Delivering health services in rural Uganda

In a country as poor as Uganda, access to quality, affordable healthcare for the millions of people living on or below the poverty line, particularly in remote rural areas, is little more than a pipe dream. As with every country on earth, if you have the money you can buy good healthcare in Uganda, most of which is concentrated in the major urban centres. For everyone else the overstretched public health infrastructure and, the ultimate fallback of traditional ‘medicine’, are as good as it gets.

Travelling through the country, it was obvious that things like running water and electricity ended the moment the roads stopped being paved and became dirt. Turning off any of the major roads into the countryside, is like travelling back in time. People live a hard existence, often as subsistence farmers. Water comes from wells with hand pumps, children walk miles to attend school, and, despite high levels of need, there is very little access to health services.

I was lucky to be able to spend a couple of days with a mobile health unit that travelled into the countryside, where a doctor and a couple of nurses performed health checks and delivered primary health care services. We went to a typical rural area in the countryside outside Iganga. Much of the work was focused on maternal and child health – there always seem to be plenty of children and pregnant women.

In the week prior to the medical team arriving, local volunteers tour communities in the area to inform them when and where the medical team will be. On the appointed day dozens, if not hundreds, of people show up and patiently wait to be seen. The centre of operations when I was there was a community centre – one of the few brick built structures in that area – augmented by a tent where blood tests were carried out in privacy.

It was a fascinating insight into how you can deliver basic health services in poor rural areas. F`or more serious illnesses, people are referred to the local public hospital – when I say local it was 50 or 60km away, and in the rainy season reaching it on muddy roads could take the best part of a day. Plus there is a cost involved in getting to the hospital and for being treated there, a cost beyond many people.

When the medical team arrive in one of these areas it is an opportunity to educate, maybe that should read educate and entertain, people in the community about health and social issues. A group of volunteers staged a theatrical performance, with traditional music, to a large gathering of people. The play was in several parts. It touched on the problems of violence against women and HIV prevention amongst other topics.

All the while, people were queuing to see the medical staff, having blood tests, receiving medicines and having their babies weighed and checked out. Elsewhere volunteers from a local NGO with international backing, gave talks to groups on various health issues. Over the course of the day, and under a very hot sun, people came from all over the countryside to visit the mobile health centre seeking medical advice and services.

It was funded by international donors and delivered by a Ugandan health organisation, without which this vital service wouldn’t have been possible. Judging by the number of people who came to see the doctor or nurses, it was definitely filling a gap in the market. One of the particular problems with delivering health services to rural areas is the lack of health professionals, most of whom work in cities. Getting people to come to the cities isn’t practical, so taking the services to them is the only realistic option.