How administrative units are denying Ugandans quality healthcare

By Charles Bawate

Uganda is a sovereign state and a member of the East African community. In 1995, following eras of political and constitutional turbulences characterized by exploitation, oppression and struggles against violent forces, the State enacted and adopted the Constitution of the Republic of Uganda – on the 22nd of September 1995. In this cardinal new system, the Government adopted a decentralization system with local governments (districts) as the centre of good governance and equitable service delivery to the local people.

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At the time, the country had 39 districts (Arua, Bundibugyo, Kabale, Kampala, Kasese, Kibale, Kisoro, Kotido, Kumi, Mbale, Moroto, Nebbi, Pallisa, Rukungiri, Soroti, Tororo, Kabarole of Toro, Kapchorwa of Sebei, Moyo of Madi, Gulu and Kitgum of Acholi, Apac and Lira of Lango, Iganga, Jinja and Kamuli of Busoga, Hoima and Masindi of Bunyoro, Kalangala, Kiboga, Masaka, Mpigi, Mubende, Mukono, Luwero and Rakai of Buganda, and Bushenyi, Mbarara and Ntungamo of Ankole).

It is imperative to note that in 1969 and 1980, there were 21 and 33 districts respectively. Article 179 of the 1995 constitution allows for the creation of new districts, and districts to alter and create new administration units within their areas of jurisdiction. Today, the districts have grown to 135, 3.5 times with reference to 1995 and 6.4 times with reference to 1969. In 1995, the population was 20.68 million people, and estimated at 49,924,252 million people in 2024, a 2.4 population growth.

In the coming financial year, the country is going to run a budget of 72.136 trillion – FY 2024/2025. Over the years, most of the budget runs the administrative costs. At the time when Busoga region had three districts, it had Jinja Regional Referral Hospital (JRRH) and two district hospitals (Kamuli General Hospital and Iganga General Hospital). With the proliferation of districts and partition of Uganda by our own fathers – Busoga region has been no exception to this trend. Today, the region has one city and twelve districts.

For equitable healthcare services which is one of the pillars of decentralization, the region is served by one JRRH within Jinja city, and four hospitals namely Kamuli General Hospital, Iganga General Hospital, Bugiri Hospital and newly established hospital in Jinja District. Now the growth of districts has outgrown the epitome of healthcare services within these new administrative units.

The consequences of these are numerous for instance – the few hospitals frequently stock out of drugs, patients walk long distances to mother units for services, and long waiting time for services at these facilities among others. The situation is worsened by mother hospitals only being allowed to plan for their own areas of jurisdiction including staffing yet serve more than that.

At this end, one can easily opine that the creation of districts is politically motivated as opposed to the easing of healthcare services to the local populace. What if instead of districts, the government had set up modern health units wherever there is a district headquarters, it would have brought this critical service to its people in a better manner.

Therefore, as we wait for the official release of the 2024 census results, let’s not agitate for more administrative units but raise up to ask for quality and equitable services. Every one of us has a role to play and let us rise up to the occasion. 

Charles Bawate is a Senior Laboratory Technologist at Kamuli General Hospital 
Email: charlesbawate@yahoo.com | Tel: 0774006908 

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