Health facilities stretched to breaking point

Jennifer Nankinga fed her ailing child from a hospital bed in Kayunga, north of Kampala, despite a strong stench from dirty toilets that filled the air in the paediatric ward.

She was lucky to have got a bed. Other children and their mothers were sleeping on the floor of the dilapidated ward of the 100-bed referral facility.

All round Nankinga, however, were signs of rot. Hospital officials said the facility had never undergone major renovation since it was opened in 1972, and lacked medical personnel.

"We are understaffed by 40 percent," hospital superintendent Ahmad Matovu, said. "The hospital is supposed to have seven doctors but we are only three."

The facility is a public hospital, but funding was inadequate, he added.

"We receive 245 million shillings [US$110,000] each year as recurrent expenditure; 40 percent of this is used to procure medical supplies and the rest to do other things and maintain this place including buying fuel to run the ambulance which is also old," Matovu explained.

"This amount has remained constant for the past five years [but] the cost of drugs and fuel has almost doubled… The money is not enough and we ask clients to buy what we do not have."


Like Kayunga, most Ugandan hospitals are in bad shape, something pointed out in a recent parliamentary committee report which looked at the performance of the health sector in 16 districts in the first few months of 2009.

"The level of dilapidation around and within the health centres at all levels was shocking," Nvumetta Kavuma, the committee chairperson, told IRIN. 

Photo: Vincent Mayanja/IRIN
The ambulances at Kayunga hospital broke down and only one, which is also old, now remains

"Most buildings needed renovation, reconstruction or extension, while some facilities were completely missing," she added. In Kawolo (east of Kampala) and Kiryandongo (in western Uganda) hospitals, despite being near main roads, the entire infrastructure required a complete makeover, the report said.

Population pressure

The report pointed out that Uganda's population was growing at a rapid rate of 3.2 percent per annum and this had put pressure on the facilities, many of which had been built during the colonial era when Uganda had less than five million people. Its current population is estimated at 30 million.

"Nearly all the health centres could not accommodate the current population pressures… Overcrowded outpatient areas and admission wards were a common picture across most health facilities," the report said.

The MPs said the country's largest referral and teaching hospital at Mulago in Kampala had been overwhelmed. The hospital was designed to accommodate 20 mothers-to-be, but now handled over 100.

Borrowing from the World Bank

Senior Ugandan officials insist matters will get better this year.

Reading her 2009/10 budget in June, Finance Minister Syda Bbumba said improving health infrastructure and provision of drugs, especially for HIV/AIDS and malaria, would be a priority.

The health sector, she added, would receive 11 percent of the US$3.7 billion dollar budget.

Health Minister Stephen Malinga said the government was in the process of borrowing $600 million from the World Bank to improve facilities like Kayunga hospital.

"The government has authorized us to borrow $600 million from the World Bank in order to rehabilitate and address all other issues with regard to health facilities and make it easier for health workers," Malinga told IRIN. 

Photo: Vincent Mayanja/IRIN
Up to 200 patients are handled daily by the outpatients section of the hospital

"Our priority will be to rehabilitee 100-bed hospitals and health centres IV and III [lower level community facilities] that have not been completed and those requiring renovation," he added.

Brain drain

"We also want to build houses for doctors and nurses to make it attractive to these workers so that when they are deployed up-country, they find a house, water and other essential requirements for the job."

Medical workers, however, said renovating hospitals and building houses alone would not solve the problem. The question of poor pay also needed to be addressed, they said.

At the moment, a newly qualified doctor earns from 650,000 to 1.2 million Uganda shillings [$280 to 550] while a senior consultant earns up to 1.5 million [$680]. This situation has forced many doctors to abandon the country for better paid jobs elsewhere.