As voters leaf through manifestos of the eight political parties that have fielded candidates in next year’s presidential poll, a contrast that sets apart the ruling party from others will be hard to overlook.
‘We have . invested in health infrastructure. Uganda now boasts of 78 hospitals, of which 54 are general hospitals, 16 regional referral hospitals, five national referral hospitals and three specialised hospitals,’ the ruling National Resistance Movement (NRM) party states in its manifesto launched on Monday, adding: ‘We have 217 health centre (HC) IVs at constituency level, and 1,553 sub-counties have a health unit of HC III and above. This is contrasted against only 49 hospitals and 597 dispensaries that Uganda had in 1986.’
Not good enough, the National Unity Platform’s (NUP) manifesto screams. Health is, says the leading Opposition party, ‘a right, not a privilege.’ The party, which also launched its manifesto on Monday, says it will ‘progressively increase health spending to 15 percent of GDP to deliver quality, accessible care for all.’ NUP promises to ‘recruit 16 times the current number of doctors and triple all other health workers to match population pressures,’ adding that this is not possible on the watch of the ruling party because of its alleged wastefulness.
‘It is only in Uganda where Museveni has more cars than ambulances attached to public hospitals. Gen Museveni has over 600 vehicles at his disposal yet the total number of ambulances in public facilities is about 178,’ the NUP manifesto thundered. The Forum for Democratic Change (FDC), another Opposition party, is also unstinting in its criticism of the NRM’s provision of medical care to Ugandans across nearly four decades.
‘ For a healthcare system to run efficiently, it requires a combination of well-managed resources, skilled and motivated personnel, effective management, accessible and quality services with emphasis on outcomes,’ the FDC says in its manifesto, adding: ‘To achieve these, a country requires significant financial investment deployed in an efficient and effective manner. Uganda spends approximately $57 (Shs197,000) per capita on health, which is below the WHO-recommended $86 (Shs297,000). Out-of-pocket payments account for 28 percent of the total health expenditure.’
Empirical evidence shows that widespread corruption and malpractice in the public health sector continue to undermine service delivery, depriving patients of essential care and straining limited resources. In an audit report covering the 2023/2024 financial year, the State House Health Monitoring Unit (SHMU) revealed that cases such as theft of medical equipment, drugs, and financial improprieties were uncovered in 17 health facilities countrywide. As a result of the investigations, the SHMU team recovered Shs719m.
The Unit also unearthed forgery of academic documents, neglect of duty, operation of unlicensed clinics, and criminal trespass on health facility land. The SHMU finance and audit output for the Financial Year 2023/2024 revealed massive financial irregularities in several health facilities, with Shs7b reported as unaccounted for or tied to suspicious accountabilities.
According to the report, the irregularities cut across hospitals, health centres, and district health offices (DHOs), with some cases already under investigation while others have been forwarded to the Office of the Auditor General (OAG) for forensic audits. In Tororo District, Tororo General Hospital failed to account for Shs194m, while at Nagongera Health Centre IV, Shs49m was misappropriated, of which Shs7m was recovered. Investigations into both cases are ongoing.
In Iganga District, the DHO’s office failed to account for Shs142m, while Iganga General Hospital posted the largest single irregularity with Shs1.09b unaccounted for, now under review by the OAG.
Bugono HCIV also reported unaccounted funds totalling Shs221m, with files submitted for forensic audit. The report further shows that Wakiso HCIV failed to account for Shs291m, while the DHO’s office in Kamwenge District had Shs1.1b unaccounted for. Rukunyu hospital was implicated in the loss of Shs595m; Bisozi HC IV Shs150m; Kitagwenda DHO’s office Shs493m; and Ntara HC IV Shs216m.
Still in Kitagwenda, several health centres reported missing vouchers, including Nyabani HCIII, Mahyoro HC III, Kanaro HC III, and Kicheche HC III, each amounting to Shs34m. In Manafwa District, Bubulo HC IV failed to account for Shs99m and reported missing vouchers of Shs19m. Bugobero HC IV had Shs123m unaccounted for and missing vouchers worth Shs22m.
In Jinja City, Budondo HC IV had irregularities amounting to Shs52m plus missing vouchers worth Shs25m. Bugembe HC IV failed to account for Shs109m, alongside missing vouchers of Shs143m. Mpumudde HC IV reported unaccounted funds totalling Shs122m and missing vouchers of Shs10m
‘High rates of scheduled and actual absenteeism in lower-level health facilities are forcing patients to self-refer to higher-level facilities. Additionally, installed biometric machines have either been malfunctioning or not properly utilised,’ Dr Warren Naamara, the HMU director, said. The report shows that in many facilities, the infrastructure, essential medicines and health supplies (EMHS), and staffing levels do not match the health care services offered.
