Key information:
- The Ministry of Health is gradually enhancing health centres classified as II and III throughout the nation to enhance the quality of care provided to Ugandans. The transformation from second-tier facilities to third-tier ones involves the construction of new outpatient departments, maternal and general wards, and the installation of fences. A rise in funding for personnel and medications will aid this process. Nevertheless, this progress is not occurring swiftly enough at Kinu Health Centre II, asGillian Nantume reports.
Similar to other communities, life in Bugweri Bunama Village, located in Kinu Parish, Namwendwa Sub-county, Kamuli District, deep within Uganda's rural areas, proceeds at a very leisurely pace. There are multiple brick homes with wooden windows, which once experienced their finest times.
The environment, nevertheless, failed to diminish the bravery and resolve of the residents of Bugweri's Bunama Village, a group whose parents, tired of traveling 13 miles to reach Namwendwa Health Centre IV, decided to construct their own medical facility. Margaret Namudiira, the LC1 chairperson of the village, played a role in the construction of the health center, though she remained low-key during the 1990s. At that time, the chairperson was her husband, Samuel Kitamirike, and she served as the women's representative on his committee.
"Many children died in the 1980s and 1990s because of diseases that could have been prevented, like measles. People were passing away in their homes, and the community recognized an issue. In 1992, led by the village head, Samuel Kitamirike, the residents contacted Dr Eriabu Muzira, who was then the permanent secretary in the Ministry of Health," she remembers. The letter outlined the difficulties the community had in reaching a healthcare facility located several miles away.
At that time, none of the villagers had a car, and there were no boda bodas available. Only a few people owned bicycles. This situation required anyone who was ill or had an ailing child to walk over 20 miles to reach the hospital.
“Dr. Muzira suggested they locate a piece of land where a health center could be built, or to lease a house that would serve as a medical facility. One of the locals, John Ibanda, offered his residence to be utilized as a health center,” Namundiira mentions.
The house was used for three years, with the Ministry of Health sending medical staff to provide care to the people at the site. However, this was just a short-term solution. The residents were determined to construct their own facility. Kitamirike provided an acre of land and urged the residents to create a group of 20 men known as Mwoyo gwa Kinu, who became the main team responsible for building the health center.
"Each family was required to bring 200 bricks and pay Shs2,000 for the construction fund. People were highly compliant with their leaders back then. I recall we used to collect stones from the bushes near the village. Anyone who came to the village to campaign for votes had to bring omuchanga (sand)," Namudiira mentions.
Sister Theresa, who was in charge at Namwendwa Health Centre IV, built a shelter where patients visiting the outpatient department could rest while waiting for their turn in the treatment room. This shelter also served as a classroom where women learned about family planning and the importance of prenatal care. "By 1995, the construction had progressed to the wall plate."
The government stepped in to assist with the completion. In 1997, we relocated the health centre from the rented house to the new location. It was classified as a second-tier health centre," Namundiira explains. Kinu Health Centre II has been beneficial to the villagers. Nevertheless, they are now urging the government to elevate it to a third-tier health facility to provide them with additional services.
The challenges
Because Kinu Health Centre is a secondary-level facility, it is not open around the clock. While the health center offers prenatal care, it lacks a delivery ward. Expectant mothers must travel a long distance to Namwendwa Health Centre IV to deliver their babies. When Irene Naigaga was pregnant with her twin sons, she regularly visited the antenatal clinic.
"I went into labor during the night. My husband took me to Kinu Health Centre II, but we were disappointed to find it closed. I had to endure the pain until morning. When I came back to the health centre, the nurse told me to go to Namwendwa Health Centre IV as I had a complication," she says.
One of the infants was positioned feet first. Naigaga's husband arranged a bicycle to carry her 13 miles to Namwendwa Health Centre IV.
"The health workers told me I required a blood transfusion, but the health facility had no blood available. They recommended that we go to Kamuli (General) Hospital. When we arrived there, we were directed to Jinja (Regional Referral) Hospital. That is when we chose to visit a private clinic," she remembers. Naigaga underwent a caesarean section. Unfortunately, she lost one of the babies because of the delay in receiving medical care.
"We don't have sufficient healthcare services. As a parent of young children, there are times when they get sick, and there's no one at the health centre to examine and treat them. When I can't afford the trip to Namwendwa, I turn to traditional herbs," says Susan Kawuma, another resident of Kinu Parish. Kinu Health Centre II has only three health workers serving an annual population of 16,000 people. One of the staff members is close to retirement age. "The health centre serves two parishes. We offer services from Monday to Wednesday. Thursdays are for prenatal check-ups, and Fridays are for child vaccinations. The health workers don't work on Saturdays and Sundays," Namundiira explains.
Another issue is the absence of housing for healthcare workers, who are forced to rent accommodations close to the sub-county headquarters. "On weekdays, health workers start work late since they need to travel a long way to get to their jobs."
"The road to Namwendwa is in a very poor state, and during rainy periods, transportation comes to a standstill," says Robinah Mukyala, another inhabitant of Kinu Parish. Although expressing gratitude to the government for establishing the health facility in the parish, Mary Namulondo, the head of Kinu Health Centre II, criticizes the absence of medicines and other essential services.
