STRATEGY
I previously questioned the endemic nature of the problems that is
steadily driving our health service delivery system to crumble. The editorial
of the Daily Monitor on October 5, 2016 remarked on the Health Ministry’s plan
to close nearly 7000 Health Centre IIs in the country. The commentary cited the
Permanent Secretary, Ministry of Health, saying that the Ministry (read
government), could not raise the human resource capacity – nearly 63,000 health
workers, needed to sustain these centres.
One of the most ornamental features of the Uganda health service
delivery system is its elaborate structure. The system was properly structured
to reach close proximity to the people who need health care services the most.
The Health centres I and IIs are at the grassroot - the Villages and Parishes.
These are the location where these services are needed the most, even if they
have been the least effective. This is where nearly 83% of Uganda’s population
can access health care.
When you study the statistics of infant mortality and
child-maternal mortality rates in Uganda, you start to realize a structural
problem starting with distance (access) to health centres, lack of qualified
professionals, and difficulties to access and negotiate for health resources,
as the key drivers of these deaths. Most of them are preventable deaths, which
occasions our children, expectant mothers and the population.
Scrapping these centres therefore, is not only alienating the
rural hard-to-reach population from any forms of social assistance, it is a
matter of inequity, a moral, ethical and human rights issue. It is symbolic of
a retreat by government from the social lives of the rural population.
Nonetheless, the Uganda health care service delivery strategy
needs a rethink. A major paradigmatic shift is now inevitable.
There is need for an ideological streamlining of health service
provision. Uganda should rethink of a new definition of its healthcare and how
they want it formatted to reach the most needy and on a sustainable,
cost-effective, efficient and reliable way.
The biggest challenge lies in the conceptualization of health
service provision that moves away from curative downstream emphasis. The
Curative is the biomedical model where ill-health is acquired by microorganisms
or injuries, and the doctor cures it. These tend to promote individualistic
consideration of health as a function of lifestyle choices, when many Ugandans
really have limited healthy choices at their disposal to begin with.
The shift from traditional conceptualization needs to happen, and
very fast, given the parlance of neoliberalism. First, government must own up
to a provision of quality health services to its population as a matter of
human rights. Second, we have to employ a wide range of interventions, mostly
psychosocial, which views health not as the presence of disease, micro-agents,
etc., rather, a cumulative effect of social and material relations; and the
complex dynamics within the environment as determined by the mode of production
in our contemporary society.
The expanded definition of health care would allow the
diversifying of health resources to address upstream, mid-steam, downstream and
health research, in proportions that make absolute sense to productivity in the
economy. Right now,
healthcare means hospitals and medicine. We are tired of seeing decaying
hospitals, commentaries about lack of drugs and doctors’ shortages. By
diversifying, we start to remove costs from downstream and spreading it to
address the inherent causes of disease, ill-health and endemic poverty that
ties the masses in that trap of vulnerability.
I believe that much of the public expenditures in health sector is
ineffective. That money should be reinvested in critical areas where the causes
of ill-health are located. People get sick because of a variety of factors,
mostly, entrenched socio-economic inequalities, chronic repression, unjust
society, corruption, and deliberate exclusion from decision-making and so
forth. These are the primary factors that lead to decay and lapses in health
service infrastructure, brain drain, unethical practices, negligence,
suboptimal deliveries of health resources and unequal access to health
resources due to gender and ethnic based inequities.
END
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