‘Most facilities, despite being classified as HC III….provide health services equivalent to a HC II such as antenatal care and outpatient services. For example, Kajansi, Wakiso, and Buwambo HC IVs receive EMHS intended for lower-level facilities,’ the report reads. According to the report, officials at health facilities in Wakiso District were found to have misused non-wage primary health care (PHC) funds for personal benefit. The team also discovered cases of mismanagement for personal gain and a lack of financial accountability by most officers in-charge of facilities.
The report further shows that Dr John Mulidho, a senior medical officer (SMO) attached to Iganga Hospital, allegedly worked 46 days from July 2023 to May 2024. He was temporarily suspended from the payroll. Moreover Iganga hospital registered 45,865 patients against a set target of 19,386 for a period of six months, which was 287 percent or almost three times the expected patient numbers. This means the target setting was low or the hospital is getting patients who are not within their population jurisdiction. The Unit wants Dr Mulidho to be forwarded to the Rewards and Sanctions Committee and sanctioned in line with the Uganda Public Service Rewards and Sanctions Framework.
The SHMU also reported payroll irregularities, noting that the PHC payroll, as of June 30, 2023, had 75 excess staff, leading to the creation of fictitious cost centres. One theatre assistant at Bubulo HC IV in Manafwa, Ms Faith Haboya, could not be traced physically or on the payroll. Several staff were found to have abandoned duties. Some were arrested for neglect of duty. In Namayingo District, absenteeism remained high despite salary enhancements.
Audits showed many officers in-charge of health facilities frequently absent, with organised absenteeism through duty rotas at Buyinja HC IV. Health workers reportedly ran private clinics in nearby districts, contributing to absenteeism and mismanagement. EMHS worth billions, procured with public funds, were poorly accounted for.
In Pader District, high absenteeism, late arrivals, poor attitudes, and unsanctioned study leave were noted. Only four of 13 officers in-charge of facilities met attendance guidelines during the SHMU monitoring visits. Stock discrepancies were found at Pajule HC IV, with medicines worth Shs14m unaccounted for.
In Mukono, review of payment vouchers and bank statements at Mukono General Hospital revealed Shs265m in missing payment vouchers and Shs260m in unaccounted or insufficiently accounted funds. Dr Patrick Kitimbo, the DHO, declined to comment on the matter when contacted.
Prof Mwambutsya Ndebesa, a lecturer at Makerere University and political analyst, said Uganda is plagued by a weak accountability system, both politically and financially. He said weak accountability has become a norm and culture in the country. ‘Political corruption must first be fixed before we even talk about financial accountability,’ Prof Ndebesa argued, accusing the ruling party of electing known corrupt officials to its top organ.
Associate Professor Paddy Mugambe, the Dean of the School of Business and Management at Uganda Management Institute (UMI), said there are serious weaknesses in the internal controls across the entire health service value chain. ‘These gaps may be contributing to occurrences that are highly detrimental to the provision of health services,’ he explained. He added: ‘The challenges could also be linked to deeper issues such as the unfavourable working conditions faced by health workers, which may lead to negligence or the intentional misuse of resources at their disposal.’
Mr James Wire, a former chairperson of the Board at Busolwe General Hospital in Butaleja District, said the challenges facing health facilities are multifaceted. They include political interference, where facilities are treated as cash cows by politicians who demand money from their PHC grants.
‘There are questionable recruitment practices that have allowed unqualified individuals to take up critical positions, and poor monitoring which leaves beneficiaries at the mercy of non-compliant technocrats,’ he said.
Poor Administration
Mr Marlon Agaba, the executive director of the Anti-Corruption Coalition Uganda (ACCU), said the biggest problem in hospitals and health centres is poor administration. ‘Health workers are not adequately supervised, and as a result, many fail to perform their duties. This is why funds are often unaccounted for,’ he explained. Mr Agaba also pointed out that medicine management is another major area of concern. ‘Problems occur throughout the entire supply chain-from procurement, issues at the National Medical Stores (NMS), distribution to districts and health centres, and finally delivery to patients,’he said.
He stressed the need to digitalise the medical supply chain up to the end user to curb these challenges. Currently, many health workers run private clinics and pharmacies, which creates conflicts of interest and opportunities for theft.
‘Medicines meant for public facilities often end up in private clinics. Government should implement a policy prohibiting public health workers from owning private clinics or pharmacies while in service.
Such a policy would help reduce absenteeism and resource mismanagement,’ he said. He added that manual record-keeping in health facilities further facilitates fraud, allowing health workers to divert medicines and refer patients to private clinics.
‘There is widespread fraud in the health sector. Some health workers take early retirement to enjoy enhanced pensions at the expense of service delivery. Others abuse study leave, continuing to receive full salaries while defrauding the government.’