Think of Uganda Private HealthCare Providers as Partners

Grace Kiwanuka Ssali, the Executive Director of Uganda Healthcare Federation (UHF) an umbrella body for private health providers wants Uganda private healthcare providers to be treated as a partners and not profit centres. 

But this will require a mindset shift perception by the public, development partners and the government. 

Speaking to Health Journalists Network members during a boot camp held in Kampala,  Kiwanuka Ssali,  said the private health sector providers need more support from development partners and the government. 

"I know that development partners say we are putting money into government and supporting Private-not-for-profits (PNFPS) but it is not as easy as saying ... I am going to support these three people the rest of you will figure it out," Kiwanuka told HEJNU journalists. 

"We need to shift the perception about the private sector health providers to be partners and not profit centres." 

Kiwanuka said the private sector health providers are waiting for the government to allow them to officially offer COVID-19 vaccination services. 

Right now the a pilot project to do this was started in Kampala, because it a unique district in terms of healthcare - 98 percent of the healthcare facilities are privately owned. 

The Uganda private health providers resolved to dialogue with the government and have the Ministry of Health (MOH) draft a policy that’s now in very early stages to allow private health providers officially offer COVID-19 vaccination when it became practically impossible to do it on their own.

At the height of the pandemic, Kiwanuka says members of the Federation went directly to COVID-19 vaccine manufacturers with proposals but they needed up to US$500,000 to make the smallest acceptable import order because companies were prioritizing the COVAX facility. The providers couldn’t afford this. 

While a number of private facilities are now offering vaccine services, according to the federation, these are being offered in a pilot mode. The accredited facilities went through a tight verification process where they gave priority to those that had been engaging in routine immunization prior to the pandemic and those that had the equipment and expressed capacity to arrest the adverse reactions from the vaccine in a timely manner case they happen.

Noteworthy, MOH had early last year drafted guidelines for private pharmacies and importers of pharmaceutical products to start dealing in vaccines, a move that was immediately shot down by critics including public health experts who expressed worries about fakes infiltrating the market.

Now, Kiwanuka says over the last two years, they have been in back and forth meetings with the policymakers to ensure that they are engaged early to participate in health emergencies. 

For her, it’s now clear that government cannot handle it on its own with lessons taken from COVID-19 interventions where they were overwhelmed when private hospitals started filling with critical COVID-19 patients and yet they were not involved in the preparations.

Because of this, she says all the solutions so far reached with the government on vaccine provision so far are not feasible for private providers. For instance, MOH had allowed them to use the National Medical Stores (NMS) to manage the vaccines logistics for them.

 

Insecurity heightens spread of Tuberculosis in Karamoja region

 A bad cough that lasts 3 weeks or longer, pain in the chest, coughing up blood or sputum (phlegm from deep inside the lungs) are some of the symptoms of Tuberculosis. 

In Napak district, Karamoja region coughing loudly and persistently without stopping resulted in a bullet shot for a TB patient and death. 

Now, patients suffering from Tuberculosis in Karamoja, one of the high burden regions with a TB prevalence rate ten times higher than the national average, are scared and want to run away from their villages due to insecurity and their TB treatment is being interrupted. 

The Karamoja region is also home to the U.S. government's Accelerated Control of TB in Karamoja program or PACT Karamoja supported by the United States Agency for International Development (USAID) launched 2018. 

USAID's PACT Karamoja program is a $7.5 million agreement (2020-2025) that aims to address the Karamoja Region’s high TB prevalence and low treatment success rates by supporting locally generated solutions to mobilize health facilities, village health teams, and community members for accelerated screening, testing, identification, and successful treatment and prevention of TB.

Paul Losiru was in his hut sleeping at night and he started coughing because he is a TB patient but on medication. Outside the “Manyatta” were he resided cattle rustlers were passing by and they heard him coughing persistently. 

They ordered him to get out of his house because his coughing and the noise irritated the warriors and alerted the security.

‘’I had them saying that each time we pass by your home, you are seriously coughing, it’s like you are cursing us or if not you are signalling to the security that we are around. This is intolorable. I immediately heard gunshots,’’ Daniel Kedi his neighbour narrated.  

This is terrible because the Karamoja region in North Eastern Uganda is one of the high burden regions with a TB prevalence rate ten times higher than the national average. The treatment success rate in the Karamoja region was below 50% until an emergency response was declared in 2019. 

TB is the world's deadliest infectious disease, infecting about 10 million people and killing 1.5 million globally each year. Uganda is among the 30 high burden TB and HIV countries in the world. 

As dangerous as TB is, it is treatable and curable but in Uganda TB disease still causes illness in about 90,000 Ugandans annually including 1,500 people who get infected with drug-resistant TB. And in Uganda, about 15,600 people died from TB in Uganda in 2019.

In 2019, of the estimated 1,500 drug-resistant TB (DR-TB) cases, only 559 were diagnosed and notified to the National TB and Leprosy Program (NTLP) 

After killing Losiru, the warriors picked his phone and they used it to call the relatives inquiring about the mood of people since the incident happened. Now TB patients in Karamoja are scared of what will happen to them too. 

Maria Nakoru, a TB patient and a resident of Iriiri trading center, says coughing is a must for TB patients and there’s nothing they can do to stop it. They are turning to God for protection.

Its not only the warriors that are scaring TB patients in Karamoja but patients are also grappling with a food crisis and yet the medicines require them to feed well. She fears that if insecurity is not addressed in the region, time will come when they will be slaughtered like chicken. 

Losiru and Nakoru both live in Napak district, which records a high number of Tuberculosis cases ranging between 500 and 600 annually. 

James Lemukol the district Health Officer Napak says that the TB patients are now traumatized because the insecurity is affecting their treatment cycle. Lemukol said when patients fail to follow the treatment series, they are at increased risks of morbidity, drug resistance, transmission and mortality.

However, without security even with the USAID Accelerated Control of TB project home based in the district, the prevalence will increase and success rate will continue to decline.