The health care system in Uganda is overrun with problems. As a community health volunteer for Peace Corps, I have been working with a Health Center II (a basic-services clinic) and have been assessing the state of health care here in Uganda.
While government health care is intended to be free, there are so many hidden costs that patients are often still unable to afford health care. The government provides free drugs and care, but when those drugs run out (which is all-too-often), the patients are responsible for going to a private drug shop and buying their medicines. Women who want to deliver at a government health center are often required to bring their own “mother kit”, a set of supplies which can include such things as cotton, gloves, needles, etc. At our small Health Center II, we have no capability of running tests such as urinalysis, blood smears for malaria, or even taking blood pressure, and often have to refer patients to either a larger government health center or a private clinic for the care they need. Many people cannot afford even 4,000 Ugandan shillings roundtrip (less than $2) to the Health Center III, a few kilometers away, for testing or maternal care, let alone a trip to a private clinic where all costs are out-of-pocket. Some of our patients walk several miles to get to our clinic.
Malaria is one of the leading causes of morbidity and mortality, and is severely over-diagnosed. Practically everyone with a fever is given anti-malarial drugs, and subsequently health centers often run out of the drugs before the next shipment arrives from the government. The cost of these drugs in a private drug shop can be 15,000/- (about $7), which is too expensive for the average rural Ugandan. The nurses at the health centers have little choice when they have no way to test for malaria before dispensing drugs – if the patient does have malaria and is not treated, he or she could die. Better to be safe than sorry, but being safe in this situation causes its own host of problems.
There is also a big problem with motivation among health workers. Salaries are very low, and some workers feel no obligation to give good ‘customer service’, which is a huge concern in privatized health care systems such as the U.S. Health workers often show up whenever they feel like it, and leave the clinic hours before the official closing time, leaving some patients to wait for hours to be seen. A small aspect of this stems from the culture where family comes first – if the nurse has to harvest millet or help a family member out, they don’t see a big problem in staying home.
So what, as a Peace Corps Volunteer (PCV), can I do? It’s a difficult question to answer – if there were an easy fix, Uganda would have great health care. PCVs don’t come with any funding or external assistance, we come to act as change agents and co-facilitators to mobilize local resources and work with what is already available. While it’s difficult to make system-wide changes or improve facilities and equipment without funding, I am working to encourage healthy behaviors, build capacity among health workers, and provide people with the knowledge they need to keep themselves and their families happy. Another PCV I know is working at the district health office, so he can encourage health officials to improve efficiency and make positive changes in the health care system. These are small steps, not a big NGO project with millions of dollars backing it, but these small steps are (hopefully) sustainable, using local resources and requiring the community to get involved to make changes in their own lives.