Do you know the health system of your Country? An analysis on the Uganda’s domestic health financing towards Health workers through a paper on Simple Solutions For Complex Problems by our Health Rights Advocate Denis Joseph Bukenya on the Wemos Knowledge Platform,
Local context
‘For understanding the context of health and illness in the country, decision makers, but also development aid partners, should go to the communities and listen to their needs. Donors and politicians do not want to see that; they stay in their meeting rooms and have no idea what is going on in the communities. If you want to understand the real situation, you have to go to the communities and work there.’ According to Bukenya, this does not happen enough yet.
Treatment of non-communicable diseases such as obesity and cardio-vascular diseases is a good example. ‘There is a common idea that these diseases are illnesses of the rich. NGOs and private doctors are the only ones who pay serious attention to them. Public health fails in doing this. Especially in rural areas, people are dying of these diseases as these remain untreated and mostly even unidentified. The contribution of the civil society to changing people’s perception is very important.’
Cooperative model
‘In Uganda, minimum wages do not exist. The private sector can pay the doctors whatever it wants. Many doctors are in fact underpaid. As companies and investors are involved in the government as well, the government does not take any action to change the situation. So health workers have to organize the change themselves.’
Bukenya tells about a private hospital in a remote area where doctors and nurses would stay only short, as the working conditions were poor. When the hospital was becoming seriously understaffed, the director called everyone together and asked for their cooperation for finding a way to continue working decently. ‘The hospital was situated in a very fertile area. They decided to profit from this: the staff set up a cooperative for cultivating fruit and vegetable on a plot next to the hospital. When that turned out profitable, the director bought some land and extended the cultivation. It became such a success that finally the hospital staff employed people from the community to take care of the plants and harvest them. The vegetables were sold on the market. That was enough to make the hospital self-sustainable.’
Ever since, Bukenya is advocating for using this as a model for other health centres and hospitals. ‘This example shows that it is possible to motivate staff for a common goal. If they form associations, the government money (which is not there anyway) is not even needed.’
This is not to say that all problems are solved. But Bukenya has a clear message: whatever the challenge, the local context has to be the starting point. ‘One of the major problems in our work has been collecting reliable data about health rights and practices. The data simply was not there. We then gave community people bicycles to get around easier, so that the data could be collected. This is another example of a grassroots action. Sometimes the solution is very simple, you just have to come to think of it.’
