Know your rights! Improving healthcare in Uganda
June 04 2007
In the past, the health system in Uganda hasn’t been as reliable as the
Ugandan people have needed it to be. Essential drugs haven’t always been
available, corruption has been a recurrent problem, and patients and health
workers alike have been let down by poor management. Also, there has been a lack
of understanding among patients about what they have a right to expect from the
health system, and among health workers about their obligations to their
patients.
But over recent years a programme supported by DFID has had these problems
firmly in its sights. The
Uganda
National Health Consumer’s Organisation – known as UNHCO – has worked with
patients, healthcare professionals and policymakers to build a system that
better responds to the needs of Uganda’s people. By working at these different
levels, UNHCO is changing attitudes to healthcare across Ugandan society, and
changing the quality of healthcare itself.
Partnerships that work
Image courtesy of UNHCO/Ronald Lumu
UNHCO began its programme in 1999 in the districts of Bushenyi, Luwero and
Kampala. In 2001 the programme was boosted when DFID added its support, and in
March 2005 UNHCO was provided with £230,000 of DFID funding to expand its
activities to the districts of Wakiso in central Uganda and Iganga-Mayuge in the
east of the country. This funding covers the period up to October 2008.
A central part of UNHCO’s strategy has been to work closely with local
communities, informing ordinary people of their rights and encouraging them to
demand the improved services that they deserve. In this way, local government
and hospitals and clinics are reminded of their responsibilities to provide
value for money healthcare to those whose interests they ought to represent.
Demanding better services
Image
courtesy of UNHCO/Ronald Lumu
There is solid evidence to show that UNHCO's approach can deliver real
improvements. For example, with the programme's backing, communities in Wakiso
asked their district health authorities to install essential facilities, such as
incinerators, at their local health centres. The authorities took notice of the
community’s wishes and the facilities have now been provided.
At a poorly managed health centre in Kampala, patients were experiencing delays
in receiving treatment and sometimes being forced to pay illegal charges. With
help from UNHCO, a petition was organised demanding that the district address
these problems. As a result of the patients getting together and making their
voices heard, illegal fees have been abolished and efforts are being taken to
make medical staff more responsive to their patients' needs.
There are strong signs that the work that UNHCO has carried out within local
communities has helped create more confidence in the medical system. In those
areas where the programme has had a presence – training health users and health
workers on policy issues, on how to provide feedback, and on rights and
responsibilities – the number of people using medical services has increased
significantly. In Bukoova health centre, for example, there were 800 patients
before the training, whereas now the figure stands at 1,500.
Making government deliver
As crucial as it is to improve the delivery of healthcare on the ground, the programme would not be doing the best for the people of Uganda if their concerns were not taken into account at a policy level. That’s why UNHCO has worked in partnership with the Government on a number of fronts, including:
- Carrying out research into patient satisfaction and rights awareness, which has informed the Ministry of Health’s Health Sector Strategic Plan II. Listening to feedback from patients is a key component of the Plan and UNHCO has been assigned to conduct a national client satisfaction survey, which is currently underway.
- Contributing to the Patient’s Charter – which protects patients’ rights and encourages good patient/provider relations – by educating people about the standard of healthcare that they are entitled to.
- Participating in the national working group on patient safety research.
- Campaigning for more money to be put into health, which has resulted in Parliament making a commitment to address the financing of infant and maternal mortality measures. Parliament will also look into the issues of corruption and inefficiency in drug management in medical stores.
The challenges ahead
Important work has been done in Uganda, and is being done, to improve the country's health system. But obstacles remain that must be negotiated.
Non-governmental organisations (NGOs) like UNHCO can be effective in helping the Government to deliver services, and in providing a voice for the people and interests they represent, but the huge increase in NGOs in Uganda over the last two decades (from around 160 in 1986 to 6,000 currently) has meant the sector as a whole has become less coordinated, and isn't always as representative as it should be. DFID must ensure that the support it provides to UNHCO enhances its ability to effect change at all levels of society. With proof of its successes behind it, the challenge now for UNHCO is to strengthen its role in making Uganda's health system even more capable, even more responsive and even more accountable.
Key Facts
- New outpatient attendance in Government and PNFP health units increased from 0.4 to 0.9 attendances per capita between 1999/00 and 2005/06 respectively (Annual Health Sector Report 2004/05 and 2005/06).
- By 2004/05, 68% of approved posts had been filled by trained health workers (Annual Health Sector Report 2005/6).
- The percentage of deliveries taking place in health facilities was 29% in 2005/6 according to the Health Sector Performance Report. The 2006 Uganda Demographic and Health Survey (UDHS) preliminary report has a much higher figure of 41%.
- HIV prevalence in Uganda has stabilised over the last five years, following a reduction during the 1990s. Currently 6.4% of Uganda adults aged 15-49 are infected with HIV. Infection rates, however, remain high, presenting a risk that prevalence rates may once again start to rise (2004/05 HIV/AIDS Sero-Behavioural Survey).
