5 die daily as Jinja hospital runs out of blood

blood-transfusionWritten by TREVOR S BALEKE, An acute shortage of blood has hit Jinja Regional referral hospital. There is no single blood unit available to give patients in critical condition, hospital managers say.

The Observer has established that on average, 12 patients are referred to Mulago hospital daily for blood transfusions. Dr Micheal Osinde, the hospital director, said in an interview last Thursday that at least five children die every day in the children’s ward due to the blood shortage. The casualty ward and pregnant mothers are also affected.

“This is the worst the blood shortage there has ever been. And because this is a regional referral hospital, we receive patients from about 10 districts,” he said.

According to him, it costs $80 to process one unit of blood. Jinja regional referral hospital needs at least 70 units of blood in a crisis-free week.

“We do not just get blood from a donor and transfuse it into the body of a recipient. It has to be processed first,” he said.

“We don’t have a single pint of blood for all the groups in the laboratory,” he said.

Asked what could have caused the shortage, Dr Osinde pinned it on funding gaps in the ministry. He said the Uganda Blood Transfusion Service had run short of money to collect, process and store blood by last December.
Source: http://www.observer.ug/index.php?option=com_content&view=article&id=25522:5-die-daily-as-jinja-hospital-runs-out-of-blood&catid=34:news&Itemid=114


Doctors’ pay raise okay but we need to do more to boost sector service delivery

Media report that the government is to double the salaries of doctors is a positive response to the demand that has taken years. Previously, we had between 10 and 20 per cent increments after strikes by health workers. Therefore, the doubling of doctors’ pay should be the beginning of a wider response in the quest for effective healthcare services.

However, there is need to look beyond the salaries as some factors may still hinder effective service delivery. I have visited some health facilities in Kamwenge District where a health centre IV is the main health facility. Rukunyu Health Centre IV did not have a functional theatre until recently, courtesy of funding by PEPFAR. As a partner, PEPFAR operationalised the theatre by providing equipment. It also supports health workers in the district.

However, the health facility still lacks electricity despite the fact that the power lines cross the compound of the facility. Whatever salary doctors will be paid, a health facility such as Rukunyu, which lacks power, will still struggle to offer effective services. Without electricity, it is not possible to use the ultra sound machines used to ascertain the condition of the baby in the womb. Yet such investigation is necessary for a doctor to make critical decisions regarding the lives of the mother and the unborn baby. Even children born premature cannot receive adequate care because the incubators cannot work.

Refrigerators for storing essential medicines will not be operational hence medicines will rot and sterilizing theatre equipment, a must-do, cannot happen. We have heard stories of health workers improvising lamps or mobile phone to provide light in labour wards as they help mothers to deliver. But such a situation is neither desirable nor sustainable. Fears that the power bills may be high for the health facility to afford cannot be reason enough for not connecting power to it.

However, the bills may not compare with the amount of fuel for ambulance and associated costs that may be required to transport a mother to Ibanda or Fort Portal for emergencies. Beyond, the salaries, urgent steps must be taken to address some of these issues as they have a direct bearing on service delivery.

Even a well-remunerated health worker at a facility that lacks the necessary tools, theatre, gloves, medicines, etc, may find themselves unable to offer effective services.

Paul Mayende Nicodemus, pmayende@baylor-uganda.org

Source: http://www.monitor.co.ug/OpEd/Letters/Doctors++pay+raise+okay+but+we+need+to+do+more+to+boost+sector/-/806314/1520826/-/151y64fz/-/index.html

Museveni calls ministers over Health budget deadlock

A deepening budget crisis in Parliament inflamed by a health sector in “shambles”, has forced President Museveni to summon a crisis Cabinet meeting tomorrow to discuss a give-and-take deal that would ease the passing of this year’s budget.

Sources told Sunday Monitor that the discussion in Cabinet will focus on the government option of discussing the politics involved and the implications of rising this year’s Shs11.4 trillion budget by Shs39.2 billion for health sector.

