Where are the Kumi district hospital doctors?
“I wonder why there is no ward round these days in hospital especially the district hospital in Kumi. Most patients ask for referral or die without being attended to by a doctor,” reveals a resident of Kumi who prefers to remain anonymous. “I was admitted on Saturday the 8th of this month and was discharged on Thursday the 13th but during that time, I did not see any doctors moving around,” the whistleblower illustrates. “The nurses were available though but most patients leave having noticed that there isn’t proper attention being given to them.” he adds. Hullo, ministry of health? Is anybody home err... at work? Hullo?
Kumi hospital is at the tier of district hospital which means that it serves a population of at least half a million and is supposed to offer preventive, promotive, outpatient, curative, maternity, inpatient services emergency surgery and blood transfusion and laboratory services. It should be a training hospital that attracts interns and the consultants who supervise them. However, rural hospitals in Uganda have an extremely hard time attracting rural and keeping doctors. Analyses of the 2002 census data show that 70% of medical doctors (who were only 664 at the time) work in urban areas leaving only 30% to serve the rural population.
A 2011 health systems assessment by USAID and Makerere University School of Public Health summarised the problem in this way, “In an ideal case, the health system will distribute health care workers to match geographic population and disease burden distributions: in other words, health care workers should go where the people are and the needs are the greatest.” The report goes on to note that, “the distribution of health care workers in Uganda does not follow this logic. While only 13 percent of Uganda‟s population is urban health workers’ distribution, particularly among higher-level professional cadres, is skewed toward urban areas. Likewise, regional distribution is skewed towards the central region inclusive of the capital city (Kampala). For example staffing levels in Kampala are 123 percent of posts, while in Namayingo they are less than 20 percent. The skewed distribution of HRH poses major barriers to access to quality health care in rural, remote, and hard-to-reach areas. This mal-distribution is a result of the failure of the health system to attract health care workers to these posts, and to retain them once there.”
However the same assessment reported that even where health workers exist, absenteeism from duty stands at about 37%.