April 2011
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Day April 8, 2011

Rebuilding Ugandas Healthcare system Bottom up – PART 2



Newton was not the first man to see an apple fall, but he was the first to see what that implied. What you may read below might not be the first time you have seen it, but I hope it will be the first time you have seen it as a story. If you visit a manufacturing center you will see an assembly line, this will most likely have a convey belt that brings together all the necessary parts, robots and humans that put together these parts as you go up the line inspecting each stage and at the final end they do get the same perfect product at any given day. At anytime if there is a mistake or malfunction they can know exactly what went wrong, how many parts they need, what changes they have to make and they can change the outcome as needed. It is a flawless system. It is constantly being watched, reassessed, and updated. That’s what I am proposing. I would like you to follow two people, a mother (Mother Uganda) and her Child (Citizen) in this new system.

The system begins at a village level, the moment Mother Uganda got pregnant a midwife and a nurse at the local community center started following her. They knew she was pregnant because they work closely with the population in this village. She was already registered in the National Health System computer, so as she started getting her immunizations and treatments all these records were kept. She was followed closely because even when she forgot her appointments the nurse and midwife were reminded by the pop ups on the laptops they carried for their usual home visits and they promptly reminded her.

Unlike her first baby they noticed some complication, the Physician assistant (Used to be called the medical assistant) at the local Center who was working closely with the Nursing practitioner ( from the new advanced nursing training center) noticed from their local Ultra sound that something was wrong with this baby. They immediately referred her to the district hospital using the ambulance they bought from funds collected locally in the Village health insurance pool which also received more funds from the national health system as needed and from donations all over the world. This team is well trained, they also have oversight from the doctors at the district hospital who periodically review the charts of the village members and visit the center for hands on management as needed. This team like all other medical personnel in the system is also closely watched by the newly funded Quality medical management branch. This branch drops in at the center for quality assessment, equipment supervision, and infection control assessment and also keeps a tab on the completion of the continual medical education hours needed to recertify the members of the medical team at every center in the country.

The center has its medication and orders made automatically because as they prescribe each medication it is logged into the new pharmacy program. The prescription has to correspond with a diagnosis which is coded as the software dictates and it can easily be audited to see if it corresponds with the patient who was logged in the medical records system. As the supply goes low those at the main supply center miles away will be notified and they will immediately send more medical supplies to the center as needed. They can even move medication from one center to another especially if they realize that the expiration dates are getting closer and the medication is not used at that center so it can be channeled to another center that can use it as quickly so that it doesn’t expire. This system can do more than you think; it keeps a watch on all the medications 24/7.

Mother Uganda went to the district hospital. This is a busy place. You just don’t walk in this place; you must be referred or brought in by ambulance. It has a big Emergency room. Fully equipped to handle all emergencies and has the capacity to deal with all medical cases. It has specialists from all fields; medical students spend a lot of time in this place. It gets part of its funding from those patients who don’t want to go to the village community center but have private insurance. It’s also subsidized by the government. Most admissions are made at this level. The computers at this center are connected with the lower community village center and the national referral centers. They are only three levels of health centers.

Mother Uganda could not be handled at this center due to the seriousness of her case there was a need to transfer her to the closest referral center as soon as possible. The national medical airlifting service was called on; she was then airlifted to the national referral center.

This center has the topmost specialist services. There a couple of these centers and they each have special specialties in which they are equipped more than the other referral centers. For example one referral center specializes in Kidney problems, the other one is a Cardiac referral center the other one is a Neurology center and there is also a Gastrointestinal center. Other minor specialties are equally distributed in these centers and also some centers like the one she went to share major specialties. She was handled well and she delivered a baby she named Uganda Citizen.

From his birth Uganda citizen was in the National health care system, he was followed closely, received all his vaccinations on time because he was scheduled at the village center and the nurses at this center made sure he came for his appointment because they actually knew where he lived. He had an annual physical every year again reminded by the local medical center. If there was any need for further care he was referred to the district hospital and just like mother Uganda the path was clearly marked. As he started working he also started contributing to the local healthcare fund. The money from this fund was used at this center to pay for medications, renovations and medical care as needed. If this center had anymore needs requests were sent to the ministry and they were addressed accordingly. The villagers had a say in what expansions to make, how many ambulances to buy and much more.

The Health ministry gave guidelines and policies which had to be followed but according to available funds at the local level including donations from outside agencies community centers were different village to village. Some centers in urban villages had better centers because of the higher income from the local population. The National referral hospitals only handled patients referred by the district center.

This story displays the skeleton of the system; individual components will be described in details in the parts that follow. Your responses will help us fine tune the Skelton.

Let me know what you think.

Dr.Kayondo Eddie, M.D

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