Junior Finance Minister Fred Omach is expected to argue in Cabinet that any attempts to bow to pressure in Parliament would “disorganise” the budget priorities and that this would require the ministry to align the budget afresh, hence delaying its execution.

The Budget Committee of Parliament has since recommended that wasteful areas in some votes be cut by 30 per cent to raise the Shs39.2b needed to motivate and recruit more health workers in the country.

This proposal was rejected by the President after Parliament recommended that defence budget be cut by Shs15 billion. The President on Monday reportedly stormed out of the NRM caucus meeting at State House after he was heckled by defiant NRM members. Trouble started after the President said he couldn’t “sacrifice the defence budget for anything”.

The President has proposed that the budget be approved and the government brings a supplementary request at a later date to address the challenges in the health sector. The president also said government would recruit 1,000 midwives this year and that the health sector will be prioritised next financial year.

“If they don’t listen to us, we are going to pass the budget as recommended by the Budget Committee, but not as Executive wants it,” Wilfred Niwagaba (NRM, Ndorwa East) said, adding: “For us to delay the process, we are only helping the government to see sense in helping the people who are dying in hospitals without doctors and drugs.”

Sunday Monitor understands that there will be an NRM caucus tomorrow to discuss the Cabinet position on the standoff holding the approval of this year’s budget.

The NRM Caucus on Thursday had tasked Ministry of Finance to work with Ministry of Health with a view of finding the required funds through re-allocations within the budget or a supplementary.

On Wednesday President Museveni summoned Speaker Rebecca Kadaga to State House where the President reportedly demanded to know why Parliament was holding the passing of the budget. But Ms Kadaga explained that she had asked the budget committee to harmonise the budget figures with the Executive after members vetoed a budget without the money for health sector.

The budget deadlock has increased the pressure on government to fix a “dilapidated” healthcare system and wobbled the centre of power in a rising political contest that has unsettled the relationship between Legislature and Executive.

The government failure to provide Shs260b to health sector has infuriated lawmakers who are now accusing the government of being “insensitive” to health of Ugandans. The government has blocked the proposed Budget Committee recommendations to cut Shs39.2b from wasteful expenditures.
Asked what will happen in the event that the government refuses to adjust the Shs11.4 trillion budget to take care of health sector, the former Shadow Finance Minister, Mr Oduman Okello, said the government would operate without a budget.

“The budget will not be passed and the service delivery will definitely be curtailed, but who is to blame?”

Nicholas Opio, an independent legal analyst, said the power of Parliament is admittedly limited to approval.

It is useful to distinguish between approval and allocation. The duty of allocation is the preserve of the Executive but the allocation is subject to the approval of Parliament.

In arriving at approvals, Article 155 (4) requires that an appropriate committee of the house provides recommendations to parliament – the recommendation then provides a basis for approval or non-approval of the budget by the house.

Source: http://www.monitor.co.ug/News/National/Museveni+calls+ministers+over+budget+deadlock/-/688334/1514638/-/8v8dyb/-/index.html

Uganda: The Deadly Hours for Women to Give Birth


Woe unto a mother who goes to deliver in Mulago hospital at night or early morning. Chances are she could die.

A new report shows that the highest number of maternal deaths (14.2%) occurs between 9 am- 10am. Other “deadly” hours to be admitted are 7-8pm, 1-2am and 9-10pm.

In other regional referral hospitals combined, the highest number of deaths (13.2%) occurred between 7-10pm, followed by the 5-6am and 1-2pm.

The revelations are contained in a report titled “maternal mortality reviews in three referral hospitals in Uganda” 2009-2011. About 300 deaths of mothers were reviewed in Fort portal, Masaka and Mulago referral Hospitals.

According to the report, these time periods, in which mothers died relate to health worker fatigue and the periods of changeover of the medical staff.

Although 42% mothers died within 24 hours of admission, 20% died in the first six hours of admission. These were considered as the “walk in” dead, which suggested that they came to hospital when it was a little too late and nothing little could be done for them.

