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Govt slashes healthcare budget, UMA head speaks out

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KAMPALA (DAILY MONITOR) – Patients in government hospitals across the country will suffer more hardships in the next financial year as funding to the health sector in 2018/2019 budget has been cut.

According to the Ministry of Finance’s National Budget Framework Paper submitted to Parliament, the health sector budget has been cut further from the previous Shs1.85 trillion in 2017/2018 to Shs1.714 trillion in the coming 2018/2019 financial year.

This means the reduction will widen from the current Shs35b to Shs137b in the next financial year.

As a result, all funding to regional referral hospitals, including Mulago National Referral Hospital and Butabika Mental Rehabilitation Hospital have been cut. The budgets of Uganda Cancer Institute (UCI) and Uganda Heart Institute (UHI) were not spared either.

Dr John Omangino, the executive director of UHI, whose budget was cut from Shs12b to Shs11b, said the reduced funding will weaken the institute’s ability to run trainings and other outreach programmes.

“A Shs1b reduction means about 100 patients cannot be given holistic treatment and operation,” Dr Omangino said.

He said he hopes the budget allocation to the cancer institute will be revisited.

The cancer institute suffered deeper financial cuts with its budget reduced by Shs12b from Shs50b in this financial year down to Shs38b in the next financial year despite the increasing incidence of cancer in the country.

The institute is caring for a total of more than 44,000 patients.

The institute has also since acquired a more advanced cobalt 60 radiotherapy machine which needs routine servicing.

Officials at UCI have blamed the rampant drug shortages at the institute on inadequate funding of Shs53b, less than half of Shs123b the institute says it needs to provide optimal care to patients

At Butabika National Mental Rehabilitation Referral Hospital, Dr David Basangwa, the executive director, was similarly disturbed by the budget cuts to the sector.

Impact

Dr Basangwa said government’s failure to increase the hospital budget means they will continue administering cheap drugs which cause a lot of side effects to the patients.

“We have been requesting for some more funding but it has not come…but the process [budgeting] is on-going,” Dr Basangwa said by telephone yesterday.

Butabika hospital budget has been cut down by Shs339m from Shs11b.

Mental health patients at the hospital, which on average handles 850 in-patients and at least 300 out-patients daily, recently complained of the severe side effects such as drowsiness, fatigue and inability to pay attention which reduces their productivity as a result of taking the cheap drugs.

Similarly, although government has committed to increasing salaries of doctors in all public hospitals following their strike earlier this year, the wage budget in the heath sector has remained the same at Shs401b. Besides, in the National Budget Framework Paper, the Ministry of Finance announced that there will be no money for salary enhancement for government workers in the next financial year.

President Museveni, during a series of negotiations with then striking doctors last month, pledged Shs5m as a starting salary for medical doctors and other scientists in a deal to defuse the strike and check high brain-drain to other countries.

Mr Jim Mugunga, the Finance Ministry spokesperson, defended the budget cuts.

“Normally, when there are adjustments [cuts], they are not necessarily affecting strategic parts of the sector but other unplanned areas like travels,” he said.

However on the issue of doctors’ salary enhancement, Mr Mugunga could not explain where else the ministry expects to raise the money to fulfill the pledge.

He referred Daily Monitor to Mr David Bahati, the Minister of State for Finance in charge of Planning, whose known cellular phone contact was not available by press time.

Dr Jane Ruth Aceng, the Health minister, was adamant that the budget cuts will not affect their operations.

Dr Aceng said the budget reductions were based on projects which ended and whose money has not been reflected in the coming budget.

She added that the ministry will focus more on promoting public health and reducing government expenditure to cover the funding gaps.

“The budget framework paper is just the beginning of the budgeting process. They keep increasing; for example, the budget for Uganda Cancer Institute and medicines and supplies keeps increasing,” Dr Aceng said.

However, despite the budget cuts, there has been a slight increase in the budget for pharmaceutical and other medical supplies by Shs41b.

The budget for Uganda Virus Research Institute (UVRI) in Entebbe was also increased by Shs4b from Shs1 billion to Shs5b.

