Patients dismiss govt ranking of Mbale hospital as top performer

Two years later, it was business as usual; more clinics are in operation, and cases of dubious referrals abounded, except this time round, with medical personnel treading carefully.

During the early-August operation, SHHMU and police arrested, among others, the Mbale RRH director, Dr Stephen Obbo, an accountant, Mr Anthony Ogwang, the procurement officer, Mr Joseph Ebasu, the hospital administrator, Mr Bruno Ojono, the plumber officer, Mr Purica Semakula, and the store in-charge, Mr Martin Kizito, on charges of neglect of duty and forging accountability.

For instance, about Shs80 million was reportedly spent to train health workers how to use social media— WhatsApp, Facebook, and Tiktok, an activity which allegedly never took place. Some of the health workers interviewed by the SHHMU team denied having attended the training despite their names being listed as participants.

According to findings, the hospital management spent Shs350 million on cleaners every year and yet the facility is ever dirty, spent a reported Shs28m on buying reams of paper during last financial year, among others.

The arrests, the SHHMU director, Dr Warren Naamara said, followed “a comprehensive and investigative review of expenditures that revealed significant misuse of funds by the hospital's top management. During the raid on one of the private clinics, 57 units of blood were recovered’’.

“After over three weeks of thorough investigations in collaboration with the Criminal Investigation Department (CID), we found out that the leadership failed to effectively utilise resources to ensure quality healthcare delivery, despite the funds being provided by the government,” Dr Namaara said.

He added: “The top management was found to be misappropriating financial resources rather than using them to improve healthcare services, which is their primary responsibility.”

The accountant, administrator, store in charge, and the plumber, were later released on police bond.

The review, specifically subjected availability of essential medicines and equipment; functionality of healthcare infrastructure and equipment; staffing levels and qualifications of healthcare workers; leadership and governance; patient satisfaction with services; and financial management, to litmus test and unraveled several inadequacies.

Stark contrasts

According to SHHMU, the hospital leadership, among others failed to “effectively utilise resources to ensure quality healthcare delivery despite the funds being provided by the Ministry of Health, with cases of misappropriation unraveled; there was “a noticeable disconnect” between the hospital’s management and the service delivery consultants; the hospital spent funds on non-essential activities, indicating a waste of resources; and, although the hospital was generally clean, there were notable hygiene issues, largely due to a significant reduction in funding for cleaning services, with blood stained walls and clogged drainage.

Understaffing, unaccounted for drugs was estimated in the ranges of Shs300m; there were instances of missing drugs including Antiretroviral drugs (ARVs) TLD 30 and 90s, Cefriaxone, Artesunate, Sodium bicarbonate, Safe delivery kits, Magnesium Sulphate, Oxytocin, and HIV test kits, the perennial extortion and brokering of patients by health workers to outside private health facilities, and congestion in the hospital wards, littered with several non-functional equipment like broken beds in wards, broken oxygen concentrator in the Pediatric wing, and faulty lights in the wards, among others.

What is “perturbing”, Mr Steven Masiga, a researcher at Makerere University’s Mbale centre, told Daily Monitor that the same things are and have been reported over and over again.

“Corrupt behaviours in public life must be confronted with full force without any sympathy for the lawbreakers. Public institutions have regulations and policies that dictate how public resources should be spent,” Mr Masiga said, adding: “Those who report are often victimised so people choose to suffer quietly. While the efforts of the State House Monitoring Unit and police are welcome, a lasting solution is needed.”

Inexplicably, Mbale RRH outperformed other 21 regional referral and private-not-for-profit hospitals during the last Financial Year 2023/2024, according to the Ministry of Health’s Annual Health Sector Report released last month. The hospital scored 64.8 percent followed, with a wide margin, by Arua RRH with 49.7 percent and Hoima with 47.1 percent.

According to the report, Mbale RRH, among others, had the highest number of admissions of 58, 169 and the highest number of deaths of 3,750.

The hospital was established 100 years ago by the British colonial administration. The 415 bed facility serves more than 15 eastern Uganda precincts of Mbale, Mbale City, Busia, Budaka, Kibuku, Kapchorwa, Bukwa, Kween, Butaleja, Namisindwa, Manafwa, Mbale, Pallisa, Sironko, and Tororo.

2020/2023 FY

In the Health ministry’s assessment report for the preceding Financial Year 2022/2023 released last year in November, Mbale RRH outperformed all others, closely followed by Hoima RRH and St Mary’s Lacor. It received a non-wage budget of Shs7b during the FY2022/2023 and Shs4.8b during the FY2023/2024.

The Ministry of Health’s report highlights that the hospital serves a big catchment area, which undoubtedly had bearing on quality of services, the ranking, however, pales in the background of the SHHU’s findings and concerns and complaints by locals and patients who have long decried the services offered by the facility. Residents have long complained about health workers extorting money from them before they can access medication.

Dearth of care

The Mbale Resident City Commissioner (RCC), Ms Asumin Nasike, said one of the problems is the poor supervision of staff which midwifes attendant problems such as siphoning of essential drugs and high levels of absenteeism.

“We also discovered that the essential medicines got lost along the way to Nakaloke Health Centre III. Missing accountability of Shs400 million,” Ms Nasike said.

