We as Ugandans disagree on a lot of things. Be it political or socio-economic but if there is one thing all Ugandans considered to be the right thinking members of the society by the majority should agree on, is that Uganda’s health sector has gone to the dogs or the dogs have come to the health sector.

Even though we are considered to be most entrepreneurial country in the world and the world’s top destination for tourism, we still see and read stories about patients sleeping on the floor in wards, hospital buildings being in a sorry state and money meant for drugs disappearing through thin air.

Here is the real situation on ground;

In Uganda, one in every 200 births ends the mother’s life, around 1.5 million people are living with HIV and although malaria accounts for 14% of all deaths, less than 10% of children under five are sleeping under insecticide-treated nets. Health statistics published by NationMaster.com indicates that in Uganda there are 0.08 physicians per 1,000 people (the average is 1.7).

To crown this up, Uganda’s healthcare performance is ranked as one of the worst in the world by the World Health Organisation. We’re ranked 186th out of 191 nations!

Now unless you’re a witch doctor who will laugh all the way to the back of his or her shrine to count money after coning an illiterate who thinks that their ‘prescriptions’ solve their current health issues, there is nothing to smile about.

A patient lies on the verandah at Kawala Health Center 111 waiting to see a health worker.
A patient lies on the veranda at Kawala Health Center 111 waiting to see a health worker.

There is nothing to smile about because it’s the poor who lose out the more. The health system today is structured in such a way that the rich and politicians go to exclusive private hospitals (that’s if an all-expenses paid medical trip to India or Europe is not available which in most case it is available) and clinics whereas the poor, who are the majority (and the taxpayers and voters), have no choice but put up with the wretched government facilities.

The truth is, the poor are paying the price for corruption.

By paying taxes, it is ordinary Ugandans who are meeting the costs of what’s supposed to be free maternity (and medical) services. After paying taxes, because of the collapse of public health services, ordinary Ugandans have to go back into their pockets to pay private (and surprisingly public)  health facilities for these services. Despite collection of taxes, because of corruption, public health services are denied to those who can’t afford then. Because of corruption, expectant mothers continue to lose their lives in public hospitals.

We seem or even actually abandoned our commitment to the sector. The Gallup World Poll last year showed how sub-Saharan Africans believe they are inferior compared to their counterparts across the globe and the feeling is mutual when it comes to the quality of the health care they receive.

Less than a fifth of African governments have met the Abuja Declaration pledge of spending at least 15 per cent of their budgets on health. The global donor community has continued to plug the funding gaps. However, most recent data show that official development assistance for health plateaued between 2010 and 2013 before dropping between 2013 and 2014.

Back home, The 2017/2018 Budget Framework Paper proposes a 5.7 per cent allocation towards financing the health sector. This is lower than the 8.9 per cent which was allocated to the sector in the 2016/2017 national budget. What the hell?

In order to improve Uganda’s health services, we urgently need to strengthen its structures, processes and outcomes. One way to do this would be through the incorporation of performance management tools and best practices from the private sector elsewhere, usually more adept than governments at managing huge and dispersed workforces.

And this is achievable. For example a balanced scorecard was made by experts over two decades ago to help private enterprises monitor operational performance and guide company strategy. Ethiopia is using it as a monitoring and evaluation tool for it’s health sector and it seems not to be looking back.


Conclusively, if we must urgently find smart ways of increasing the efficiency and accountable public health system in Uganda, we have to strengthen and monitor its structures, processes and outcomes. By structure, I mean stable, material characteristics (infrastructure, tools, technology) and the resources of the organizations that provide care and the financing of care (levels of funding, staffing, payment schemes, incentives).


By process, I mean  the interaction between caregivers and patients during which structural inputs from the health care system are transformed into health outcomes and lastly, the  outcomes can be measured in terms of health status, deaths, or disability-adjusted life years—a measure that encompasses the morbidity and mortality of patients or groups of patients.

If we don’t do that, we won’t heal the health sector.