#OutToLunch The easiest way to regulate medical bills in private hospitals

By Denis Jjuuko

The High Court in Kampala issued orders to force government to regulate medical bills for COVID-19 patients. The worst place to be for an average Ugandan today is to be in need of an Intensive Care Unit (ICU) bed so you could see another day. It is understandable that the high court came to the side of the people in need of ICU and High Dependency Unit (HDU) beds but it is the wrong thing.

Uganda subscribes to the liberal economy theory where everyone charges what they want. Demand and supply determine how much people charge. In early June when many people were dying and as Ugandans looked for anything that could help them survive COVID-19, lemons, and I mean lemons, went from Shs100 in some markets in Kampala to Shs2000 each!

If you need a taxi in rush hours, they triple the transport fare from A to B. Each fuel station in Kampala from the same brand has a different price per a litre of petrol. In Bakuli near Mengo, a litre of petrol is cheaper by about Shs500 than in Ntinda or Bukoto.

Schools charge as exorbitant fees as medical facilities. A kid in a nursery school who is trained how to use a potty, which it already knows pays more than those at some universities. The reason is because parents are very excited when their offspring are still young. As they grow, the excitement wanes but also there are more options. Some people go to universities while others abandon school and go do other things since they are adults.

The point is that in Uganda everyone charges whatever they want whether it is medical or not. And this didn’t start with COVID-19. Pediatricians to examine a child for flue charge as much as Shs100,000 in consultancy fees!

How is the government going to regulate these fees? Cancer patients long before COVID-19 have been paying enormous bills yet the government spends USD150 million a year on average taking its officials abroad for treatment. This is enough money to set up hospitals here.

I was looking at the Kampala COVID-19 ICU/HDU Dashboard set up by the Association of Anesthesiologists of Uganda that give real time update of the availability of ICU/HDU. A hospital in one of the suburbs set up originally in a home less than 10 years ago has 17 ICU beds — the most in any private facility. How did they get them? This hospital is run by a couple who are as old as the NRM has been in power. How did they set up the facility where the government has failed?

The easiest way for the government to regulate medical bills and even school fees is by building more hospitals and schools. Most people in government today who make decisions were either born in public hospitals or at home by traditional birth attendants. The majority if not all went to public schools. Today, nobody with some little income wants to take their kids to public schools. People rather take on unbearable debt borrowing school fees to give their kids a fighting chance later in life than sending them to a school where they won’t learn much.

Uganda’s population has significantly grown over the last 30 years from 18 million to 45 million today but the public facilities such as schools and health facilities haven’t. If we had working public schools and hospitals, we won’t be running to court to regulate anything. The super wealthy would take their kids to the few expensive private schools while the majority would be fine with public schools. The same with hospitals.

The best way to regulate medical bills in private hospitals is by having effective public hospitals in adequate numbers to match the population. The private hospitals will then charge what is acceptable to stay in business. They would also improve their service to attract the super wealthy customers. The same would be for schools.

Today, we have 529 members of parliament. The argument for the proliferation of political constituencies is to serve the population. Why don’t we flip the chart and ensure that before a constituency is set up, there is a proper well managed hospital and public schools to serve the increasing population? Do people want more MPs or more hospitals and schools? The money spent on a single MP every five-year term is enough to set up a hospital and a school in that area. If we invested in such for 10 years and then bring in MPs, the MPs wouldn’t have to buy 25-year-old Toyata Supercustom vans and paint them with a cross and the word ambulance.

The writer is a communication and visibility consultant. djjuuko@gmail.com

Tags: COVID19 Treatment in Uganda, Denis Jjuuko, Mulago hospital, Out to Lunch, Private hospitals in Uganda

