Why more Ugandans prefer witchcraft than hospitals

 

 HEALTHCARE FAILURES

 

I read Dr. Diana Atwine's speech in the Daily Monitor on May 9, 2023, about the prevalence of Tuberculosis and Leprosy in Uganda. Dr. Atwine is the Permanent Secretary of the Health Ministry. The Health Ministry is a very critical public institution whose role in helping Ugandans cope with ill health and health-related threats is complementary to Uganda's national development goals.

 

In the referenced DM article, Dr. Atwine advised Ugandans that TB and Leprosy were not witchcraft-related diseases. By that statement, Dr. Atwine invites Ugandans plagued with TB and Leprosy to seek healthcare services for proper assessment and management of the diseases.

The problem is, Ugandans fear Dr. Atwine's public healthcare system!

 

In Uganda, the explanations of the causation of "unwellness" have strong roots in personal and cultural health beliefs. Many Ugandans are still semi-illiterate and broke (poor); even those who are learned, health services consumption behaviors are strongly influenced by costs.

The cost and stress of encountering Dr. Atwine's public healthcare system are itself pathogenic.

 

Dr. Atwine and her team must be knowing that witchcraft practices increase in Uganda when the healthcare services run short.

 

The glamorous buildings that emerge randomly to define our skylines during economic hardship like now, probably belong to witch doctors, their intermediaries, and certainly corrupt government officials.

People have turned to traditional beliefs and practices due to fear of confronting the ever-money-sucking healthcare workers, poor services (attitude and skills), high costs associated with buying hospital supplies and drugs that government should provide, and poor outcomes (rigor mortis/frequent deaths) in government hospitals.

 

The health care system, itself a key determinant of health, is simply inaccessible to many Ugandans in the moments of their urgent needs.

 

However, the health ministry is doing some great investments – rehabilitating and refurbishing hospitals, healthcare centers, and so forth. However, a colorful hospital building is not what makes a hospital a hospital. It is the sum total of socialization therein – ethical socialization - to be precise, that makes a hospital a hospital. And, this basic element is grossly missing.

 

The quality of care in government hospitals and health centers is seriously wanting. The unethical conduct within these institutions needs immediate attention if sick Ugandans including Leprosy and TB patients are to seek treatment there.

 

The hospital, however, is a place of extortion that begins for most Ugandans at the gate with the Askaris. Patients and caregivers are milked right from the point of registration to the most sophisticated professional. It is like the government only pays the basic salaries of these health workers such that the ill Ugandan must pay out-of-pocket for supplies and drugs. This is not even cost-sharing as we once knew it!

Most times, you find poor people being charged for gauze, cotton wool, a pint of blood, etc, including a piece of paper to document their care or else their patients are left to die or unattended. What happened to medical ethics and Hippocratic Oath that we once swore with pride?

 

While the fiscal constraints with which the health ministry operates are worthy of our empathy, the idea is to let the care process be functional with some proactive oversights.  Uganda currently allocates a paltry 6.1% of its national budget to health (See DM editorial of May 12, 2023). This is not for the lack of money, given the high cost of public administration. This, precisely, is a neoliberal policy strategy to renege on the state's role in healthcare provision for a perpetually cash-poor population.

 

Further, the poor service delivery at the local government level attests to the collapse of local government functions, and least to the lack of donor support to the health sector. The purpose of decentralization was to bring services closer to the people and empower people to seek direct accountability for these services.

 

Right now, the services are alienating the very people and no one dares provide accountability for the pathetically awful healthcare services.

 

The health ministry itself snubs citizens' attempts at providing direct feedback on these horrendous encounters. Empowering the population means that end-users of the healthcare facilities should provide direct feedback for you to acknowledge and respond to.

 

If the Ministry feels that it cannot accept feedback from the everyday users of the healthcare system, or those rebuffed by the horrible experiences in the system, then why should a local government-run health center be accountable to the people? The Ministry should not shut out civic engagement that empowers its service users else people drift to witchcraft.

 

In sum, Ugandans are turning to witchcraft to "treat" their frustrations and ailments, including TB, Leprosy, HIV, mental illness, and so forth because witch doctors are more accessible, affordable, professional, accountable, and provide some form of psychotherapy, however deceitful to the poor, than our educated experts. People now know that government hospitals are places where their poor loved ones go to die.

End