"Although we get some medications, many essential drugs are unavailable. We also don't provide critical services. For example, if a pregnant woman experiences issues, we send her to Namwendwa. However, most of them don't go there due to poor road conditions or lack of transportation costs," she explains.
This implies that a number of women in the community continue to deliver their babies at the homes of traditional birth attendants (TBAs). In May of last year, the government prohibited TBAs, claiming they do not possess the required expertise to handle pregnancy-related issues, which has resulted in many deaths among expectant mothers and infants.
"Many women are delivering babies with the help of traditional birth attendants, and this has hindered the government's efforts to eradicate maternal deaths," Namulondo confirms.
According to the Ministry of Health data, the Busoga sub-region, which includes Kamuli District, has 93 maternal fatalities for every 100,000 live births. This figure is significantly higher than the country's average of 82 deaths per 100,000 live births.
Moving to a Health Centre III In addition to women turning to traditional birth attendants for maternal care, others who become ill over the weekend have started purchasing medicines from drug stores and keeping them at home. If they get sick on weekends or during the night, self-medication becomes their only choice.
"On multiple occasions, we contacted the local authorities regarding our grievances, until we were informed that, as per public service regulations, personnel at secondary-level health centers do not work on weekends. We attempted to gather funds to construct housing for the healthcare workers, but we were unable to collect enough money to purchase cement," laments Namundiira.
In 2020, the district health officer inspected the health center and recommended that they avoid the responsibility of building staff housing.
"He informed us that we must increase the land where the health center is located and then apply for its upgrade to a third-level health center. I contributed half an acre of land to add to the area my husband had donated years ago," Namundiira explains.
The Youth AIDS Education Group (AEGY), part of Twaweza Uganda, carried out a study in the village and encouraged the locals to identify the six main social issues they couldn't address on their own. Two of these issues were the health center and the poor state of the road leading to Namwendwa. "We started sending letters asking for assistance to improve both the hospital and the road. We wrote to the district health officer and copied the letters to the resident district commissioner and the chief administrative officer. They replied by telling us to increase the land area where the facility is located," says Namundiira.
In 2022, the locals also contacted the district chairman, the resident district commissioner, and the head of administration, expressing concerns regarding the road. In reply, the district officials dispatched a tractor to perform some repair work on the road.
"They didn't install culverts on the road where rainwater was supposed to drain. When we raised the issue, they made small openings along the road's edge. They told us to locate marram, which they could use to pave the road. We obtained the marram. However, the local authorities never came back," she says with regret. Now, the road is in a terrible condition, and during rainfall, it becomes inaccessible. To make things worse, the villagers claim there is no village health team available for initial medical care.
"When it rains, health workers don't make an effort to come to work. We can't hold them responsible since the road becomes dangerous. The government has been careful in building schools for us, but we also require proper medical care. We have a high birth rate, and our women face difficulties during childbirth," says Patrick Kimera, another local resident.
The mindset of the people in Bugweri Bunama Village is praiseworthy, as rather than relying solely on the government to handle everything, they are making efforts to take control of their situation. Nevertheless, it is now time for the government to support them by upgrading their health center to a third-level facility to enhance healthcare availability and the quality of services provided.
What they say?
Many children were lost during the 1980s and 1990s because of diseases that could have been prevented, like measles. People were passing away in their homes, and the community recognized the issue. In 1992, under the leadership of village chairperson Samuel Kitamirike, the residents contacted Dr Eriabu Muzira, who was then the permanent secretary in the Ministry of Health," explains Margaret Namudiira, the LC1 chairperson of the village.
Although we get some medications, many essential drugs are unavailable. We also lack critical services. For example, if a pregnant woman experiences issues, we direct her to Namwendwa. However, most of them do not go there due to poor road conditions or lack of transportation costs," says Mary Namulondo, the head of Kinu Health Centre II.
The distinction between Health Centre II and III
Health Centre II and Health Centre III are both essential components of Uganda's primary healthcare system, yet they vary considerably in the range of services provided and the number of staff employed.
Health Centre II
Emphasis: Mainly on outpatient services, health awareness, and illness prevention.
Staff: Usually managed by a registered nurse.
Target Audience: Approximately 5,000 individuals.
Services: Handling of typical ailments, delivery of fundamental health information, and restricted diagnostic procedures.
Health Centre III
Focus: A wider array of services, such as outpatient care, inpatient treatment, maternity services, and laboratory testing.
Personnel: Comprises a senior clinical officer, nursing staff, midwives, and an operational laboratory section.
Number of people served: Approximately 10,000 individuals.
Services: Ambulatory care, prenatal services (including childbirth), fundamental laboratory examinations (blood, urine, etc.), and hospitalization for simple cases.
Supervisory function: Monitors and assists Health Center IIs in its designated region.
In conclusion, Health Centre III expands on the groundwork established by Health Centre II, providing more thorough and advanced medical care. It also serves a crucial oversight function, enhancing the referral process and increasing availability of vital health services throughout various communities.