However, speaking during a community baraaza on September 27, in the aftermath of the arrests at the hospital, Dr Obbo said they are overwhelmed by the numbers, with staffing capacity of 22 percent serving 4.8 million people.

“We have to answer the queries that have been raised by SHHMU. We have been given time to respond. We have also been given errors to improve,” Dr Obbo said.

What started as a probe into maternal deaths, Dr Namaara said yet again instead brought several old issues to the surface.

“We came to investigate why the mothers were dying. We also discovered that health workers don’t work, drugs are missing, equipment is not there and yet they received such equipment. Some money is also missing,” Dr Naamara said.

The outrage was sparked by a recent incident involving a 26-year-old mother who passed away with a twin pregnancy after experiencing a three-day delay.

Harriet Muduwa, a teacher by profession and resident of Malare in Mbale City, was admitted on July 13, referred from Busiu Health Centre IV with clear signs of labour. The mother was reportedly neglected until she tragically passed away after three days with the babies still in her womb.

With the high levels of absenteeism of senior personnel, Dr Namaara noted and patients have long complained, the healthcare is usually left to medical interns usually working without supervision. With the high amount of such absenteeism, patients are often referred to private clinics or left fate.

Such is the case when Kevina Gatami’s 32 year old son, David Wabusimba, was admitted to the facility two months ago following a motorcycle accident that left him half-dead. Upon arrival at the hospital they were simply told he had suffered internal bleeding to the brain which required surgery.

“Medical officers at Mbale General Referral Hospital advised that patient be taken to another facility which asked for Shs4 million to handle the patient. However the hospital that they directed us to go to insisted that we first pay the Shs4 million before they could work on us. So it was indeed after paying the Shs4 million that he got medical redress,” Gitama, a resident of Runyoro Cell, Bunawana Ward in Butiru Town council, Manafwa District, recounted.

Three months later after the surgery, Wabusimba’s condition has never improved; he remains in a vegetative state while his relatives have resigned to fate.

Robinah Nambozo, a resident in Mbale City, said they hope the arrests will address the anomalies, which have been going on in the hospital.

"The hospital has become something else. It's even more expensive than some of the private facilities,” she said.

Mr Ivan Wekesa, has battled a bout of headache since and has been in-and-out of Mbale RRH without ever seeing proper medical help.

Betting lives

“I have serious pain only on one side. I was taken to Mbale hospital to check me and the results were not clear and they wrote for me the medicine which is very expensive,”Mr Wekesa said. 

He added that when he went back to the facility, he was asked to go to Mulago National Referral Hospital. He is currently using painkillers to reduce the pain.

Mr Masiga said it defeats all understanding that a regional health centre works like a health centre.

“They’re unable and people are dying and numbers are not disclosed. There are many instances of deliberately telling people that machines are down and have to seek related services at private clinics. As a matter of fact the starting point would be to remove all clinics from the radius of the hospital,” he added.

During the September baraaza, Dr Brian Arinaitwe, the SHHMU assistant director, revealed that the main hospital serves as re-routing point for drug supplies to lower health facilities such as Nakaloke Health Centre III but there have been reported instances when drugs disappear at source.

“There is serious fraud in Mbale RRH. They are good at preparing documents but all are forgeries,” Dr Arinaitwe said.

Operation

In September, SHHMU/police raided the Health for Life General Medical Clinic located in Nkoma Ward, Mbale Northern City Division, following intelligence information. 

The seized items included more than 57 units of expired blood and Class A drugs, reportedly stolen from Mbale RRH. Some of the stolen blood belonged to rare groups such as O, exacerbating the scarcity of critical medical resources in the region.

Dr Julian Nabatanzi, the SHHMU deputy director, disclosed that the clinic is owned by Mr Alexander Nyongesa, a clinical officer attached to Mbale RRH.

According to authorities, the facility has been under investigation since 2021 when oxygen cylinders meant for the referral hospital were found hidden there during the COVID-19 pandemic.

The Divisional Police Commander of Mbale City, SP Kenneth Bakashaba, confirmed the recovery of the blood, and several assortments belonging to the main hospital.

For years, theft of blood and drugs has remained a major challenge at Mbale RRH as most of the stolen supplies end up in private medical centres or exported to eastern Kenya through the porous border points.

HEALTH INSURANCE BILL

In August, Dr Diana Atwine, the Permanent Secretary at the Monistry of Health, said the line ministry is increasing efforts to ensure there is a National Health Insurance Scheme (NHIS) to protect the public from catastrophic health expenditure. 

“The NHIS Bill, as far as the Ministry of Health is concerned, we finished our job. We did the consultation, wrote the paper and submitted it to the Cabinet. It is until the Cabinet discusses it that it will come [to Parliament],” she said. “We want this NHIS [like] yesterday because we know it will improve risk pooling and it will make us more responsible and reduce catastrophic expenditures on health care.” 

Dr Jane Ruth Aceng, the Health minister and Member of Parliament for Lira City, also said: “Because healthcare is expensive and we don’t have money, we are all aware that the NHIS Bill has been on the agenda since last year, it needs to be fast-tracked because it is the only way we are going to mobilise additional resources for health. We cannot keep talking about free health services, somebody must pay for it.” 

Currently, the health sector is struggling under the weight of poor or limited infrastructure in many health facilities and limited quantity of drug supply.

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