Lutgard Musiime

A healthcare system simply refers to the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. Day 8 of the #UgBlogMonth required me to write my thoughts on Uganda’s health care system. Talking from the angle of a health worker, I pray my thoughts are not perceived biased. I will talk about the health care system in the categories that our definition has given us.

The people

This organisation of people majorly constitutes the patient, who is the main recipient of the health care and a health worker who primarily gives this health care. Now in my country we have a system that empowers the giver of health care (the health worker) too much over the patient. And naturally when you are a patient, it is just natural that you are in pain or need that you need instant relief and this automatically gives the other party power. Therefore it is not news that some patients will have to buy their way into receiving this health care and those that do not have enough, more than often have it rough to the tune of loosing their lives.

When I was growing up, I was meant to believe that nurses were the most rude people the world had. Thankfully the world threw me in the health care system where I worked so closely with them and I saw the complete opposite. These humans are very loving and dedicated although I cannot deny the fact there are a few ‘spoilt tomatoes’ like in any other place. Now you will need to work in a health facility to understand the kind of pressure that exists there. Sometimes you will go hours without rest or a sip of water to cool down your thirst, and the next patient who comes in will not think about it or give an ear. Others are just ‘too stubborn’ and come with a preconceived mind and if they receive anything less, it will be war. In short the pressure for health workers can really be intense yet any slight mistake probably due to honest exhaustion will be termed as sheer negligence and the effects are far reaching for both the patient and the health worker.

The last thing I will make mention deals with the health workers themselves. One day we were on a ward round and everything was going well until one of the doctors literally screamed at a nurse for not doing something apparently she was meant to do before the doctor arrived. It was a full ward and everyone just stared at the doctor in utter shock but no one had the courage to say a word. Me inclusive. After a brief uncomfortable silence, the ward round continued. You may be wondering what happened to respect but this is something that happens quite a lot. Persons in superior positions tend to down look the other even be it a fellow colleague. It is quite sad but that is what it is.

The institutions

The structure of the health system in Uganda is divided into the national and district levels. At the national level are the national and regional referral hospitals, and semi-autonomous institutions including the Uganda Blood Transfusion Services, the Uganda National Medical stores, the Uganda Public Health Laboratories and the Uganda National Health Research Organization. At district level we have the health centers I-IV. And just to get a little closure on the expectations of these categories, I will briefly explain.

Health Center I is made up of village health teams (VHTs) who are volunteer community health workers. These are predominately meant to deliver health education, preventative services and simple curative services in the community. More less like first aid. Health Center II is an out patient service and run by the nurse, so patients receive the care and then return to their homes. Health Center III provides out patient, in patient, simple diagnostic, and maternal health services. It is run by a clinical officer. Finally a health center IV is run by a medical doctor and provides all services that a health center III provides as well as providing surgical services. Now I bet many of us did not know about these variations.

When you watch the news, one is meant to believe that we have the worst health system structure especially given the fact that media will always look for the spoil more than what is working. Having worked in this system I know that the population does not know these variations so you will find people going to a VHT for maternal services or a health center III for surgical services. Do you know what happens? When this goes utterly wrong and the system is blamed so severely for something that could perhaps have been avoided if the service was sought it the ‘right’ place. Does this mean that these facilities have all they require, of course not but the one thing I know is, they have dedicated people who do their best humanly speaking to preserve life.

Resources

These resources are not limited to money but extend to human resource as well as equipment. Much as I hate to say it, this is the one place that determines the success of any health system yet in Uganda this is the one place we limp the most. If you do not hear of a vital machine in the referral system that broke down or does not exist, you will hear that a certain facility does not have enough health care providers. Just as that is getting out of the way or being swept under the carpet, you will be hit by doctors striking over delay of their payments or an increase in their wages. Drugs are always missing and patient beds are for some reason always less. The story never ends.. It rips my heart that we have very selfish individuals who choose to take these resources (money especially) and care less about those affected, after all they can afford to get specialised treatment over seas. This however does not water down the efforts of the very dedicated Ministry of Health we have in Uganda and it’s partners including UNICEF, WHO among others who do and are doing their best to support this part of the health care system.

As a Health Care provider, I believe it takes every one from the patient to the government and health worker to make a functional health Care system.