The report is the first of its kind and was carried out by the Association of Gynecologist and Obstetrics in Uganda, to explore why women continue to die in labour. An estimated 6,000 women die every year due to birth related problems.

Months of death

Overall, many mothers admitted at Mulago Hospital died in January and in July. These two months a number of changes on the calendar- the university examinations and holidays for the lecturers and some medical students, as well as recruitment of new interns.

“These personnel changes, impacted on the quality of services, provided at these hospitals,” the report states.

Furthermore, June and July was cited as the end of the financial year, and the hospitals were generally faced with challenges in procurement of essential supplies.

Causes of death

Presenting the findings at a conference on Thursday, Dr. Jolly Beyeza, a senior gynecologist and obstetrician said heavy bleeding ranked the highest cause of mortality at these hospitals, which often resulted from complications in labor, and delivery.

Other top complications, according to Beyeza were abortion, infections, and hypertentive disease in pregnancy. “Among mothers who died from abortion and ectopic related conditions had never had any antenatal care,” said Dr. Beyeza. Among the mothers whose mode of delivery was recorded, 11% died undelivered. Seven mothers were brought in hospitals when they were already dead, while the majority of mothers who came in with abortion or after delivery were critically ill.

Should abortion be legalized?

During the conference, participants debated on whether to legalise abortion or not.

Joy Asasira, a lawyer with the Center for Women’s Rights and Development said a lot of women are unnecessarily dying from crude methods of abortion.

“If a woman wants to have an abortion, it does not matter what the law says. She’ll have it anyway,” Asasira said.

“Many people don’t want to talk about it, but it happens. If you don’t talk about abortion, yet we want to achieve the Millennium Development Goal of improving maternal health, we are deceiving ourselves,” she added.

Asasira argued that the government was spending sh7.5billion every year to treat complications resulting from unsafe abortions. The World Health Organization estimates that in Uganda, about 300,000 abortions are carried out every year.

Statistics show that the use of contraceptives is still low in Uganda. About 26% of women in Uganda are using modern contraception methods, while about 16 women die every day due to maternal health problems, including abortion.

Asasira stressed that nearly all unsafe abortions are because of unwanted pregnancies.

She also acknowledged that while the law in Uganda does not criminalize abortion, terminating a pregnancy had to be done within constraints of the law.

Quoting Section 224 of the Penal Code Act, Asasira said: “The law doesn’t prohibit abortion absolutely. It has a provision that acknowledges that to save the life of a mother, in case of a severe illness, that is threatening the life of a mother; a safe abortion should be carried out. But most people are not aware of this fact.”

However, doctors were skeptic, arguing that if safe abortion is readily available, women might choose to use it as a form of family planning, rather than an emergency solution to an unwanted pregnancy.

“The best thing is preventing pregnancy itself. You cannot start solving a problem from the bottom of it. Even if you made removal of pregnancy available, women will decide to use abortion as a family planning method,” argued Prof Donald Amoko, a Ugandan gynecologist based in South Africa.

Dr, James Batwala, a senior consultant obstetrician and gynecology was also pessimistic. “I am sure as we talk now; abortion is going on either legally or illegally. When you think about it, a woman has a right [to abort]. But what about the child? Don’t they have a right to life? We need to draw a line. What is more important right now is that abortion is a killer,” Batwala said.

Reacting to the concerns, Asasira, argued: “As a lawyer, rights begin at birth. I am a woman, I love babies, but there are some issues beyond the woman.”

What mothers say

The median age at death was 25 years. According to the study, only 57% of women in Uganda deliver in a health facility. “We are wondering. Where do the rest go?” asked Beyeza.

Many mothers cite lack of transport from home to the health facilities in time, staff lacking expertise and shortage of doctors among others. But doctors also complained that patients came to hospital when it was way too late. They also lacked essential facilities in health centers to carry out emergencies.

Way forward

Participants noted that most the complications were treatable. Dr. Florence Mirembe, a gynecologist said involving men in the maternal health fight would make a difference. “The men need to walk with us,” she said.

