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BIG INTERVIEW-: Uganda must adopt Abuja Declaration to address declining health funding - medics president

Big Interview -->
BIG INTERVIEW-: Uganda must adopt Abuja Declaration to address declining health funding - medics president
Dr Herbert Luswata

In April 2001,  African Union countries met and pledged to allocate at least 15 percent of their annual budgets to improving the health sector, urging donor countries to scale up their support.

The Uganda Medical Association (UMA) recently expressed concern over the declining government funding for the health sector, calling for alternative solutions to address the affected interventions and high donor dependency.

According to government data, the health budget has decreased from Shs4 trillion in the last financial year to Shs2.9 trillion in this financial year. Meanwhile, the total national budget has been increasing, reaching Shs72 trillion this financial year.

In an interview with Nile Post, Dr Herbert Luswata, the UMA president, stated that Uganda needs to adhere to the Abuja Declaration, to which it is a signatory, and allocate 15 percent of the national budget to the health sector.

Excerpts;-

How can you assess the state of healthcare?

Uganda currently has human resource coverage ranging from 22 percent to 62 percent in different public health facilities, with an average of 42 percent (according to the UMA human resource survey of January 2024). This leaves a human resource gap of more than 50 percent on average in the health sector, which significantly affects the effectiveness of healthcare delivery to Ugandans.

The government had embarked on lifting the ban on recruitment, recruitment and promotions have been ongoing by the health service commission following our advocacy, however this ban on recruitment has been reinstated as communicated by the ministry of public service in June this year.

The health care in Uganda has both local and international funding, however our local commitment currently requires more commitment from our government following international cuts on funding the health sector in Uganda due the recently passed anti homosexuality Bill.

Uganda currently use the policy of free healthcare for all Ugandans , however this approach has not been effective as expected and National health insurance scheme was proposed discussed and passed by parliament more than a year ago, however the Bill has not been signed by the President.

The government has made tremendous achievement in improving national referral hospitals eg Mulago national referral hospital, Butabika hospital etc, regional referral hospitals eg . Masaka Regional Referral Hospital, Mubende, Kayunga etc with support from global fund and we think this has been a great achievement, there has been upgrading in a number of health center threes to health center fours and construction of new facilities through local funding.

I also wish to note that there has been miss appropriation in this area, where money has been allocated to construct hospitals and yet there has been no results ie the case of Lubowa hospital.

Some public health facilities have got equipment but they face challenge of maintenance and this has prompted the administrators to come with official changes to be paid for by patients. The changes paid for range from CT scan fees, X-ray, ultrasound scan, MRI, dialysis services and this cuts across all the national and regional referral hospitals where such services are available.

However, a number of public facilities lack equipment, including basic equipment like ultrasound scan in health centre IVs which are very crucial in prevention and reducing maternal mortality.

Ambulances are one of the important equipment required for emergency care and with 58 percent current coverage, but more Type B and C ambulances required.

How many doctors are members of the Uganda Medical Association?

We currently have a membership of around 8,500 doctors.

Are there any penalties for doctors who have not joined the Association?

Membership in UMA is voluntary; however we are making steps to ensure that our membership becomes mandatory through formulation of a society. I'm in touch with members of parliament, and having discussions with one of the member of the health committee of Parliament. We want to push for private members Bill to have UMA transformed into a society, where every doctor automatically becomes a member after medical school .This will ensure returns to the association because every doctor and other health workers benefit from our work but many of them do not pay subscription fees to fund our projects.

Has the issue of internship deployment been resolved?

They are currently making applications with the Uganda Medical and Dental Practitioners Council, for those who have been submitted by different universities their names are going to be submitted to the ministry of health for deployment to different internship sites and start internship by August 1.

As the president of the Uganda Medical Association, what progress have you made in your responsibilities?

We have advocated for a lift in the ban on recruitment, which was done, promotions and recruitment of new health workers and this has been ongoing. We have formally achieved new positions for medical doctors at health centre III (sub-county level) communicated by ministry of public service this year in May 2024, following negotiations with government this year, and reminder on the presidential directives of 2021 following the UMA nationwide industrial action.

We have made positive steps on achieving a new title for the specialists (associate consultants) and we have hope that this will be finalised this year plus correction of errors in salaries for specialists.

We are making progress on registration of our labour export company which started mid last year despite a few challenges but we hope to have this work finalised this year and formally start externalisation of healthcare services to other countries as one of the alternatives to solve unemployment of health workers in the country.

There seem to be fewer strikes these days. Does this indicate that the government has fully addressed your concerns?

We still have challenges in the health sector and concerns about our welfare,. However, this time we have decided to embark on negotiations with government and so far the concerned officers have been available to showing willingness to solve our problems. We intend to continue with this approach for now unless otherwise things change for the worst.

How has the association assisted doctors in finding jobs both in Uganda and abroad?

We are in touch with the loyal college of physicians UK, who currently have currently opened up opportunities for Ugandans to work in the NHS of UK. We have a series of meetings which have been scheduled, between Ugandan doctors through UMA and the loyal college of physicians UK, where our doctors are being supported with information on the required exams, available positions and air tickets to the UK though Medical training initiative.

We are also working on formalisation of labour exchange with Rwanda, and other countries.

You recently expressed concern about declining funding in the health sector. Can you elaborate on this issue?

Parliament had appropriated funding for the health sector. However, money was removed from some critical areas which unfortunately cannot wait and we requested for supplementary budget for have these areas funded.

What are your proposals to address the funding challenges in the health sector?

Uganda needs to embrace the Abuja Declaration to which we are signatories and provide 15 percent of the country's budget to the health sector. This local commitment will push our health sector to greater heights. We need to embrace the alternative funding of the health sector through the national health insurance scheme which was passed by Parliament.

Discuss the regulation of the medical tourism and how it can improve the healthcare system.

Uganda has a medical board, let the board be fully functionalised to ensure that only government officials with conditions which cannot be managed in Uganda are allowed to use government funding to access health care in other countries. This will help to reduce the budget allocation to this area over the years and more of this money can be channeled to our health sector.

What is your last message to the public?

UMA is committed to advocating for good quality health care for all Ugandans, and we shall use every opportunity to ensure that our health sector continues to improve over time.

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