Out to Lunch

#OutToLunch: Make cylinders of 1kg, 2kg if gas is to replace charcoal

By Denis Jjuuko On a trip to northern Uganda some years ago, I asked the transport team to provide a sports utility vehicle (SUV). I prefer SUVs for long journeys as they are more comfortable and can handle the terrain. We were to spend a week traversing the breadth of northern Uganda. It didn’t take long to realize that some of the people I was traveling with were unhappy but I couldn’t put a finger to it. I thought maybe they didn’t want to make the trip. Along the way, the driver pointed to a roadside makeshift market and said in Luganda, “laba emaali,” loosely translated as look at money while pointing at sacks of charcoal that were packed beyond the rims with a fibre net holding the extra black pieces together. That is when my colleagues said that I have made them miss returning to Kampala with charcoal. That I should have asked the transport team to provide a pickup truck. “We are not ministers to travel in this kind of car,” another angrily quipped. I was ably informed that a sack of charcoal cost a fraction of what the traders in Kampala charged. I understood their sentiments. I offered lunch and dinner for the weeklong trip, arguing that they can use that saving to buy charcoal when they returned to Kampala. I ceased being a fan of buying stuff along our highways to return with to Kampala after realizing that prices quoted by traders or vendors depended entirely on the car you drive and how you look but that is another story. Also, I have never been a fan of charcoal. I find it expensive, easily wastable by households, dirty and cumbersome to use. After that trip, I understood the place charcoal occupies in people’s hearts and households. It wasn’t, therefore, surprising when panic engulfed Ugandans especially the urban dwellers when there was an announcement that charcoal had been banned in Uganda ostensibly to protect the environment. Social media went gaga. Parliament swiftly stepped in and advised the government to give it a week by presenting its comprehensive plan. Charcoal is a byproduct of trees and many have been felled to make it. Truckloads of it used to dominate certain routes to urban areas. Many roadside kiosk owners survived by vending charcoal. We have just experienced a severe drought in Uganda and I believe that many people won’t have food to eat in a few months. I perfectly understand why government wants to ban it. As somebody who isn’t a fan of it, I have no tears to shed to be honest. But that would be selfish. The majority of households can’t afford the alternatives — electricity and gas or even briquettes. Beyond price, both forms of energy also have distribution limitations in Uganda. Liquefied petroleum gas in Uganda is largely sold in cylinders of 6kgs and 12kgs. If you don’t have a cylinder, the startup cost is approximately Shs170,000 for 6kgs and Shs266,000 for a 12kg. The median monthly income in Uganda is Shs200,000! What makes charcoal the preferred choice by at least many urban households is because with Shs1,000, one can get a palmful of it which they can use to cook something. Many of our people don’t earn a predictable regular income. They wake up, go to work (if they find it) and are paid per a day or work done. Once they get that money, they can buy some charcoal of Shs1,000 and some maize flour or a few fingers of Matooke and prepare the day’s meal. They can’t afford to spend more than their monthly income on the gas equipment. There was a time government distributed some gas cylinders freely. I believe that at Shs60,000 for a 6kg and Shs112,000 for a 12kg for a refill respectively, the majority of our people can’t afford it. Gas cylinders even if distributed for free will most likely end up as decorative materials. What then can be done? Government must or support the private sector to make gas cylinders of 1kg or 2kg which means that the majority of households can afford to refill at Shs10,000 for a 1kg or Shs20,000 for a 2kg or even lower. That is why manufacturers of consumer goods like sugar or cooking oil don’t sell only 25kgs or 5 litres respectively. They sell in small quantities that the majority can afford. Our people buy sugar by spoonful, diapers by a piece, eat beans but ask the restaurant to add in meat soup (because they can’t afford meat). They can only afford gas by a kilo or a half not 6 or 12kgs. The writer is a communications and visibility consultant. djjuuko@gmail.com

November 3, 2026

Out to Lunch

#OutToLunch: Medical apprenticeship programs critical in improving diagnosis and treatment

By Denis Jjuuko You probably know somebody who after trying many healthcare facilities, they were told there was nothing wrong with them and they should go back home. The symptoms persisted though and the more facilities they visited, the more they were told the same. Sometimes they were given painkillers to psychologically manage them. Desperate, they visited a traditional healer whose Thursday clinic deep in the village is thronged by many people who share similar experiences. The healer is basking in glory. He saved so and so; his marketing team disguising themselves as waiting clients assure them. After a few months of some relief, the pain comes back and this time more excruciating. But since they tried everything and failed, they give up and wait to die. And indeed, they die. At their funeral, we claim that it was God’s plan! Well, if you don’t know anyone who has gone through that, at least you heard of King Oyo’s story. The now deceased Tooro Kingdom leader visited some high-end hospitals in Kampala after feeling persistent backpain. X-rays, MRI scans later, they told him they saw nothing. Being a person of means, he flew to a hospital in Nairobi where he was diagnosed with cancer. A year later he was dead. What did the people in Nairobi saw that the Kampala ones couldn’t? Well, Nairobi has a PET Scan or a few. Kampala and the whole of Uganda don’t. A PET Scan costs about US$3m or approximately 17 Landcruisers. If there was a meeting of government officials, you would run out of space to park them. That is how many we have in Uganda but a PET Scan is not something we have been able to buy and install yet. But it isn’t just the lack of technology that is a problem. You can have a PET Scan and still fail to diagnose a patient properly. Patients aren’t sent for a PET Scan on their first visit to a clinic as it is rarely used as a diagnostic test rather one that determines an extent of the disease. Other tests have to be done. And still a diagnosis can be missed depending on who has done the scan or X-ray and the reading of the results. If for example a child has a bone tumor, a pediatric radiologist would probably pick up the first signs that an adult radiologist may easily miss. Even then, the doctors who ordered the tests and other specialists can sit as a group and discuss what they are seeing. They may even disagree. After that, they could order for a biopsy and eventually a PET Scan if it is needed. You see, that means that you need to have a team of specialists with not only adequate training but also experience that exposed them to a diverse spectrum of patient diseases and how to diagnose them. If you only train in Uganda and practice in Uganda for a year or two, it is most likely you won’t be able to diagnose many diseases even with advanced technologies at your disposal. Doctors in Europe struggle to diagnose and even treat malaria, which is many times chicken feed to Ugandan doctors. When did your doctor last consult anyone before prescribing drugs? Most likely he or she listened to you, sent you to the lab, looked at the results and sent you to the pharmacy or told you to go back home. Isn’t that likely to lead to a wrong diagnosis? I am not saying that a team needs to look at each and every case but you get the drift. To have good doctors in Uganda, there is a need for a robust apprenticeship program so that the graduate doctors can learn from as many experts as possible. When we spend years discussing intern doctors’ wages, it means we are delaying their learning. They aren’t getting the right exposure from the seniors. And if they aren’t properly apprenticed, they will not become good doctors. There is no two ways about it. We also need to have a critical number of health workers sent elsewhere for exposure. They should learn how medicine is practiced elsewhere while getting exposed to different diseases and treatment methods. Government should be talking for example to American hospitals for medical residency. We could send some to Aga Khan in Nairobi as well. Those who are sent by government, they should be contracted and incentivized to come back to work here. The right technology and generally good working conditions should be in place. Upon return, they should train others through apprenticeships. They should spend a certain number of hours a week for a few years in public hospitals with the list of young doctors they have mentored as part of their deliverables. Ensure that those trained doctors remain in hospital wards too. This is actually cheaper than sending politically connected patients abroad for treatment because Uganda can only send so many. The writer is a communication and visibility consultant. djjuuko@gmail.com

