March 2009

Day March 2, 2009

Buganda assets according to 1995 constitution

The Traditional Rulers (Restitution of Assets and Properties) Act 1993 (Ch 247) lists the properties below as those assets to be restored to Buganda ‘s traditional leader.  The “Akenda” and all that it represents in reality is none of those properties.  Just for your information. 


I have attached for you the full act for your reference.

1.    The Bulange

2.    The Lubiri at Mengo

3.    The Butikkiro

4.    The Buganda Court Building

5.    Kabaka’s official 350 square miles of land

6.    Namasole’s ten square miles of land

7.    Banalinya’s land

8.    Kabaka’s lake

9.    Former Omulamuzi and Omuwanika’s official residences of Mengo

10.                       Land adjacent to Lubiri on which three Buganda Ministerial houses used to stand

11.                       All Bassekabaka’s Tombs

12.                       Buganda Works Building at Kakeeka

13.                       Basiima House

14.                       Nalinya’s house at Lubaga


Lance Corporal (Rtd) Otto Patrick

Health insurance in uganda

Health Isurance scheme is  full of valid questions and I hope it won’t be rolled into the budget before its being fully discussed. Our government is full of business men more than civil servants, these ladies and gentlemen spend their time figuring out ways they can fleece our country in the name of helping the people. In the end what we get are ventures which don’t succeed but have generated monies for those involved during their span. I hope that more questions will be asked, all parties involved should be given a voice.

Personally I think that many other measures have to be taken at the same time as any form of health insurance is rolled in. Health care in Uganda is not just about money. This insurance scheme resting on the current health system will be much more costly than the current stipulated funds. I hope the president will keep this scheme out of the upcoming budget which is just 3 months away. Howcan you expect to have a valid and extensive discussion in such a short period? What’s the rush, are some afraid that they won’t be in a position to swindle after 2011? Our Health system has been dead in the water for years, if the president embarks on it recovery its worth doing it the right way other than bungling and rapidly firing hoping to fix it anyhow.

I alluded to this when I mentioned ghost patients in the UAH forum, I just don’t know how they even came up with the monitory figure, I guess they used census figures. Evidently many people are already in the system especially those employed by the government, but that’s a small percentage of the whole population.A unique identifier is very crucial not only for the management of theinsurance scheme but also for the follow up and insurance of individual health and a check on duplication of services.
These are some of the discussions that have to be embarked on hand in hand with the proposed insurance bill.

In my opinion the three main problems that the needed healthcare
system overhaul face are :

1. Politicization of the process.

2. Greediness and corruption of the involved leaders.

3. Fear of change by the old healthcare guards.

If the president can tactically figure out a way of addressing these issues there will be a very health discussion on the needed changes. Fundamental change before pouring funds or a concurrent happening of the two should be the goal. The health care discussion can no longer be left to those in the ministry of health or parliament. It’s not a purely political or health issue, it needs economists, auditors, architects, engineers, and many more careers, the whole population has to partake and understand the needed changes. An aggressive campaign, to overhaul our health system will not only create many needed jobs but will also bring in more investors and restore the pride of in our health care institutions.

In regards to the national identification, we need some form of identifier; it will also be the basis of a needed massive health information system that should cover the whole country.

The supply side can be manipulated. We can train enough doctors to meet our demands going forward. We have a big pool of doctors in private practice and in diaspora who can rejoin the service with very minimal incentives. A lot has to be done with the nursing personnel. Medical assistants who in Uganda work as physician assistant have to be given more support and training. To me the issue of supply is the easiest to fix. We shouldn’t even burn midnight oil over that.

One Ugandan suggested starting the project in July; I think that is
like delivering a premature baby. You can aggressively manage the baby outside the mother’s womb and sustain it at a very high cost and manage complications for years to follow with a risk of losing it at any one moment, or keep the baby in the mother’s womb and deliver it when it’s due. You chose.

The reason this scheme is not appropriate at this time is  not necessarily because of lack of doctors. The problem is that its being introduced in a health care system that is already broken and wasteful. That’s why I used the analogy of a concrete beach and sand. We have to reform our health care system before pouring in such amounts of monies. The ratio of doctors per patient in Uganda is in the range of 1:25,000. We can reduce this ratio by training and retaining more doctors within public service, but a gain you have to realize that some patients can be seen by well trained medical assistants or even the introduction of a nursing practitioners program would be welcome. That’s why I said that the supply side can be manipulated to work for our population as we build up our physician pool. We need some form of insurance but it should be blanketed by other necessary changes which are not currently discussed.

