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Institutional support for the private-non-for profit (PNFP) health sub-sector to promote universal health coverage in Uganda

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‘Unfortunately a lot of diseases are still poverty related’

 ‘Unfortunately a lot of diseases are still poverty related’

Doctor Daniel Okello has worked for Angal Hospital, in the Northern region of Uganda, for over 6 years. The hospital is situated in a poor and rural area and faces, like many health facilities in the region, a lack of means and under-staffing. Still doctor Okello carries on: "In this hospital we look out for each other, the job satisfaction makes it worth to push through the hard times."

 I’ve been with this hospital for 6 years now. I came here fresh from school because, they urgently needed medical officers. In the beginning I had a hard time adjusting. The place is remote compared to Gulu, the city I’m from, but as soon as you adjust your mind-set, you can handle it.

Most people in this area are living in poverty. Therefore a lot of  diseases are poverty related and could be easily avoided, if not for the lack of recourses people face. You see this for example in perforations of intestines due to bad food patterns when people eat roots or bad herbs. A lot could be prevented given the correct health education. This could truly make a difference.

I try to take the time to teach my patients, teach mothers about basic healthcare for their children. But this takes a lot of time and as a doctor you are often the only one in a ward. Taking 20 to 30 minutes per patient to talk things through isn’t always possible and takes a lot of effort.

Student life
In 2009 I finished my training through an internship in Gulu hospital and went straight to Angal. When you are a medical student it is all about the books and the exams. Doing my internship in a town setting also made it easy. It got me thinking: ‘this doctor thing is rather easy’. But there is much more you need to take into account. I realized the climate, the culture of the people, the working conditions can vary a lot. Overall I think it is important to understand as a trainee that what you learn in class is less than 20% of what you do on the ground.

As a kid I admired doctors. I wanted to become like them, even though I didn’t really understand what they were doing. So when I got older I informed myself on the  profession and decided I wanted to go ahead with my childhood dream. I have never regretted it.

Result-based financing
I like the quality aspect that comes with introducing result-based financing. Before we didn’t always take blood pressure of every patient, we didn’t do a full lab test. Instead we mainly treated patients based on a doctors clinical assessment. Now we fully investigate. This has made a big difference. We now know in advance if people are fit for operation. We spend more time with each patient and have more drugs than before to treat people.

We are happy with the support from BTC but I think we could still benefit from more regular visits of the project team. Result-Based Financing is not an easy system to implement. It really takes a complete mentality shift. Therefore it is good to have close contact with each other.

One big challenge remains the lack of qualified staff. We are understaffed and under paid. With more patients coming in due to lower fees, it creates more fatigue with staff.  We are in need of specialized medical doctors and not just generalists. If possible I would love to go back in for training.

Some of our wards are too small. We currently have about 70 beds in the children’s ward, but during busy times almost 200 children stay there. They sleep on the floor to save space. In future, this needs to change.

Working together
What I like about Angal hospital is that regarding of the circumstances we really work together as a team. We look out for each other. Besides this, the job satisfaction makes it worth to push through the hard times. As a final remark I want to say that our lab has recently really improved, which has made our work easier and made us deliver higher quality care. 

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