Can Africans hold their leaders accountable to deliver the health services they need? Reflections from Kampala
By Elizabeth Ekirapa-Kiracho, Makerere University School of Public Health, Uganda, and Future Health Systems.
As we celebrate the World Health Day I am asking myself a question: have African governments done what they should for their people? Or have they ensured their own comfort forgetting about the people who vote them into power? These thoughts were sparked by a talk show I listened to last night in which the Chair person for the Uganda Medical Association noted that while the Ugandan Government allocated only about 6 percent of its budget to health this financial year, the parliamentarians who are responsible for passing this budget ensure that they have health insurance for them and their families.
What does this mean if there are no drugs in the government hospitals and health centres? If the health workers operating in the public facilities are poorly paid and not adequately skilled to provide the services?
These parliamentarians do not suffer like the common man. They have health insurance and can go to a private facility that has all the required services. They can even travel out of the country for medical care if what is available is inadequate! If our parliament and other government leaders in key positions cater more for their own needs rather than for the needs of the majority of the population, how can the people ensure that government provides the social services that it should provide to them?
We have been holding dialogue meetings with the community in Kibuku district as part of a community scorecard project that is being implemented by Makerere University School of Public Health under the Future Health Systems consortium funded by the UK Department for International Development. In many of the meetings the communities have made their grievances clear. The health workers have also been able to attend the meetings and they have also explained their part of the story.
For example, in one lower level facility there was no midwife and no delivery beds. The district leaders responded by deploying a midwife and two delivery beds were eventually provided to the facility. These kind of opportunities for open dialogue are rare and yet they bring the truth to the fore front and allow the concerned parties to identify local problems, identify solutions, agree to work together to address the problems, appoint specific people to follow up the processes, and, most importantly, meet again to assess progress in implementing agreed plans.
I believe that if we had more similar opportunities for open dialogue in families, communities, and both government and non-government institutions, we would be able to express to our leaders our dissatisfaction with the way they tend to ensure their own comfort while letting the rest of the population suffer in the cold!
Of course it also provides an opportunity to appreciate the efforts of leaders and government for the positive developments they have helped achieve. For example in Uganda now 83 percent of the population resides within 5 km from a health facility (Uganda National Household Survey 2016/2017), and antiretroviral drugs are largely available to treat the millions suffering with HIV (ART coverage is 88 percent according to the Uganda Health Sector Development Plan 2015-2020). However, our health outcomes as a country are still very poor and more needs to be done! For example our maternal mortality rate stands at 336 per 100,000 live births (Uganda Demographic Health Survey 2016).
Leaders need to prioritise the needs of the majority when allocating financial resources that determine the services available to the population. Uganda needs to meet its Abuja Declaration commitment by allocating at least 15 percent of its national budget to health. This action would allow us to celebrate World Health Day and the good health of Ugandans as well!