represent 78 percent of the 490 private, nonprofit health units in Uganda, while the rest are run by humanitarian and community-based healthcare organizations.

Efforts to reconstruct the government healthcare system started in the late 1980s, after the change of regimes back home.

In 1996, the private, nonprofit health facilities asked the government to partner with them so they could survive, and the government began to seriously negotiate with them in 1997.  The official Public-Private Partnership for Health (PPPH) began in July 2000.

D.A. is a reporter based in Kampala, Uganda.  He is committed to helping the Ugandan diaspora follow critical issues back home.

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