Our Side of the Story - Ugandan health workers speak up - VSO

Our Side of the Story: Ugandan health workers speak up
Health workers cared passionately about the consequences
for poor patients: “Few can afford even 2,000 shillings [US$1],
so day after day they walk here and wait. Walk 15, 20km
despite the pain.” They felt the pain too when patients
became more unwell while waiting for their families to raise
money to purchase medication.
Hospital doctors spoke of how they were forced to refer
admitted patients who could not afford to buy medicines, or
just keep them in a bed without medication. The quality of
care also suffered when the patient could afford only cheaper,
inferior drugs which then failed to improve their condition,
resulting in referral, an option many patients could not afford.
The impact on community relations
“It puts a lot of strain on community relations.” Health workers
said it was hard to make patients and other community
members understand why drugs were not always available.
They acknowledged that people sick and in pain had little
appetite for words of explanation, and that the complexities
of the supply system were beyond the understanding of some
people without education. But they also told of angry, bitter
patients who cursed them and refused to listen.
In the past, Ugandan healthcare users maintained a belief
that government health facilities lacked medicines even when
receipts increased. According to health worker participants,
there now appears to be a prevailing belief that health facilities
are well supplied with medicines: “People say why don’t you give
us drugs” A particular problem arose when a health facility
changed ownership from not-for-profit to government and the
previously superior supply of medicines could not be maintained.
Health workers said that communities served by government
facilities assumed health workers took the drugs: “Patients think
you steal” and “patients call us thieves.” They said that patients
believed that health workers took government supplies to stock
their own clinics and drug shops, to which patients were then
sent to buy medicines. It was acknowledged that such abuses
had occurred. Indeed, good supplies in one hospital were
attributed to the fact that few of its nurses ran private clinics
and drug shops. Health workers regretted the lack of trust put
in them and the effect on community attitudes: “When drugs
are not there, they tend to hate nurses.” In contrast, it had
been observed that patients’ attitudes towards health workers
improved when given supplies of drugs to last several days. It
was especially upsetting to be directly accused of theft when
a patient demanded a drug that the clinician knew was not
appropriate for their condition.
“What kinds of drugs can we steal
Paracetamol Because that’s the
only drug in the hospital!”
There was widespread indignation at accusations of stealing
non-existent medications: “What are they supposed to be
stealing” or “What kinds of drugs can we steal Paracetamol
Because that’s the only drug in the hospital!” and “How can
they take things that are not there!” Health workers felt that
local leaders and politicians made matters worse when they
failed to present the true picture to complaining patients, and
even accused health workers in front of the patients: “It is
making us lose morale for what we are supposed to do.”
Health workers resented negative stories in the print media,
TV and radio, believing that journalists blew up single incidents
unfairly to give an exaggerated picture of the extent to which
frontline health workers were guilty of pilfering drugs.
A stakeholder concurred: “We can’t brand all health workers
as thieves just because someone has stolen a tin of aspirin.”
Stakeholders noted that press stories about health workers
stealing drugs had increased with the work of the Medicines and
Health Supplies Delivery Monitoring Unit, an autonomous unit
set up in October 2009 within the President’s Office. While there
was support for its efforts to expose poor working conditions as
well as abuses, the view was expressed that it was unhelpful to
create a media story around every case of wrongdoing the unit
uncovered: “They tried to create publicity instead of dealing
with the real issue of what is causing the stock-outs.”
There was also hurt and indignation when top public figures
spoiled the professions’ reputations by stating publicly that
health workers are thieves: “How can any patient value a
doctor, value a nurse, when they say such things about us!”
It was felt that government conspired to make out that all
health workers were thieves although, in the opinion of
health workers, top managers and not frontline workers were
the chief culprits. Public accusations by the President were
especially damaging to health workers’ self-esteem.
“Patients get angry because the politicians tell them drugs
are provided.” Views were expressed that politicians
deliberately mislead the public: “Government makes them
believe they have sent drugs” and “The public is being
hoodwinked!” But for a public servant it would be “suicide”
to contradict political masters.
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