Uganda was the jewel in Africa’s AIDS response but we are now seeing a situation where people are being turned away or starting treatment later than ideal because there aren’t the drugs available.
But it’s not only the provision of treatment for people living with HIV. Another huge challenge is the lack of a functioning healthcare system and under investment.
Most of Uganda’s hospitals were built in the early 1960s and 70s and have suffered total neglect during the years of political upheaval in the country. Equipment is either obsolete or unusable and services have deteriorated due to poor management.
Dr Ali Ssetaala is a doctor who serves around 134,000 people at the Mukono health centre. It’s a staggeringly high number of patients. On average in the UK a GP will have a patient list of around 1,500-2,000. This level of need is a huge strain on a creaking, barely functioning health service.
“From November 2007 to 2008 we have tested 335 pregnant women of which 103 were positive. We have many problems. It is really difficult to do CD4 counts for example. When we need to do them the patient needs to be with us by 8am so we can give the blood by 1pm for testing.
“Some of our people come from 30 kilometres deep in the village or even from the islands. We can’t do liver or renal function tests and we have no paediatric formula.
“And then there’s the stigma. ..It’s the stigma and distance that prevents the people from coming to get their treatment. We can’t follow up with them because we don’t have enough fuel for the car.
“The best way to improve health is through the community. There are just too few health workers but there is a lot the community can do with training,” says Dr Ali.
This was certainly the case in the Alliance’s Networks Project in Uganda funded by USAID. The objective of the three-year project was to use networks of people living with HIV to increase access to HIV services.
Groups of people living with HIV linked up communities and those who were living with HIV with their local health services. Over 1.3 million people accessed HIV services through the three year lifetime of the project demonstrating that it is possible to bring services to national scale through community intervention.
Elaine Ireland is an Alliance policy officer. “We see a chronic long-term under funding of health services in Uganda which is bound to affect the ability for doctors to provide healthcare to their patients.
“While community involvement will help to increase the uptake of testing and treatment for HIV it is critical that donors stick to their funding pledges, that there is free access to healthcare for the poor and support for healthcare workers, in order to manage the care for the estimated 1.1 million people living with HIV in the country and prevent millions of others from acquiring the virus.”
stigma and distance prevent people from coming to get their treatment