By Senfuka Samuel
Kabale district is found in south western Uganda about 500km from Kampala. It is one of the two districts White Ribbon Alliance for Safe Motherhood Uganda (WRA Uganda) selected to advocate for recruitment, motivation and retention of health workers through a ‘Teaming Up’ approach. This was based on a human resource assessment by WRA Uganda indicating inadequate staffing especially for maternal health.
Budgeting for health workers
16th December 2011 was a Budget Conference day for Kabale District Local Government which is the basis for the preparation of a budget and work plan for Financial Year (FY) 2012/13 and a time when the district presents the performance of the ending FY and the local governments (Sub-counties) present their budget proposals to be integrated into the district budget.The outcome is a district Budget Framework Paper (BFP) which is submitted to the central government for consideration; the BFP can be passed back and forth until agreed upon before the national budget is passed.
Paradoxically remuneration of one Member of Parliament pays about 20 doctors. The Ministry of Finance has commissioned a review of Local Government financing which is hoped to adequately address the financial discrepancies to enable LGs perform better.
Dr. Tusiime and other hardworking Officers are quite frustrated by the perennial challenges. He further cites the ambulance system which is functional but with operational challenges such as repair and maintenance of all vehicles at all levels of care, inadequate fuel for the ambulances to refer patients and lack of allowances for overtime work by the staff.
“A Health Centre IV like Kamwezi is about 2hrs drive from the referral hospital with a bad road. It requires about 40 liters of diesel for one referral but the health centre is allocated only UGX 650,000 (Approx USD 260) per month for all routine operations including purchase of fuel and other maintenance costs for the ambulance” He explains.
At about 22:50hrs as the discussion went into the night; Dr. Tusiime received a phone call from one of the health centres that a mother had complications and needed transport to be referred to Kabale Regional Referral Hospital. This is the only referral health facility which can manage complications because the other seven Health Centre IVs do not have a single doctor so their theatres are non-operational. When I asked Dr Tusiime why there are no doctors the answer was obvious. They all left for better working conditions and even when jobs are advertised there is little response. To partly address the lack of doctors and referrals he suggests task shifting of Clinical Officers by retraining them in surgery to be able to carry out C-Sections.
Dr Tusiime called a driver to go and get the ambulance to pick the mother but the driver needed money to get a motorcycle from his home to where the ambulance was parked. This meant that Dr Tusiime had to pay the bill himself.
Some have called for a review of the user fees and perhaps reinstatement to meet operational costs, as promised access to free services without adequate planning and budgeting for it from the government has placed heavy strain on the health services. Dr. Tusiime suggested:
“Our leaders and other partners should sensitize Community members and make them aware that they have a role to play in saving their lives. They should be made to understand the benefit of contributing to their health.”
A couple of years ago government tabled in Parliament the National Health Insurance Bill but it was later shelved for unclear reasons. The passing of the Bill into an Act may go a long way to address this challenge as it has worked in neighbouring countries like Rwanda.
These are some of the issues which make the existence of WRA more relevant particularly using a teaming up approach to tackle them through advocacy, awareness and mobilization of stakeholders. In order to execute this Teaming Up members were trained in advocacy and communication skills before the budget conference.
In addition, the Teaming Up members prior to the district budget conference met and engaged the district executive council members and district counselors on the key interventions for achieving the national maternal health targets as described and guided in the Road Map where LGs are key implementing institutions. We also lobbied them on the critical core budgeting areas as they discuss the planning and budgeting for FY 2012/13.
|Mr Barusya Julius, Media Rep WRA Kigezi region presenting during a pre budget meeting with district executive and counselors organized by Teaming Up members|
|A district woman Counselor making a strong submission in support of budget increase for maternal health|