Interesting Realities in a Rural Uganda Health District
By Dr. Agnes Kobusingye
Kampala, Uganda
March 3, 2008

It was a bright Wednesday morning and I was looking forward to a rewarding discussion with the district health team in a newly formed Uganda district where the Foundation is supporting prevention of mother-to-child transmission (PMTCT) services. Little did I know that my day wouldn’t feel so bright after listening to a few realities of the world in which we work!

Reviewing the program’s performance was the focus of the meeting, and one of the most critical issues that arose was how to ensure timely reporting of the district’s PMTCT activities. The health team identified several delays at both the health facility level and the district level. The following is part of the discussion with the ten staff members who were in this meeting:

“In order to solve the health facility delays, let us provide the implementing health facilities with money for public transport so that they can bring the monthly reports to the district office.”

This first suggestion was quickly followed by: “But that will not work, since most of the public transport is only available on market days, which are once every two weeks.”

Silence followed as the reality of the situation sank in. Another suggestion came up: “An alternative is to provide cell phone airtime to the staff persons at the health facility, so that they can call the district staff person and read out the reports and then later send the hard copies when transport is available.”

This suggestion was received with a lot of laughter, and I was puzzled until I heard the next comment: “There is hardly any cell phone coverage here at the district headquarters — how do you expect to receive those reports? You all know that to receive or send a phone message, you must climb the hill behind the offices and place your phone on that anthill.” There was more laughter following this comment.

We finally decided to provide the district staff person with transportation so that he could visit the health facilities and collect the reports. The health facilities with access to regular public transport would bring the reports to the district. There is no functional vehicle at the district’s medical department, so the Foundation decided to provide a motorcycle and to repair their old vehicle.

At the district level, the causes and solutions to the problem of the delayed reports were even more interesting. When the district person responsible for the reports was asked what the problem was, he responded “We have no access to internet services — I have to go Mbarara, which is 80 kilometers away, to email the report.”

I asked, “So does that mean that if internet services could be provided to the district, then the problem would be solved?”

He quickly added; “But the department does not have a computer, either.”

My response was, “No problem, the Foundation will provide the computer as well.”

There was a moment of silence and then he said shyly, “But how shall we use this computer when we have no electricity — maybe we could get a generator, too?”

At that point one of the other members asked, “Will the district be able afford the fuel to run this generator?”

Another added, “Before you discuss the cost of fuel, I hope you all know that the nearest gas station is 40 kilometers away, so the costs should include the fuel for the vehicle that will go to collect fuel for the generator.”

There were giggles in the background…I was at a loss for words, so I looked at the district director of health services for a comment.

He looked around uncomfortably and said, “What I have to say is not a solution, it is actually another hiccup that none of you have mentioned. The buildings housing the new district offices were constructed in 1961 and there is no wiring for electricity and security. So using the generator will require wiring, and keeping a computer will require burglar-proofing.”

By this time I had developed a mild headache from just listening to all these realities affecting implementation of services in this newly formed district. We did not come up with a conclusive solution. Our next meeting is scheduled for two weeks later, so I am still looking for solutions!

I am Dr. Agnes Kobusingye, and I graduated as a medical doctor from Mbarara University of Science and Technology (MUST). I work as a technical advisor for the Foundation. Before joining the Foundation, I worked with the Uganda Ministry of Health. I am married with two children, and most importantly I love being around children.