In the face of a novel coronavirus, the Ugandan government has taken affirmative action, instigating lockdowns across the country. Following the announcement of the first infection on March 21, the government closed the national borders leaving them only to cargo movement. Other measures included, among others, the shutdown of education institutions and the banning of public gatherings. Since then, the president has together with key leaders like the Ministry of Health, Office of the Prime Minister, and the National Task Force been updating the country over the new developments and measures aimed at combating the disease and normalizing the situation in the country.
During the presidential addresses, he has been consistently calling out for public contributions towards district vehicles to support the district level task forces. This reflects one of the gaps that need to be closed in the health system’s infrastructure among other health system core indicators. The COVID-19 pandemic has exposed the weaknesses in Uganda’s health system. The country lacks sufficient equipment and other medical supplies to keep health facilities ready to receive the patients and achieve the minimum service standards even beyond the COVID19 pandemic. The medical workers in hospitals that were taking care of the confirmed Corona Virus cases lacked Personal Protective Equipment (PPE) making them vulnerable to the virus.
Above all, attention should be given to the Local Government health facilities’ capacity to ably address the health-related cases at all levels. This calls for reawaking of the decentralized health system from the grassroot to the Regional Referral Hospitals. Communities need to be empowered to report potential cases and then follow the pattern of the health referral system. Health Centre III’s, Health Centre IV’s, District Genral Hospitals and Regional Referreal Hospitals need to be empowered. Specifically, the government needs to improve the following areas in the Decentralized Health System:
Health infrastructure and equipment need to be improved. Effective health care delivery requires a network of functional health facilities to increase the coverage beyond the current 72%.
Also, the Health Information Management System need to improve since it does not reliably report on medicines availability at service delivery levels due to incomplete reporting by health units, denominator problems, aggregate errors and poor utilization by medical personnel in health planning. This translates into poor coordination of essential medicines and medical supplies leading to shortages.
Similarly, to effectively implement cost-effective health interventions, there must be an adequate number of health workers who must have the appropriate skills, competencies, training and motivation to do so. Much as significant progress has been made in recent years in increasing the production of health workers and in producing a multi-purpose nursing cadre that can perform both nursing and midwifery tasks, there are gaps and shortages at different levels of the health system. There is one doctor for every 7,272 Ugandans. The related statistic is 1:36,810 for nurse/midwifery professionals. The shortages are worse in rural areas where 80% of the population resides, as 70% of all doctors are practising in urban areas.
Public health financing needs to be increased. Out-of-pocket (OOP) expenses accounts for the largest share, with 37.9%, followed by the government with 33.6%, and external sources with 28.5%. The total health expenditure per capita is estimated at $51, below the WHO recommendation of $60, (World Bank, World Development Indicators), Public financing for health is at 8.4%, below the Abuja target of 15%,. The health sector is underfinanced and cannot deliver the Uganda National Minimum Health Care Package (UNMHCP) to all, which highlights the need to use limited resources for pro-poor and essential services.
