Healthcare System, Uganda Style

Obama, after a protracted battle, failing of which would have irrevocably crippled his presidency, finally triumphed amidst the clamoring noises of the Sarah Palens of the American world. Those who have had experiences with the sometimes capricious American healthcare insurance industry may breathe a shy of relief: At last!

In Uganda, to say that the healthcare system is a survival of the fittest (no pun intended) is an understatement. Stories are abound of stolen drugs by medical workers, dilapidated state hospitals, patients sleeping on hospital floors, and unsanitary conditions that could lead to serious disease outbreaks in the same hospitals meant to cure.

Let us get under the hood and take a glimpse of the structure of the system.

The Uganda healthcare begins largely as a bequest bequeathed by the British colonial master. This was a system of state hospitals and clinics distributed throughout the country to which anybody could be treated for free. The Obote I government maintained and improved on it. For modest a fee there were also Catholic missionary hospitals. Asians, and increasingly Africans, had private clinics which served a certain clientele base.

Fast forward to today. The Catholic hospitals have expanded, and served heroically during critical times, especially in the Northern 20-year LRA war of attrition. New private hospitals have been built by entrepreneurial clinicians. There is a vast array of clinics by doctors, some of whom work in government hospitals. The government hospitals, which service the great majority of the population, have regressed with broken infrastructures and poor services.

Here are some experiences that my good friend, we will call him Ojukkwe, had recently.

Ojukkwe hooked up with an old flame. Ojukkwe, like Reagan with the Russians, has the motto of: trust but verify. So he convinced the woman to check if she was “clean” before they got intimate. She, of course being relatively well-heeled, had insurance through her work. She thus walked into a private hospital in the capital city. The waiting room was clean, and the young doctors and orderlies looked efficient. There was not much waiting. She got her results, and they were soon on their way to consummate their pent-up missed opportunities.

Another experience occurred when Ojukkwe was knocked to his rear-end by nonstop partying and needed to extend his stay by a of couple weeks to recuperate. He did not want to pay a penalty for rescheduling his cheap ticket. When in Rome, do what the Romans do. He contacted a London-based doctor friend, who recommended a local doctor to provide Ojukkwe with a sickness note to present to the airline. The local doctor, while working for a public hospital, also had his private clinic in one of the slums that mushroom the city outskirts. When the doctor finally arrived past the appointed time, the nurse assistant ushered Ojukkwe in ahead of the other patients. The doctor was paid far above the requested fee, and the assistant welcomed a surprise tip. That is Ojukkwe, my friend. His other motto is: one good turn deserves another!

It thus seems then that in the present Uganda, if you have the means, your healthcare needs are taken care of without dislocation of resources. For the high-and-mighty you might even get flown out of the country to specialists and better medical technologies—all at taxpayers’ expense, for you are more valuable than they are. What about the teaming millions who have to use state hospitals and clinics? Are they forever cursed with dirty dilapidated buildings, lack of drugs, and poorly paid attendant physicians and orderlies?

The present is a legacy of the NRM government’s priority. Every hospital death that could have been prevented is its responsibilities and has to be accountable. It cannot escape by some futuristic gimmick declaration of transforming society. We all know that much of the 54 trillions transformation budget will go down the dark holes of corruptions.

We need leaders who are genuinely pro-people—not showmen, charlatans and pirates. If we examine the history of Uganda healthcare systems and study how similarly-challenged countries are handling theirs we can customize our solution. For example, Brazil provides basic preventive primary care to all its citizens. Malaysia has individual account system, called Malaysia National Health Accounts Unit that service basic healthcare needs. We cannot transform a society with a sickly population.