Dr Emmanuel Ootala is Uganda’s Minister for Primary Healthcare. He is a confident man as he leans back in his sofa in his smart, air-conditioned office in Kampala.
”This government has prioritised human development, such as health and education, because it believes a healthy nation is a wealthy nation. It is the first government to address access and equity of services for all the people of Uganda,” he declares proudly.
”Past governments would boast of 23 general hospitals, but we are proud of the focus on health centres. We have 1 000 health centres at constituency level and three in each sub-county. We want, eventually, everyone to be within 5km, walking distance, of a health centre.”
Ootala is keen to talk of his government’s record on tackling malaria and HIV/Aids. He also points out that Uganda is one of the best countries in Africa for its provision of mental health services; he claims that there are psychiatric clinics attached to every regional hospital.
He sees that aid helps develop health services, but it’s a means to an end. ”When people are healthy, there is increased productivity, and what Uganda most needs to develop is trade, not aid.”
The problem in his ministry is lack of money. ”We have a surplus of health workers in Uganda right now because we don’t have the resources to employ them. There are so many competing demands in our budget, so we can’t recruit according to our requirements. We have set standards and we estimate that we reach only 68% of them, so we have a 32% shortfall.”
The most difficult problem Ootala has on his desk is the shortage of doctors in rural areas like Katine, where there is no doctor working at the clinic. Eighty percent of Uganda’s doctors are in urban areas, yet 80% of the Ugandan population lives in rural areas and have to depend on clinical officers instead, he explains.
But he insists: ”Health is not just the responsibility of the health department. Communities have a major role to play and the village health team concept is very important. Health is made in the home, and 80% of all diseases in this country are preventable, such as diarrhoea and malaria. Water and sanitation, and education all play big roles in delivering better health.”
But what seems to prey on his mind is the issue of how to ensure that there are more doctors — he was, after all, a doctor himself, before he entered politics.
”We need better remuneration to prevent the brain drain by which doctors leave to work in Kenya and Rwanda. We have tried to propose salary increases, but it’s not going to get into the budget. The priorities for government expenditure are education, defence, energy and only then, health.
”The president says to me that energy is essential and that my doctors can’t work without electricity,” he concludes.
The government focus has been on primary care for 30 years, but Ootala is also keen to develop the tertiary health sector. At present, wealthy Ugandans go to the United Kingdom, India or South Africa to be treated by Ugandans for major operations.
”We want to have cancer and heart institutes and renal institutes here so senior consultants can come back to Uganda to work. We have had donations from the crown prince of Saudi Arabia to build a heart institute. You have to remember that Uganda was the first country in the world to do open heart surgery back in 1963 — since then it all collapsed in the turbulent years.”
He adds: ”I came from a rural area, but now all the people in medical school come from the urban areas and they don’t want to go and work in the rural areas. They come from well to do families and go to good schools and get the government scholarships.
”[The scholarships are judged] on merit, so someone from a rural area can’t get the grades to compete. But we need students from rural areas because they have the feelings to go back to work there.
”We have 180 doctors graduating every year, but the numbers have been stable while the population has tripled. About half of these new doctors go abroad because there is no employment in this country. The ratio of doctors to population in this country is one to every 15 000 people.
”We opened a state-of-the-art outpatient department in Tororo [a rural district in the east] which had been constructed with the Japanese. They advertised for a doctor and no one applied. We don’t know what to do to attract them. We have tried nice houses, electricity, car loans and internet links.”
He looks defeated as he describes the problem, and then rallies. ”We still need to put our heads together to see what to do.” — guardian.co.uk © Guardian Newspapers Limited 2008