Universal Health Coverage

I wrote about about this is in previous blog about Millennium development goals. It tugged at my heart quite a bit because of the contrast between service provision at Kisoro and Mbale hospital. The Mbale experience really bothered me. Patients showing up bare expecting 'free' services only to be told that right from simple things like a cannula, they had to go to nearby shop to purchase. (Sometimes, these purchases could be made from the staff). I remember the severely anaemic children who showed up in shock and we had to send parents off in a hurry to buy cannulas.

As I sat here, I remembered a middle aged woman who I saw when she was rushed into the casualty department. I had never made so many diagnoses in one patient! HIV positive with severe anaemia, hypertension.. the list continued! The reason I remember her is because I run around, trying my best to correct as much as we could in the shortest time possible because in so many ways, she really was a ticking bomb!

She survived! Was transferred to the ward where she was monitored as she stabilised. What amazed me everytime I came to do the ward round is how she had not taken medication. She had no money to buy it! The pain! Lord! What was I to do? Tried to get her drugs but they were not available at the hospital plus she wasn't really feeding well or being taken care of.

In spite my scepticisms, I do see the difference that UHC if done properly can make to help the poorest:

• Those anaemic children who really do not have to die of malaria
• Those pregnant women who show up in the middle of the night
• The patients with chronic illness who I have always felt are too poor to have such diseases!
• The patients who needed emergency surgery
• Those who begged me to discharge them in spite the fact that they were not well because they had run out of money to be in the hospital. Some asked to return home so as to 'look for more money' before returning. 

Poverty is so real back home. But for this system to be effective, the issues underlying need to be addressed. The health system blocks need strengthening and In Uganda, staff motivation is key and salaries could really use a bump. Also, there is increasing need for appropriate oversight.

I am working on a proper paper with references and everything. I just wanted to voice my thoughts. I hope that lady is ok :-( However, that would be nothing short of a miracle. By the time I had moved to a different rotation, she had already been re-admitted about 3 times in 3 months.

Universal health is basically about health for all with Financial Risk Protection(FRP). Individual countries in adopting strategies and moving towards UHC need to ensure that whatever the 'scheme' used, patients are covered for the things especially that tend to incapacitate them health wise and financially. Clearly a physician consult did not do much for this woman, she really needed drugs.

I was about to voice my concerns as to whether UHC can actually attain universal health but the more I think about it, the more I am convinced that yes, health coverage can help free the poor from the crippling power of illness. However,again, this can not stand alone. Other health promotion activities are still necessary to curb preventable illnesses and prevent 'over-usage' of the services. It must also be noted that many of the out pocket expenses in relation to poor health are not always addressed within the existing framework of health systems such as transport to the health centres and food for the attendants and patients as shown in rural Tanzania.