A shortage of trained medical staff in the war-torn northern Ugandan district of Kitgum is compromising efforts to improve the care, support and treatment of HIV/AIDS patients.
Continuing insecurity and dire living conditions in the district's ubiquitous camps for the displaced are prompting qualified staff to quit in search of a more comfortable working environment, leaving already ill-equipped health centres even more short-staffed.
"It's a real struggle to get qualified staff in Kitgum," said Dr Vincent Oringa, district director of health. "Working conditions in the camps are not easy, simply because the basic necessities like decent housing, running water and electricity are not there."
That is having a direct impact on the Ministry of Health's attempts to scale up HIV/AIDS treatment programmes in the region.
In the early 1980s, HIV/AIDS was unheard of in northern Uganda - the few early cases were presumed to be the work of witchdoctors. Today, however, the prevalence rate in the districts of Kitgum and Gulu is more than nine percent, according to a recent nationwide study – three percent higher than the national average.
More than 90 percent of Kitgum's population has been forced into overcrowded, unhygienic camps by a 20-year campaign of terror waged by the brutal rebel group, the Lord's Resistance Army.
The HI virus has flourished in an environment where men find little to do other than drink, where women and girls find themselves vulnerable to sexual abuse, and where health facilities are woefully inadequate.
At St Joseph's Hospital in Kitgum town, staff shortages are severely affecting the AIDS clinic's performance, according to Dr Pamela Atim, who says the clinic should employ two doctors and four clinical officers, but currently has just one doctor and two clinical officers to deal with the overwhelming demand for testing and treatment.
"People don't want to come and work in the north yet the numbers that come to the clinic keep swelling. We could have more patients but we've had so many doctors and clinical officers moving to greener pastures and this is slowing us down," she observed.
There's growing concern among health officials and humanitarian workers that the district's inability to respond to the ever increasing demand for voluntary counselling and testing (VCT) and antiretroviral (ARV) treatment could undo the progress made in raising levels of awareness on HIV-related issues.
One organisation looking to start providing VCT, and ultimately to the provision of ARVs, is the international medical charity, Médecins Sans Frontières (MSF), which currently operates a referral service in five camps in Kitgum district.
"We have a situation whereby sensitisation and awareness levels are high, there is a demand for voluntary counselling and testing, but the services are not there to meet the demand," said MSF project coordinator Heather Thomson, describing the district's capacity as "limited".
Katie Opoka, director of a community-based organisation, Meeting Point, which supports HIV infected individuals, worries that this gap is fuelling frustration among people in the camps.
She said: "There's a real risk of people losing interest in going for tests. We are hearing people say, 'Why do you teach us these things when the services are not there?'"
The Ministry of Health in the Ugandan capital, Kampala, says a new emergency programme aimed at scaling up access to health services will double access to general medical services in the region within the next six months.
In Kitgum, Dr Oringa said VCT services had already been expanded to 11 district-wide sites and that the district authority was in the process of opening up two ARV centres to the north and east of the Kitgum.
He admitted, however, that the expansion programme was proving arduous. "Scaling up of ARV provision is proving slow due to the poor human resources we have available in this region. ARVs need qualified staff to administer treatment and follow-up," he explained.
"Why would anyone want to live in the environment we have here if they have the option of moving to Kampala and receive the same salary," Oringa said. "We have asked the Ministry of Health for a 'top-up' salary to provide an incentive to work in the region but so far no changes have been made."