#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

Health

#OutToLunch: Unless we do something, we shall soon be sent to the villages to die

By Denis Jjuuko In the years when HIV/AIDS was wreaking havoc to the country, it was not uncommon to hear that somebody who is sick has been sent from the city to their village. Whenever you heard about it, tears simply rolled down. It was a metaphor for death. Everything has been tried and there is nothing else to do. Chronical illnesses leave many families in poverty and since there was nothing else the family could do, they decided to cut expenses, one of which was the transportation of a dead body. Transporters always charged a fortune. They understood that we may abandon people when they are alive but show immense love to them when dead! And that was before funeral management became a professional service. One could have thought that we had turned a corner from those devastating years of the 1980s and 1990s. That falling sick didn’t mean death but we seem to be slipping back to those dark days. At least two recent cases provide a reminder of where we are. It all started with a senior judge detailing the difficulties she faced when her now late husband was admitted and ended up describing the national referral hospital as “a monument” to the chagrin of its administrators. Before that dust could settle down, the country woke up to a crowd fundraiser for a heart transplant for one of Kampala’s highflyers who unfortunately died before the money could be raised, raising another spotlight on Uganda’s healthcare challenges. The two cases above were public figures hence the publicity they raised. People were bitter that we have neglected our healthcare by outsourcing it to private and foreign hospitals. If you have some money, you run to a private hospital in Kampala. If you have real money, you run to Nairobi or other foreign capitals outside the continent. The majority of Ugandans have no money to run to a private health facility in Kampala or any town in Uganda for that matter. They resort to witchdoctors, fake pastors and prayer to survive. And probably we are about to start seeing families sending back the sick to their villages to die like it was in the late 1980s and 1990s. We many times get obsessed with economic growth and transformation, rolling figures off our tongues. And as the national budget is being read this week, such numbers will be making headlines once again. If we really want to put money in people’s pockets, we must think about social services such as health and education. The cost of healthcare goes beyond what we pay to buy the drugs and pay for consultation fees. There are many lost hours when one falls sick. The sick person and the caretakers are unable to work and are spending money on transport and medicine. Given who we are, others are spending money to check on the sick. It deters economic growth. There is a need to improve our healthcare services as well as promoting health seeking behaviours among the population. If people are healthy, they will be able to attend school or get involved in productive work that leads to economic transformation. Although one of the cases mentioned above involved a heart transplant and many people called for establishment of such facilities, it is probably something that we can do in the future. The doctors who can do heart transplants and such high skilled procedures exist in Uganda but if we are still dying of malaria and such other diseases, our focus should be on primary healthcare services. Lower-level health centres should have well trained personnel who are motivated to work and given the tools they need to diagnose and treat people. The majority of our people seek services at such facilities but many times when you visit, you see despair. From people suffering from simple diseases such as malaria or women getting complications while giving birth. Many times, the health workers are very frustrated. They see their patients die who shouldn’t be dying. When such patients die, we convince ourselves that it was God’s plan. It wasn’t at all. We simply failed at the basics. One of the basics we have failed at as a country is health insurance for all. We know the cost of healthcare. We also know that the benefits of health insurance for all can offset the costs of healthcare but we do nothing about it. Unless we do something about healthcare for all of us, we shall return to the days of being sent to the village to die. The highly connected may laugh at this. But I have heard of some who have been sent back from Nairobi and India to die from here. The writer is a communication and visibility consultant. djjuuko@gmail.com

June 23, 2025

Out to Lunch

#OutToLunch: Canadian visas and what Africans must do to avoid humiliating rejection

By Denis Jjuuko I recently applied for a visa to Canada to attend a Rotary conference in Calgary and thereafter visit a few of their attractions like the Niagara Falls and return to Kampala. The application was rejected on grounds that I didn’t have enough assets and therefore I might not return. I thought that the visa officer had missed something, so I appealed and I attached some more assets. I thought no sane person would have such assets, get a visa to Canada, fly for 2-3 days, reach an airport and then disappear into mountains of snow! But the Canadian visa officer sent back my application rejected with the same reason. I believe they never read anything I attached. I don’t know anyone entrepreneurial like myself who would spend nearly Shs10m on an economy class air ticket to Calgary and then decide to disappear into thin air instead of returning home. I am also too old, lazy and highly educated to directly wash cars, clean airport bathrooms and such other menial demeaning jobs the majority of people who disappear in Canada do to survive. Some of my friends urged me to appeal again. I refused. I am not desperate to fly for a few days to Calgary or anywhere in north America, western Europe or anywhere anyway. I thought I could invest the money I would have spent in Canada on starting a new business venture whose profits could pay for the next Rotary convention in Taipei in 2026 or even donate it to charity. I actually donated some of it last week. Anyway, I hadn’t realized that I had become a statistic until I read a recent story by CNN that Africans lost nearly US$70m in 2024 in denied visas. That is a lot of money. If the US$70m is the annual average, in just a decade, the continent has lost US$700m. If you think of the interest that could have earned when compounded, it is in billions of dollars. Since the release of that report, many Africans have taken to social media platforms such as X to argue that the continent should become reciprocal. Charge westerners same rates they charge us and then give flimsy reasons to deny them access after all many that travel to Africa have no real assets to talk about. The argument is popular but lacks thorough thought. African countries actually are as discriminatory only that they do so to fellow Africans. Many people from the west can fly to any airport and access a visa on arrival with zero chance of rejection. Africa’s richest man, Aliko Dangote, says in a popular TikTok video that he needs 35 visas to cover the continent while most Europeans don’t need any. Why doesn’t the African Union copy the European Union and ensure that there is no need for visas to travel anywhere in Africa by a citizen of any member state? That would spur a lot of growth when Africa becomes borderless like Europe is. Also, why do Africans go to the west? It is because we have failed to put in place facilities and create jobs that we need here. With all the coastline we have, why would anyone fly to resorts in Europe, America or the Middle East? Africans fly there because there is nothing at home to write about. We can sing about lions and gorillas but we can’t even build an airfield where planes could easily land. Ssese Islands or Buvuma can be as beautiful as Bali or Ibiza or Santorini. But the infrastructure is lacking. That is why even when the visas are nearly free for Americans and Europeans, Africa still struggles to attract tourists. You don’t want to fly into Entebbe and then drive on the Mityana-Kyenjojo section of the road to catch the elusive lions in Queen Elizabeth National Park. Hotels are too expensive and poorly done. You can spend a night in a European resort paying only EUR160 or less inclusive of an endless flow of meals, beers, champagnes and whiskeys. Here? Somebody charges US$1,000 a night for a hotel room with a floor made of uneven stone slates! Our universities still teach stuff that one can easily find online and hospitals are in a mess. Can we host international conferences like the one I had wanted to attend in Canada? Only a handful of countries in Africa can. But African countries have money for the shiniest military hardware and rigged elections. No ministers fail to get the latest Landcruiser to go launch a pit latrine built with funds from western donors. We must build the kind of countries that we love to see otherwise Canadians and other westerners will continue rejecting us without any care in the world. The writer is a communication and visibility consultant. djjuuko@gmail.com