The ministry of health permanent sectary Dr. Asuman Lukwago said the government was committed to give more resources to the sector. He also announced that a women’s hospital at Mulago Hospital would be ready within two years, and called for the need for training of more gynecologists and obstetricians to work at the center.

Frank Tumwebaze, the incoming minister of presidency said the government would look into recruitment of midwives. He also called on parliament to advocate aggressively for the increase of doctors and nurses salaries, saying it would make them motivated.

Source: http://allafrica.com/stories/201209220493.html

Monitor investigation reveals health sector in a sorry state

Standards of public health care are in free fall as fresh evidence now points at the acute shortage of sick-beds, especially in intensive care units, forcing doctors to discharge patients prematurely.

A Daily Monitor investigation has found that there are only 37 intensive care unit beds in the country, with 12 in Mulago National Referral Hospital. The hospital beds (per 1,000 people) were last reported at 0.50 in 2010, according to a 2012 World Bank report.

A doctor in Mulago who only agreed to speak off the record, said “discharge decisions are made with bed-capacity constraints in mind.” The doctor said the push to get patients out of the beds is based on the crucial need to save “those who are badly off” using the few resources available.

Some patients with serious illnesses are left unattended to for weeks and access to drugs and feeding in public hospitals remains a challenge for many.

Premier Amama Mbabazi told Parliament on Thursday that government is aware of the challenges in the health sector and blamed the crisis on a “limited resource envelope”. The country’s growing budget is now at Shs11.4 trillion but has yet to find a panacea for the overburdened public healthcare system.

At public hospitals, the few doctors and nurses available are struggling to cope.Arua Regional Referral Hospital, which covers all West Nile districts and also DR Congo and Southern Sudan, has only 15 doctors, including the director, who is mostly doing administrative work.

This means that the doctor to patient ratio is 1:178,600, while the recommended World Health Organisation ratio is 1:12,500. There were 56 vacancies at the hospital most of which were critical in service delivery.

In Kabale Hospital, the situation is not different. The hospital on average admits 1,805 patients yet it had only 310 beds. One doctor attends to over 9,000 patients and one nurse supervises over 400 people.

The hospital also lacks adequate space in the maternity ward, an accident and emergency unit and incinerator to safely dispose of bio-waste. The old sewage system and toilet facilities cannot match the ever increasing number of patients.

Jinja hospital risks disconnection after it accumulated domestic arrears of Shs.454.1m in respect of water bills out of which Shs93.2m relate to 2010/11 financial year.
While this situation severely undermines public health service dispensation, the management of Arua hospital said they had reported the matter to the Health ministry but no action has been taken to fill the vacant posts for doctors.

The government has slapped a ban on recruitment of health workers citing financial constraints. This means that undermanned hospitals, can only recruit to replace those who have either resigned or died in the line of duty.

The March 2012 report of the Auditor General calls for radical action to reorganise hospital care so that “Ugandans receive the care they deserve”. Three-quarters of doctors are under more pressure now than they were 10 years ago, and nurses report an unmanageable workload.

Health Service Commission Chairman Pius Okong has warned of a “disaster” if government doesn’t lift the ban on recruitment.

While appearing before the Health Committee of Parliament, Prof. Okong said: “If we don’t recruit, the manpower crisis in the health sector will be compounded. Some facilities have less than 30 per cent staffing level which is untenable.”

The Director General of Health Services, Dr Jane Aceng, puts medical staffing levels at 58 per cent. Dr Sam Lyomoki, the chairperson of Health Committee, has proposed that an additional Shs260b be allocated to the health sector to boost staffing level to at least 66 percent.
Parliament heard last week that the hospital care was under intense pressure, leading to unnecessary indignity and distress. But government insists it needs more time to agree to the Shs39.2b the House Budget Committee found from cuts out of the Shs260b needed to fix the system.

Source: http://www.monitor.co.ug/News/National/Monitor+investigation+reveals+health+sector+in+a+sorry+state/-/688334/1509184/-/11o9rn0/-/index.html