Medical Association decries declining public funding

Uganda Medical Association (UMA) has decried the declining government funding for the health sector, calling for alternative  solutions for the affected interventions and addressing high donor dependency.

According to data from the government, the health budget has declined from Shs4 trillion in the last financial year to Shs2.9 trillion in this financial year. But the total national budget has been increasing, hitting 72 trillion this financial year.  

Speaking to journalists in Kampala on Monday, Dr Herbert Luswata, the UMA president, said the government failed to provide Shs27 billion which was meant for maintenance of ambulances.

"We commend the government for its recent investments in healthcare, including funds for medical intern and resident wellbeing, staff recruitment,promotions and the procurement of 116 ambulances with support from UNICEF, Japan International Cooperation Agency (JICA) and global fund, among others," Dr Luswata said. 

"However, we express concerns about the operationalization and long-term sustainability of these initiatives. Recent parliamentary discussions have raised concerns about the removal of 27 billion shillings allocated for ambulance maintenance, which could hinder their utilisation. Uganda currently has an ambulance coverage of around 58 percent, and we don't have staff who should work in these ambulances as patients are transported following the referral," Dr Luswata added.

The UMA said that as a result of the gaps in the ambulance system, patients are dying on the way, before reaching the health facilities. Dr Wilberforce Kabweru, a senior consultant surgeon and the UMA chairperson for ethics and professionalism, said many ambulances in the country are not suitable for patients they transport. 

"Most of the ambulances we see in Uganda are class A, which are basically carriers for patients who are very stable. The class B ambulance should have a health worker with the patient, alongside the driver and during that time the health worker should administer some treatment," Dr Kabweru said.

"Class C ambulance is what we should endeavour to have because many times when we decide to refer a patient, the patient is unable to support themselves and their body system is failing. Such a patient needs a very technical person to be moving with them in the ambulance which has a life support system but I am told in Uganda, we have less than 10 class A ambulances," he added.

Dr Luswata on the other hand, said they are concerned about the potential loss of funding for other critical healthcare projects, including: "26 billion shillings for ongoing health center construction, 26 billion shillings for additional ambulance procurement, 5 billion shillings for the Mbale Surgical Complex construction and 59 billion shillings for the Masaka Regional Referral Hospital Intensive Care Unit construction."

Dr Joel Mirembe, the UMA secretary general, was specifically bitter about the money for ambulances and hospitals which he said MPs last week removed from the budget and gave to Roko construction company when the President asked them (MPs) to revisit the allocation of Shs750 billion in the national budget.   

“We see them (MPs) passing supplementary budgets every now and then for giving investors money -investors who should be coming with money to invest in Uganda but it is us who should now give that money. This should not have been done, it must be stopped. Now that they have done it without shame, MPs should organise a healthcare focused supplementary budget to fund all these priorities which were reversed," Dr Mirembe said.

"For us we are constructing life, the other people are constructing buildings which we can do without. Government should ensure every district has at least a government-owned, facilitated and operated ambulance to ensure that our people are safe," he added.

However, Mr Ramathan Ggoobi, the Permanent Secretary of the Finance Ministry and secretary to the treasury, said on X (formerly Twitter) that the public is missing some facts about the Shs300 billion allegedly allocated to Roko.

“First of all, there had been an “over cut” of Treasure Operations budget for item code 242003. The budget was Shs256.2 billion, but Shs 300 billion had cut! The Shs256.2 billion was allocated as follows: Shs200 billion, as payment for Bank of Uganda bank charges for managing Government of Uganda (GoU) accounts of all entities, that is to say, to enable GoU pay out the Shs72 trillion in the budget, plus payment of government securities,” Mr Ggoobi said.

He continued: “Shs56.2 billion, as payment for the shares GoU acquired in Roko Construction Company, as approved by Parliament in July 2022. Roko has contracts worth Shs 1.4 trillion including Parliamentary Building…By the way, the budget already had substantial amount of money for buying ambulances, building and equipping health centers, hospitals and referrals, schools etc. as presented in the budget speech.”

In the Finance Minister Matia Kasaija’s budget speech last month, he said the “Government has provided 116 new ambulances to 100 constituencies, another 10 ambulances for the Regional Referral Hospitals and six (6) for the Command Centre at Naguru; among others.”

“Under the Uganda Inter-Governmental Fiscal Transfers (UGIFT) Programme, 371 Health Centre IIs were planned for construction and upgrade to Health Centre III Status. So far 261 Health Centre IIs have been upgraded to Health Centre IIIs and are fully operational. An additional 110 are on-going at different stages. Meanwhile, 11 hospitals were rehabilitated, in Busolwe, Kapchorwa, Kambuga, Buwenge, Koboko, Amuria, Kotido, Kaberamaido, Kawolo, and Kitgum Districts,” the Minister added. 

Dr Mirembe and UMA members, however, said they are not satisfied with the government's funding. "We expect the healthcare budget to be a minimum of 10 percent of the national budget, currently it is being reduced to less than five percent. So, we want to promise the government, if they don't come up with this in the next few months, we shall rally the general public to get this from the government because it is worsening healthcare service delivery. Ambulances are not a luxury, you miss an ambulance for 30 minutes or one hour you are dead,” Dr Mirembe said. 

Dr Mirembe also challenged the reliance on police in handling emergency situations. "When we get casualties and fatalities on the road, it is the police who come for the victims. This should stop. Police officers have no technical expertise in evacuating accident victims. Infact, on many occasions, they've killed the victims, not because they want to but because they have mishandled their neck. The person comes when their neck is no longer functioning. They just throw them behind those patrol vehicles. The accident victims are not criminals. This will only work by operationalising ambulance service countrywide," Dr Mirembe added.  

Furthermore, the doctors demanded the entertainment industry cease misusing our clinical coats and stethoscopes, saying "this undermines the professionalism of our medical community and erodes public trust."

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