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School of Public Health
College of Health Sciences, Makerere University

COVID-19: Countries must strengthen National Healthcare Systems

Posted on : Sunday, April 19, 2020

World Map Showing COVID19 Infections
Chrispus Mayora
Chrispus Mayora

By Chrispus Mayora | Source: New Vision

It all started in Wuhan – a city in Central China – and in a space of about four months, the COVID-19 Pandemic has brought life almost to a standstill across the world.

The pandemic has hit hard countries that are known for the most developed and sophisticated health systems, where many individuals crave to seek for ‘quality’ healthcare services.

In an attempt to prevent and contain the COVID-19 spread, many countries in Africa suspended in-bound and out-bound travel, essentially leaving many individuals stranded in different countries, sometimes away from home.

In Uganda, those severely affected by the lockdowns, include individuals and families that either had traveled or were slated to travel out of the country to seek medical care abroad. Incidentally, they cannot access the much needed specialized care they much needed.

The need for specialized care for cases of cancer, diabetes, heart and heart failure, and organ transplants has been on the rise.

Ugandans spend substantial resources to access “quality” healthcare abroad.

Expenditure data from the Ministry of Finance shows that in financial year 2014, sh270b was spent on treatment and sh418b on travel and upkeep for patients funded by government to seek health care out of the country.

In 2016, the Government facilitated up to 5,000 people for treatment in India, spending sh455b on treatment in India alone.

In the same year 2016, up to 8,200 persons applied for medical visas at the Indian High Commission in Kampala. The amount of resources spent on just government officials in 2016, was almost 20% of the Ministry of Health budget for 2016. And this is data on those who go to India – government officials or individuals related to government officials who have the privilege to tap into that purse. To those, add individuals who sometimes run public campaigns for support (crowd funding), and families that bear the costs for their loved ones.

These resources would otherwise remain in the country, to strengthen the weak healthcare system so as to address their health care needs, and for thousands of Ugandans out there who do not have the same privileges of access to media agencies and social networks to crowd-fund nor link to the government purse to facilitate their quest for healthcare abroad. Dire scenarios when families incur catastrophic expenditures through the sale of all their assets to treat a loved one have become commonplace.

These families are still expected to survive after that treatment episode, regardless of the outcome, probably on God’s mercy. In some cases, patients, once in foreign hospitals, are attended to by Ugandan doctors who have been highly trained at Ugandan Medical Schools, on government scholarship or subsidy, but the government could not manage to retain them.

With the current COVID-19 crisis and the consequent lockdowns, even for individuals who may have resources – no matter what medical condition you have – it may not be possible to access specialized care outside the country.

In fact, for COVID-19 cases, even where a victim may have resources, they have limited choices to make on where they can be treated apart from the designated treatment centers of government. An important lesson to pick from this COVID-19 crisis; is that, in a country that is over-dependent on other countries’ health systems, we are all vulnerable, no matter who has (or not) money.

There are situations where money may not directly buy you health. This leaves an “egg on our faces” that ‘shipping abroad’ for treatment can be untenable. Some degree of self-sufficiency at the system level is necessary.

No matter how connected one is or how much resources one has, a strong national healthcare system is our common good – the poor and the rich. Thus, investing in and building capacity for national healthcare systems is the surest and sustainable way of keeping citizens safer and healthier and assuring the benefit of all, rather than a selected ‘well-connected’ few.

The current focus of the ministry of health, to create Centers of excellence in different areas of health, including for cancer care, heart disease, maternal and child health, among others, which are well equipped with modern technology, is a positive step in the right direction.

The MOH should also look at building capacity of regional and district health systems to allow the national referrals and centers of excellence to handle complicated cases that need specialized care that hitherto would be sought abroad.

To this, add investment in training and retention of human resources, expanding bed capacities, promoting local manufacturing of medical equipment and supplies to mitigate shortages, streamlining and strengthening clinical management systems, health prevention, promotion, and disease surveillance, and research and development.

The COVID-19 crisis presents an opportunity to re-think government priorities and re-direct resources towards strengthening Uganda’s health system. The Ministry of Health must seize this opportunity to make a case for more resource allocation to health. My guess is that the argument is easier to make now than ever before!

The writer works with SPEED & the Knowledge Management & Evidence Response Unit (KERU), Makerere University School of Public Health.

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