On Sunday 20th March 2022, the president of Uganda broke the news of the untimely death of the Rt. Hon. Jacob Oulanya, the Speaker of the eleventh parliament of Uganda. Since his accession to the office of Speakership, the Rt. Hon. Oulanya had been in and out of the hospital and the Deputy Speaker of Parliament informed the house on 8th February 2022 that he had been flown out of the country for specialized treatment. Recently, it was revealed that a Uganda Airlines plane, Airbus A330-800 Neo, which has a sitting capacity of about 220 to 260, was chattered for five hundred thousand dollars to fly the speaker to Seattle, USA for treatment. The Chief Justice and Deputy speaker were facilitated to fly to the United States to check on the speaker with all expenses paid out of the national coffers. As we mourn for the charismatic and eloquent speaker of the august house, it is only imperative for us to ponder whether it is still prudent for Uganda to spend billions paying for medical treatment abroad while our hospitals are still in tatters.

It is commonplace for government officials to seek treatment abroad at great debit to the national purse. The preference for treatment abroad is beyond political pomp. The reality that Uganda does not have the requisite medical equipment, medicines and hospitals to treat almost all grave and advanced illnesses behoves high ranking civil servants to seek treatment elsewhere at taxpayers’ expense. The wanting state of our health care system has brought death closer to the poor and necessitated haemorrhage of state funds to save the lives of the all-important government dignitaries. For the vast majority of Ugandans, illnesses like cancer and heart disease are considered a death sentence owing to the high cost of treatment required for one to obtain specialized treatment.

"Studies show that the majority of Ugandan trained doctors work abroad because of the meagre and often delayed payment, lack of adequate working equipment exacerbated by long working hours."

Uganda’s health budget is somewhere below 7% of the total national budget, a very insignificant proportion for a capital-intensive sector like health. The national hospital bed density is 0.5 beds per 1000 persons. A number far too low for the forty-three million Ugandans. This explains the high number of patients sleeping in the hallways of government hospitals, with some removed from hospital beds because they cannot afford a bed fee. Many government health centres still suffer leaking roofs, shortage of drugs, congestion, lack of medical safety equipment for doctors and understaffing–especially those under poor management. Studies show that the majority of Ugandan trained doctors work abroad because of the meagre and often delayed payment, lack of adequate working equipment exacerbated by long working hours. The state of Uganda’s health sector has encouraged private players to join the sector and dictate the cost of treatment to a magnitude that excludes the poor majority of Ugandans. During the surge of the COVID-19 pandemic, families had to pay millions of shillings daily lest their patients were left to die owing to the high demand for medical services.

The state of Uganda’s health system has also lately been struck by the atrocious business of illegal organ trade. Credible reports have it that illegal organ traders have infiltrated hospitals to facilitate the unauthorized extraction of human organs for sale. The troubles bedevilling our health system are sometimes downplayed and often ignored, a typical reaction in a country with a proclivity of ignoring important matters. Grim as the picture of our health sector stands projected for the world to see and Ugandans to suffer its flaws, the solution is not as complex as many would want us to believe. It is first and foremost the government’s repossession of the health sector. Complete and total monitoring coupled with real investment in the life-saving infrastructure and better working pay for our medical personnel will do for the start. The health sector, just like the defence and education sectors, the health sector must be under stern monitoring and direction of the government, with the government providing a significant part of the services. It is foolhardy for these sectors to be left to the whims of private players, given their profound impact on the country. Any government that is lukewarm about controlling these sectors creates fundamental problems for the country.

The Government should earmark health facilities for construction every financial year the same way it earmarks roads to be constructed or upgraded. With sufficient hospitals in different parts of the country and the construction of more national referral hospitals, to increase the capacity of the industry the serve the country and counter private control of the sector. If Uganda’s political nobility want a hospital of their own, a befitting facility can be constructed so that they are treated here. This will save the hundreds of millions spent on travelling abroad, attract foreigners to receive treatment here and financially capable citizens will also have their costs reduced not to mention the income generated by the government for the treatment.

The COVID-19 pandemic has should have been an aide-memoire for constructing a self-reliant health sector. When countries closed their doors to all those beyond their borders, every country had to rely on its health system. Uganda is among the countries that managed to register relatively low numbers of COVID-19 patients, but the facilities could support even the few that were hospitalized. A key highlight of the pandemic was when the vaccine was developed. Manufacturing companies withheld vaccines from African countries for many months even when African countries were willing to buy them. In a logical world, we would see a significant improvement in medical research through the construction of modern medical laboratories, training of researchers and purchase of equipment. But in a country where the luxury of a few is more plausible than national progress, the peasants must pay for the comfort of those whose life is more important.

The obvious peril of relying on foreign health systems is that those who cannot afford the luxury of travelling abroad and paying the high costs are forced to receive mediocre treatment at best. This does not justify the continued payment of taxes by people who live on the bare minimum of health services. I hope the protagonists of our policy-making bodies can be moved to make a difference in the lives of so many who pay so much to see them live a more honourable life.