June 23, 2025

Out to Lunch

#OutToLunch: Farmers are willing to do the hard work, government must do the same

By Denis Jjuuko Agriculture has been for long touted as the answer to the poverty that is exhibited everywhere you turn in Uganda and in most parts of Africa. A recent study by Global Right Alert even confirmed that Uganda can get UShs10 trillion (nearly US$3 billion) annually from coffee. Our much-heralded oil revenue is estimated at about US$2 billion annually. When I read snippets of the report, I was at first tempted to ask where should we put our money? I quickly remembered that developing a country can’t be one directional. Extract the oil and get that cool US$2 billion every year and work on the coffee to get that US$3 billion too. Although many people have been focusing on coffee given the recent increment in quantity of production in central Uganda and elsewhere and the resulting high prices that have turned peasants into shilling millionaires, there is a lot that still needs to be done. The majority of farmers depend on unpredictable rainfall yet we are experiencing irregular seasons and changes to the climate. It is no longer guaranteed that it will rain during the months we all knew as rainy seasons. And sometimes when the rains come, it is very little or too much. No farmer wants to experience either. We still depend on the hand hoe to till the land to the extent that it is one of the most distributed items by candidates seeking support in the upcoming general elections. Although many farmers have small plots of land on which they grow food and cash crops, a hand hoe is 19th century stuff. Luckily, the Chinese have been kind enough to invent petrol powered ones that can help a farmer till the land faster and easily. The traditional hand hoe is a back breaking tool. One of the reasons many young people would rather sell the land, buy a boda boda, which they turn into a bed for daytime napping due to lack of passengers than spending the day in the garden. Inputs are expensive and fake. There is a need for the Uganda National Bureau of Standards to do their job to ensure only genuine fertilizers, pesticides and other inputs are on the market. It shouldn’t be very difficult to find who makes or import fake inputs. We can’t always blame everything on the impunity of some individuals with high political and military connections. If such people found a serious officer desirous of doing their job, they would back down. A certain government entity that owns a printery always refuses to print campaign posters of highly connected individuals on credit. The individuals usually curse the managers and promise to teach them a lesson but return with cash and pay. If they had found weak managers, they would abuse the system. A public officer who fails to reprimand the so-called Gamba Nogu (people with military and political connections) is just weak and wants to use the system to enrich themselves illegally in many cases. The other problem for Ugandan farmers is transportation. Some are able to grow significant amounts of produce but transport is a very big cost to bring the goods from the farmer to the market where the prices are not laughable. Agricultural produce can be rotting in a garden less than 100km to the market where there is a high demand. It was thus refreshing to read in newspapers last week that there is a project, at least for the northern region, that is working to change this narrative. With support from the Germans, the Ministry of Local Government is implementing the Rural Development and Food Security in Northern Uganda (RUDSEC) project. This newspaper reported that more than 1,300km of roads connecting farmers to markets will be rehabilitated and upgraded in Acholi, Lango and Teso regions. I regularly travel across the country and including these regions. Sometimes you find farmers with vegetables being sold at giveaway prices. One of the challenges they face is transport. The rundown Sahara or Isuzu can’t manage the roads many times. Yet we should know that an improved transport and market infrastructure would allow year-on-year accessibility. The cost of inputs would reduce because it wouldn’t take one so much to buy them. Ideally that should lead to increased inputs. Many farmers are willing to do the hard work to increase production. Entrepreneurs will set up the processing plants for value addition. The government should do its part too. Pay road contractors on time, make genuine inputs affordable, provide technical expertise and access to the market. Poverty would be history for many people. The writer is a communication and visibility consultant. djjuuko@gmail.com

June 23, 2025