These ideas can be improved by intensive scrutiny. Full participation of all Ugandans is needed. Feel free to print it and discuss it with any reasonable person that you find, hopefully we can come up with a good plan for the future of our country.
I will start by listing what I think is wrong with our current system:
It doesn’t promote good health. Primary health care has fallen short of its goal mainly because it was an addition to the system but not a foundation. The population is primed to go to the doctor when they feel sick and many times it’s too late and the cost of treating these chronic illnesses is very high.
It is a disorganized system that lacks proper follow up procedures. Partial treatment is some times worse than no treatment. There is no continuity in patient care.
It lacks proper referral procedures. This has led to over crowding of the National referral hospital, misuse of our specialists and has affected the teaching of medical students. Not enough time is dedicated to continuing medical Education for the specialists and the medical students don’t get enough time to manage chronic patients that are admitted on the wards.
Pharmaceutical services lack a proper auditing system and this has led to misuse and diversion of medication and sometimes expirations of medications in storage.
It is not geared towards provision of quality Health services. Proper monitoring and licensure of health units, equipment calibrations are not enforced as they should as quick examples.
It does not encourage or enforce continuing medical education for all healthcare personnel’s and their associates.
It discourages patient participation. Doctors and nurses are not questionable and they rarely take time to educate their patients about their illnesses or side effects of their medication. It is not easy to communicate with your provider after the fact.
A new system should include the following:
National Electronic Medical Records Center. Every citizen should have his/her medical history ready to be reviewed as needed at any center within the system. It doesn’t matter where you were treated before, your medical information should be accessible to the next provider who is caring for you. This off course is under the umbrella of total confidentiality like everything else in the healthcare system.
For the above EMR to be effective, they must be some form of national identification system for all citizens.
All citizens should contribute to the healthcare system via a national health insurance; the fees can be accessed depending on the income. This should be enforced. Management of these fees will be discussed later. The government should be the largest contributor to the system.
Every citizen should have an Annual physical, this is necessary not only to control the cost of care but also to encourage good health. They should be some kind of enforcement on this issue.
There should be a central pharmacy control system linked to the EMR, this can be used to monitor prescriptions in real time, at the same time it can be used to easily audit any prescribed medication as it should be corresponding to a particular diagnosis. This system can also used to prevent expiration of medications as the can easily be moved to needed areas and orders can be made as per the prevailing need as represented in the national EMR system.
The presence of national internet access.
Proper coding of diseases should be instituted. This will not only be important for insurance reasons but it is needed for proper functioning of EMR system and also can be used to quickly asses the public health of any given area.
Referral system should be streamlined. No walk-ins should be allowed at National referral hospitals. All medical care should be initiated at village level, and referrals are then made up the system. This off course depends on the severity of the presentation. Those with private health care insurance who want to jump any level should be charged a high price accordingly.
Trained personnel in the Diaspora should be given incentives including but not limited to tax breaks, recognitions to encourage them to periodically return to treat fellow citizens and train our medical personnel.
The medical school should have a plan to fund student training outside the country after which they have to come back and serve the nation for a given period. This should include agreements with any country they are sent for training. Students should also be encouraged too take standardized external exams like the United States Medical Licensure Examination while they are attending medical school. This will encourage them to get further education outside the country and will also keep them at level with the current medical practice.
We should have strong and very well funded Quality assurance and Continuing Medical education board.
In Part Two I will propose how we can put all of this in one package, how we can build anew foundation for our health system bottoms up. Mean while please feel free to respond to this post as you wish. Your feed back can only make it better.
For God And My Country.
Dr. Kayondo Eddie, M.D