October 26, 2026

Out to Lunch

#OutToLunch: Uber’s abrupt exit calls for regulation of international brands to protect users

By Denis Jjuuko Ten years ago, Kampala was all the rage. Uber, the global taxi hailing app launched in Kampala with fanfare. The razzmatazz that comes with a global brand that promises to change the world. All our transport problems, at least in Kampala, would be sorted. It was cool to order a Uber or arrive at a fancy party in one. If you hadn’t installed the app, you were being left behind. There was no need to buy a car. Uber would sort that at the fraction of the cost. If you had a car, it was so cool to use it as a Uber on your way to or from work. And if you didn’t like your boss, you could quit your job and become your own boss as a Uber driver. It wouldn’t get any fancy than that. Some people cashed out their savings, bought a few corollas, got their cousins who had previously graduated from university and made them Uber drivers. Side hustle had never been so simple. Special hire drivers cried. Calls placed to their previous customers went unanswered. The suitor had a new lover. You were exploitative. Uber transported someone to wherever they wanted at the cost of a chapati! Some young people decided to create Uber for all sorts of things. Looking for somebody to wash your clothes over the weekend, a “uber” was created for that. Need a truck to transport something? There was a “uber” for it. Need a boda? Well, another “uber” was created before Uber itself introduced bodas. Innovation hubs were full of ideas with young people dressed in hoodies spending all their time trying to create the next Uber. To be fair, it wasn’t just in Uganda. Every new innovation has somebody trying to replicate it for another industry. With apps like Uber and AirBnB and their early global success, other platforms for gig work or sharing were created everywhere. UpWork, Fiverr, DoorDash… the list is endless. We were told the sharing economy was the new thing. That we didn’t need to own stuff. We could easily share. The problem though with international brands like Uber is that they can wake up and make a decision that affects many people. Like they did when they announced that they will no longer be available in Uganda. And within a few minutes, they were gone. They didn’t even have the courtesy to inform the drivers signed up on their app for at least a week. I believe some were even still processing the news and maybe even parked at malls waiting for clients only to realize that the application had gone mute. I believe those who hadn’t checked their communications platforms restarted their phones several times. Developing economies like Uganda shouldn’t just allow these brands to come in, do and go as they wish. They can’t just be making abrupt decisions from Silicon Valley. Why couldn’t Uber give time before exiting the country? They could have given a 90-day notice so that their drivers and customers have enough time to prepare. To operate here, the government should force them to follow some rules and regulations. Usually when they start offering service in smaller economies like ours, there is something they want which isn’t direct revenue. It is global presence that enables them to have an explosive initial public offering on the New York Stock Exchange or attract some funding. Once they achieve those goals, their mission is over and can do whatever they want especially where there is no regulation. In markets where they are regulated, they can’t just wake up and announce that they have closed. Also, the actions of brands like Uber mean that there is a need to identify our challenges and find applicable solutions. For many years, I wonder whether Uber drivers made any money. The rates were so low prompting many of them to try to negotiate out of the app. What had made Uber appealing to drivers was the near guarantee of a return trip. Unlike a special hire (cab), the driver would be able to find a customer after dropping off somebody. That increasingly became difficult yet the rates remained low. When fuel prices went up, Uber didn’t respond appropriately. Apparently, increments had to follow some policy created based on the American or western European economy. Bad roads and traffic jams were never factored in. Ugandans largely drive old cars which means that they consume a lot of fuel and susceptible to breakdowns. If the roads are potholed, maintenance and repair become costly. An unregulated global brand wouldn’t care much about that while setting rates especially when they don’t own the asset that guarantees their return (25% of each trip in the case of Uber). Regulation of global brands is critical in protecting the interests of users. The writer is a communication and visibility consultant. djjuuko@gmail.com

October 26, 2026