Next step is the insurance agencies are going to have a field day in Uganda, and the few doctors we have are going to be forced out of work or forced into private care or pick and choose who they will see.Having said that it’s good to have a tough hand hanging around the doctors, it forces them to handle cases more seriously than they have been lately.

What is needed more than this though is the improvement of the quality management arm of our healthcare system before we go on threatening to sue our doctors. If you did a quality check in Mulago hospital you will be forced to close the hospital on spot.Quick examples, the most feared and serious cause of deaths in hospitals world wide is infections patients get while they are in the hospital. Washing hands after every patient is a song every medical provider should sing in there dreams. I challenge any one of you to visit Mulago hospital and just look around at the nurses, medical students or doctors, make your count as to how many patients these providers examine before they wash there hands.
Patient identifiers; there is a reason why you are tagged when you get to a hospital, its no joke, by the way how many times have you seen a doctor in Mulago and asked about your full names or date of birth to confirm that you are the actual patient the provider has to see.
Medication errors; who takes which medications? Have you ever been give a medication list in Mulago after being discharged? Well may be you don’t have allergies to any medication but few providers even ask about that.
When was the last time the blood pressure machine the doctors you saw in Uganda was recalibrated? Or, so you thought that these machines actually work to perfection?
Those are just a few examples and each of those mishaps has actually killed more patients that we can figure. Who are we going to sue then? The ministry of health? Before we give sound bites that will sell the plan to the people, let’s get our foundation steady.That is my only short coming with this plan. The monies so mentioned can be used to make the system far much better before introducing this money guzzler on the road.

I was one of the interns who did strike for better pay being led by Dr. Sam Lyomoki. I have to say that demanding and striking can’t really change the system.We,Ugandans abroad have been exposed to a good healthcare system and it takes some one who has seen the best to make this a reality. The leaders the president has been choosing to revamp the healthcare system have not invested in dealing with the basic foundation of our system. They come up with promises of the best sex ever but then deliver on a concrete bed. That hurts if you know what I mean.Good intentions, but wrong footing.We have to work our way up from the roots and all the rest will come into place.
Through out my writings I have tackled different sectors that have to be fixed before we bring out the big guns. About the specialist issue, we actually have many specialists, but when you get the specialists to do primary care work then they won’t serve you well. The referral system has been totally screwed. Mulago as a referral hospital should not actually see any patient who just walks in with out referral from another doctor. Primary care services in Mulago should totally be shut out. We should even go as far as creating another referral hospital before getting to Mulago. It’s a waste of brains to have a senior consultant or resident run a primary care clinic or fill a hospitalist position. Well cared for consultants have no need of running private clinics. And its not only about higher pay, but paying for further studies in other countries, conferences, providing them with the necessary equipment and support there research ventures to make them shine among there other collogues is a big bait for the healthcare providers. Supporting their associations is a big push forward.
By the way I don’t even know why the government doesn’t actively work towards more Ugandan doctors or nurses coming over to the states or Europe or South Africa for further training and then go back home to serve for some years, a deal can be actually worked out. Medical student observer-ships, the best of our best can be sponsored to visit other hospitals while in training. What about the government arranging for the likes of Dr.Sarah Matovu who are shinning in thir fields to go back annually and teach or work in our hospitals, I know friends of mine who are practicing in the states who never even step in any hospital when they go back to Uganda.Cardiologists, anesthiologists you name it. A well managed plan for exposing our providers and circulating our hospitals with those that have been exposed to a better system will be a good start.  LPNs, CNAs , RNs, MDs, Healthcare managers, information system specialists,who have practiced out side Uganda should have a program within the healthcare ministry where by they can be channeled into our system for varying periods, paid or on a voluntary basis to teach and pass on there acquired knowledge. How can they change unless they are shown?
All these steps will create a foundation on which the necessary major changes will be made and make it possible to control the unnecessary waste of our merger funds.

Dr.Eddie Kayondo

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