KAMPALA – When Ms Aisha Nakato heard about the official handover of Mulago specialised Women and Neonatal hospital to government by the Arab Contractors, she sighed with relief.
It sounded like a miracle and she remarked, “At last government has started thinking about us ordinary citizens who pay tax, our children will no longer die and our women will no longer die while delivering.”
Like many ordinary women in Uganda, Nakato knew that women and their newborns in need of specialised services would check into the Mulago Specialised Maternal and Neonatal Hospital for medical attention.
She also knew that women and children with high-risk antenatal care, delivery and postnatal services and gynecology services, surgical, ureteric reimplantation, complex fistula surgeries and vaginal hysterectomies reconstruction after female genital mutilation would now be treated here.
But, just a few days after the handover, government announced that the facility is only expected to handle referral cases from other hospitals and that the patients are expected to pay for the services.
According to Dr Jane Aceng, the minister of health–patients seeking treatment at the new Mulago Specialized Women and Neonatal Hospital will part with Shs50,000 as doctor’s consultation fees while those seeking in-vitro fertilization (IVF) will pay Shs13 million.
Although the 450-bed capacity hospital was meant to handle women with complex reproductive health problems and also reduce referrals abroad for specialised reproductive and Neonatal treatment, the charges at the facility make it impossible for ordinary women to afford it.
On September 11, the health minister defended the new charges saying government had made thorough consultations on the charges after visiting other countries offering similar services.
“The services will be classified as standard, VIP and VVIP; Clinical services offered to all patients at all levels irrespective of pay will be the same,” Dr Aceng said while addressing the media.
“Patients accessing the services should be referred patients from our referral facilities except for those that are exclusively offered at Mulago Specialised women and neonatal hospital such as IVF, laparoscopic surgery,” Dr Aceng added.
According to the minister, an antenatal package which will have a maximum of eight visits will also include baseline laboratory tests,13D/4D, 2 ultrasounds, essential drugs for antenatal and immunization.
She explained that patients will be required to part with shs13 million for specialized treatment, Neonatal follow up per visit or immunization will cost shs70,000, patients will pay shs80, 000 per day for accommodation and this includes food, utilities and linen.
She revealed further that examination under anaesthesia will cost Shs800,000, Fistula reconstruction is Shs 2.500,000, a Caesarian section will go for Shs 2,000,000, Epidural and spinal analgesia will cost Shs 1.600,000 while Sperm injection will cost Shs 14,000,000, DNA testing will cost shs500,000 and Antenatal cost Shs 890,000.
“Uganda largely operates as a cash economy. We expect foreigners to pay. We can no longer depend on the government budget to provide services. The doctors at the hospital will also want payment. If you need high-quality services. You must pay,” she said.
Ms Nakato’s relief has now turned into despair because she can not afford the consultation fee to talk to a doctor about her situation.
“In the village, I use Shs1000 to treat myself and I find it expensive, so how will I pay for Shs 50,000 to just talk to a doctor without treatment, God should just have mercy on us rural women,” said Ms Nakato.
Ms Nakato is not alone; people across the country now think government is interested in saving the rich from diseases and leaving the poor to fate.
Mr Nathan Nandala Mafabi, the FDC Secretary-General says the costs are too high for an ordinary woman in the village and that many of them will just die in rural areas because they can’t afford these costs.
He said no one chooses to get sick but that once we do, we should all be treated equally in the eyes of the Constitution and that we all deserve medical care to the highest possible standards.
He explained that the financial burden of paying directly for health services is one of the big hurdles standing in the way of Uganda achieving universal healthcare and that the other two major contributing factors are low allocation to health in the national budget and lack of access to quality treatment.
Several legislators have protested the application of medical fees on the services saying that the government facility will not benefit majority of the women who can not afford the cost and are living in rural areas.
“The first priority at this new health facility should be provision of health care, but not asking for payments and this is being done to continue suppressing the poor taxpayers because they can’t afford private medical bills as well as going abroad,” Mr James Baba, Koboko County MP said.
Although families have to pay directly for medication and treatment, accounting for a quarter of total spending on health, experts say payment of medical bills from personal funds might prevent people from seeking care and also lead to impoverishment.
Policy makers are calling upon government to balance between dimensions while maximising the magnitude to which people’s needs are met without impoverishing them.
“Universal healthcare ensures everyone gets quality health services where and when they need them without suffering financial hardships,” said Dr Sam Lyomoki, [MP Workers].
Mr Emma Ainebyoona, the ministry f health senior Public Relations officer says there should be no reason for alarm because the poor will also receive services at the new facility as long as they have to go through the referral system.
“There will also be a committee that will vet the patients and recommend them for treatment at the facility at no cost,” said Mr Ainebyoona.
Dr Sam Wajega, the acting DHO Budaka district says in his years of practice as a medical worker, as a general practitioner, the one thing he has never quite gotten over is just how much people take their health for granted.
“This happens uniformly across all Ugandans, irrespective of their walks of life and I am taken aback by a woman who suffers from post-menopausal bleeding for two years without going to the doctor because she has no money, let us go to hospital and be referred to the new facility for treatment,” said Dr Wajega.
Dr Ekwaro Obuku, 40, the president of Uganda Medical Association (UMA) said health care is utterly; totally expensive whichever way one wishes to look at it and that someone somewhere pays for it even when the recipient of the services may not pay directly.
He revealed that although the facility is expected to reduce maternal mortalities which the ministry confessed remains high at 336/100,000 compared to the global rate of 216/100,000 live births, the situation in rural areas among the poor might remain the same.
Mr Ainebyoona says that part of the cost includes health worker remuneration, which should be commensurate to work done and skill set applied.
He added that the new hospital will have services classified as standard, VIP and VVIP and that the difference in the costs will be on accommodation.
“There will be suits for those patients who wish to be treated as VIP or VVIP with Dstv services and that foreigners would be charged differently from Ugandans,” said Mr Ainebyoona.
About the Hospital
The new Mulago specialized Women and Neonatal hospital was funded using a $25m loan from the Islamic Development Bank and is designed to accommodate 450 patients with one attendant each. The hospital is all piped to enable medical gases, nitrous oxide and oxygen to be pumped directly to patients on their beds without using an oxygen cylinder. There is also a laboratory where urinal tests and cancer screenings can be conducted. The facility is expected to reduce maternal mortalities which the ministry confessed remains high at 336/100,000 compared to the global rate of 216/100,000 live births.
The 9-storey hospital has specialised equipment installed in the hospital cost at a cost of $8m and the hospital offers services for complicated pregnancy cases, urinary complications, reproductive system and early cancer detection and In-vitro fertilisation (IVF) among others and according to government will help decongest the old Mulago National Specialized hospital