Breakdown of health budget cuts

Institute 2017/2018 2018/2019
National Medical Stores Shs237.964b Shs278.964b
Uganda Virus Research Institute Shs1.833b Shs5.833b
Primary Healthcare Shs343.233b Shs340.955b
Wage Shs400.858b Shs400.858b
Non-wage Shs408.433b Shs446.811b
Internal funding (Dev’t) Shs102.135b Shs7.724b
External Funding (Dev’t) Shs912.656b Shs686.299b
Uganda Blood Transfusion Services Shs9.441b Shs8.928b
KCCA (Community Health Management) Shs16.602b Shs16.602b
Health Service Commission Shs5.421b Shs4.796b
Programme service 2017/2018 2018/2019
Health Monitoring and Quality Assurance Shs0.639m Shs0.713m
Health infrastructure and equipment Shs118.679b Shs150.163b
Health Research Shs1.040b Shs1.343b
Clinical and public health Shs49.782b 0.000
Pharmaceutical and other Supplies Shs762.634b Shs515.101b
Public Health Service 0.000 Shs30.701b
Clinical Health Services 0.000 Shs29.932b
Policy, Planning and Support Services Shs38.966b Shs30.693b

Referral hospitals

2017/2018 2018/2019
Mulago National Referral Hospital Shs66.514b Shs65.278b
Butabika Mental Referral Hospital Shs11.020b Shs10.861b
Arua RRH Shs6.188b Shs5.839b
Fort Portal RRH Shs6.205b Shs6.016b
Hoima RRH Shs6.678b Shs6.409b
Gulu Shs6.283b Shs5.999b
Jinja Shs7.857b Shs7.519b
Kabale Shs5.733b Shs5.637b
Masaka Shs6.217b Shs6.078b
Mbale Shs9.720b Shs9.312b
Lira Shs6.234b Shs6.035b
Soroti Shs5.734b Shs5.492b
Mbarara Shs6.628b Shs6.542b
Mubende Shs5.423b Shs5.338b
Moroto Shs5.531b Shs5.475b
Naguru Shs6.301b Shs6.141b
Health Sector Budget:
HEAD OF UGANDA MEDICAL ASSOCIATION SPEAKS OUT

The president of the Uganda Medical Association, Dr Anthony Ekwaro Obuku, has said his attack last week will not intimidate him to stop the struggle of advocating for doctors’ welfare. “I am not in any way influenced by this attack that maybe we should change tactic [in expressing our displeasure about the doctors’ welfare] or call it [the strike] off all together,” Dr Obuku told Daily Monitor in a telephone interview on Wednesday.

Dr Obuku, who led medical doctors across the country to lay down their tools in November, demanding improvement of their welfare, was attacked by suspected thugs at his gate in Kitikifumba, Kira Municipality, last Wednesday. The thugs, who vanished with his wristwatch, wallet and mobile phone after smashing his car windows, also inflicted injuries on his face. He was taken to Case Hospital in Kampala. Dr Obuku said he did not want to agree with earlier suspicions that it was a political witch-hunt, but wondered how ordinary thugs could dress up so smartly and speak fluent English like his tormentors.
“They were well dressed …So one wonders whether they were either robbers or state agents …and how they knew that I could not speak Luganda…that I knew English,” he said. The doctor is currently recuperating at his home. “Investigations by the doctors indicate that I got fractures to my facial bones [any of the bones surrounding the mouth and nose and contributing to the eye sockets, including the upper jawbones] and the nose bridge; affecting the alignment of the teeth that I cannot chew meat now,” he said. Narrates ordeal On the fateful day, Dr Obuku took long to leave his office at Makerere University Medical School at Mulago hospital because his supervisor was concerned he was lagging behind to complete his PhD final paper.
“I got home and had not yet hooted when…around five [people]surrounded me. They hit the car from the sides with a huge stone on all the three windows. I think as I turned to see who was at the window, it [the stone] hit my face because I saw somebody on my right [window],” he narrates the incident, before thugs demanded his watch. Realising they could turn to his family members who had intervened after hearing the scuffle, he told them to call for help by telephone until police from Kira Police post arrived. He then asked police to protect the rest of the members as one of his neighbours took him to hospital.
Due to the insecurity in the area, Dr Obuku said residents have since formed a group of crime preventers whom they pay through collective fund-raising. The group was occupied at another scene of crime where his other relatives had been attacked hours earlier. Although police say investigations into the incident are on-going, Dr Obuku is doubtful, accusing them of failing to help him the first time he was robbed of property worth Shs15m when he had just moved to the house. “I have not heard anything from them but also don’t expect much because their role has been reduced to quelling political riots,” he said. Dr Obuku urged government to get a durable solution to fight crime and youth unemployment.
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