Editor
Mulago scandal points to need for wider, urgent reforms in health sector
Under-fire Mulago boss Dr. Byarugaba and State house health monitoring unit leader Dr Warren Namara
The scandal surrounding the alleged theft of billions of taxpayer money that was meant to buy medicines and equipment at Mulago national referral hospital has led to the arrest of a few of the institution’s top leadership.
In an apparent mockery of justice, the former director of the hospital Dr. Baterana Byarugaba was made to handover the office to his deputy Dr. Rosemary Byanyima.
Whereas the State House Health Monitoring Unit headed by Dr. Warren Naamara should be congratulated for revealing this scandal. Their effort will likely not reach far enough if the existing conditions and systems are allowed to prevail.
One needs perhaps to ask the following questions. Who are the supervisors of the health sector in Uganda? Where were they all these years when the scandal was unfolding? About this question, for instance, the privately owned First Pharmacy in Mulago has operated for over a decade and no one from the Ministry of health, located just a stone’s throw from the ministry, had ever called into question this arrangement. It leaves one wondering; were they beneficiaries of the scandal?
One of the most delicate topics in Uganda’s health system is the parallel existence of private health practice alongside or perhaps within the public health system. There’s an urgent need to draw a clear line between these systems for better service delivery.
In countries such as Rwanda that have much better health care services, there’s no private medical practice. All doctors are employed by the government. Uganda may not aspire for such radical reforms, but should copy the good.
For example, Uganda needs to introduce measures that force health workers to choose where they belong; public or private. The practice of allowing private practice to permeate into public service has fomented corruption, absenteeism and wanton theft of publicly funded drugs and abuse of patients rights.
When it comes to delivery of drugs, the National Medical Stores needs to be responsible for delivery of drugs to the last user with the help of a digital system that tracks and stores user data to be able to track the medicines and treatment.
This means that NMS should be empowered to hire and place pharmacists in government hospitals who hand-out drugs to patients using doctors prescription. Those in charge of drugs must also work under a strict monitoring system, perhaps provided by state security agencies.
This strict supervision in government hospitals is urgently needed to also ensure that health workers don’t ask for bribes from patients, don’t harass patients and that equipment and other facilities of the hospital are not stolen and sold on the open market.
Any meaningful reforms must be able to give patients a say in the running of the hospitals. Uganda’s public service has to adopt a mechanism that allows patients to give feedback on services and treatment they receive from health workers.
Considering that patients already pay a lot of money for health care, the government should introduce an arrangement that shifts from free services to subsidised or cost-sharing.
But for all these reforms to happen and make a difference, they require a substantial investment that includes hiring many more and remunerating all health workers and supervisors. It requires greater government commitment to build and equip hospitals to cope with the demand.
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