After gross mismanagement of the covid 19 pandemic and severe under-funding of the health sector by President Yoweri Museveni’s government, his archival, Presidential candidate Robert Kyagulanyi Ssentamu aka Bobi Wine is offering a better health care package to save Ugandans from unnecessary deaths resulting from preventable and curable diseases.
First, Bobi Wine, the leader of the National Unity Platform, says he will provide health insurance cover for all Ugandans upon replacing President Yoweri Museveni after early next year’s polls.
For about two decades now Mr Museveni’s government has been debating whether or not to provide all Ugandans with free health care.
Bobi Wine’s political organization, the National Unity Platform, plans to implement a health financing policy that guarantees sustainable universal access to quality health care while keeping the cost of care in control. The primary intervention will be the implementation of health insurance.
Universal health insurance has been on the cards since 1999 when the ruling National Resistance Movement government first presented a National Health Policy.
At the time the government spoke of introducing a social health insurance scheme to address challenges in ensuring equitable health financing in a sustainable manner. The main target was the poor and vulnerable who were not able to access private medical care.
In 2006 the Ministry of Health was asked to design the social health insurance scheme. The plan has since then been on and off.
According to the National Health Insurance Scheme draft law, government and private employees are to contribute 4% of their monthly salary to the insurance cover while employers will contribute 1% of each employee’s monthly salary. Self-employed individuals are expected to pay 100,000 Ugandan shillings per year and pensioners to contribute 1% of their monthly pension payment.
Accessing healthcare in Uganda is quite expensive. A visit to a health centre averagely costs about shs12,000 (approx. $3) and shs110,000 (approx.$30) in a private clinic.
The cost of delivery, which is among the costlier procedures, is between shs90,000 (approx. $23) at health centres and shs650,000 (approx. $207) at referral hospitals.
Yet in Uganda over 40 percent of the population lives on less than a dollar (approx. shs3800) daily. Most of this money is paid by individuals in cash.
Specialized services such as surgery are also out of reach for the majority, 75 percent of the population would be bankrupted if they had to pay for surgery.
Bobi Wine in his manifesto also promises to establish a maternal health facility in every sub-county and scrap birth certificate fees
Bobi Wine, a musician-turned-politician, who is being promoted as Uganda’s symbol of the ordinary people’s struggle for democracy, freedom, liberty and social transformation, has emerged as the main challenger against President Museveni, who seized power in 1986 through a five-year rebellion.
Through his music that is laced with messages critical of undemocratic policies and tendencies in Uganda, Bobi Wine has become appealing to majority unemployed and frustrated youth.
The 38 year-old says his government will recruit more medical personnel to close the human resource gap in the health sector, and offer them competitive salaries. There remains a shortage in healthcare workers, with only one doctor for every 8,300 Ugandans.
With 70% of doctors practicing in urban areas, where only 20% of the population lives, the coverage in rural areas is much worse: one doctor for every 22,000 people.
Bobi Wine promises to further invest in medical infrastructure and provide the necessary medical equipment, which has largely been ignored by President Museveni’s National Resistance Movement government.
Raising necessary funds
The National Unity Platform administration plans to raise money to spend on public health by purging public expenditure through merging government ministries, departments and agencies into a lean and efficient government.
There are now over 100 ministries and autonomous agencies. Mr Museveni is still reluctant to run a smaller government arguing that a bigger government creates employment. That is why he is still reluctant to merge some or even abolish government departments that add no or little value.
Recruitment to these agencies is used by the ruling elite to maintain a system of political patronage. NRM cadres are favoured and they receive exponentially higher pay than their traditional public service counterparts. The outcome is poor or absent service delivery.
Bobi Wine says he will further raise money for the limping health sector by reducing the size of cabinet and the size of parliament to a maximum agreed upon after a national dialogue. He also plans to eliminate wasteful political appointments and enforce performance contracts between senior officials and the government.
Bobi Wine’s government also plans to negotiate with the World Bank to cancel payment of debts that added no value. The money saved will also be used to form a National Health Insurance Scheme.
Mr Museveni’s government has been investing steadily less in healthcare since 2008. In 2020/21 the health sector was allocated 7.9 percent of the budget, down from 9.6 percent in 2009/2010. This has resulted into shortage of drugs, equipment and staff in public health facilities.
Health infrastructure too is insufficient; there are sub counties without a single public health facility.
About 30 percent of Ugandans cannot reach a health facility without difficulty.
Statistics show that government health services are being abandoned as they deteriorate and those who can afford opt for private health care.
The government set an unrealistically low ceiling on health and social welfare expenditure. For example, a realistic annual budget for a large teaching hospital in 1996 was 30bn shillings (£10m, $17m, €13m) but the ceiling was set at 12.26bn in 1996, 8.87bn in 1997, and 13.28bn in 1999. Given the rise in inflation over this time, expenditure on health services (particularly on hospitals) was effectively held constant and yet the population was growing at a rate of 3% a year.
Currently, over 50 percent of Uganda’s health sector spending comes from external aid. Ugandan families cover 37 percent of healthcare costs. Donors contribute 45 percent and government meets the remaining 15 percent. Nearly all ARVs and vaccines are supplied by donors. 81 percent of mosquito nets are paid for by development partners.
Therefore, re-establishment of a functioning healthcare system will require heavy investment in infrastructure, which means more dependence on outsiders not less.
Covid 19 pandemic has worsened conditions in Uganda’s health care system. In addition, Mr Museveni has borrowed millions of dollars to contain the covid 19 pandemic but this money has been misappropriated by his government officials.
In addition, the governor Bank of Uganda says that the recent loans acquired during the COVID-19 pandemic could push the ratio up in part also due to the weaker fundamentals including slow growth, exchange rate depreciation, weaker exports and a fragile domestic revenue base.
More than 1,000 health workers across the country have so far contracted Covid-19 while 10 have succumbed to the disease, according to statistics from the Ministry of Health.
Hospitals in some districts have closed due to Covid-19 infections among health workers, which has left thousands of patients stranded.
Mr Godfrey Kabbyanga, the Kasese Municipality mayor, told local media that Nyabirongo Health Centre III, which serves about 20,000 people, was closed after majority of its workers tested positive. Dr Yusuf Baseka, the district health officer, said 13 out of 18 health workers at the facility tested positive.
“We have registered 218 infections in the last two weeks and 46 of them are health workers. We are managing it through home-based care where only those who need medical assistance are admitted,” he said. Kyondo Health Centre III in Kisinga Sub-county was also affected. Uganda Red Cross Society had to take over.
Three health facilities in Katakwi and Kapchorwa districts also closed fully or are operating partially. Magoro Health Centre III and Opeta Health Centre II both in Katakwi, which serve more than 30,000 people, were closed for a week. Residents have to walk long distances to access health facilities in Ngaraim, Toroma and Omodoi sub-counties.