Private Clinics in Uganda Struggle Under Mounting Patient Debts and Operational Costs

Private Clinics in Uganda Struggle Under Mounting Patient Debts and Operational Costs

By Tonny Abet 

Kampala – A Ugandan doctor has spotlighted the harsh realities of running a private health facility, revealing how unpaid patient bills, combined with taxes and rent, forced the closure of his clinic after years of unrecovered debts.

In a widely shared post on X, Dr. Sserunjogi Emma recounted a patient’s promise during treatment: “Doctor work on me, don’t worry about money, just save my life, payment is going to come.”

Three years and seven months later, the patient’s life was saved, but no payment arrived.

"It's been 3yrs and 7 months. Life was saved, no money came. URA came for its tax, landlord rent was paid out of pocket and patient is now driving," he added. 

His experience is far from isolated. Dr. Robert Kalyesubula, a specialist and former clinic owner, shared a similar story in response, confirming he had to shut down his Kyanja Clinic when patients owed nearly 67 million shillings. 

“By the time I closed the Kyanja Clinic, my patients owed us about 67 M. The clinic collapsed and the patients sought care elsewhere,” Dr. Kalyesubula wrote. He now works with larger hospitals that handle billing, taxes, and collections, allowing him to focus on care and take a cut of the remainder.

The posts have sparked widespread discussion among Ugandan medical professionals, many of whom described identical challenges: patients seeking emergency treatment on credit, then vanishing or blocking contact once stable.

 According to the doctors, without widespread health insurance or strict payment systems, private facilities often absorb these losses while still facing fixed costs like rent, supplies, staff salaries, and regulatory demands.

tonnyabet@gmail.com

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Managing Measles: Understanding, Treating, and Preventing the Viral Threat

Managing Measles: Understanding, Treating, and Preventing the Viral Threat

By Tonny Abet 

tonnyabet@gmail.com

Measles, a highly contagious viral infection, manifests with a characteristic widespread skin rash and fever. This vaccine-preventable illness, caused by the measles virus, remains a significant cause of childhood mortality globally. The virus spreads through airborne droplets expelled during coughing or sneezing and through direct contact with an infected individual.

Dr. Michael Baganizi, head of the Ministry of Health's immunisation programme, has highlighted the persistent challenge measles poses in Uganda. Recent outbreaks have been severe enough to necessitate the reopening of the measles ward at Mulago Hospital, a stark indicator of the disease's resurgence.

"The measles ward at Mulago [Hospital] is full. Those wards had been closed but now they have reopened and they are full," Dr. Baganizi stated, underscoring the gravity of the situation. He further commented on the link between vaccination gaps and outbreaks: "That is what happens when vaccination breaks down. We hope that with this intervention it will be curtailed."

Data from the Ministry of Health reveals a concerning trend: the number of districts reporting measles outbreaks surged from approximately 20 in 2023 to 40 by the end of 2024.

Medical experts explain that measles typically begins with a high fever accompanied by symptoms such as a runny nose, a distinctive barking cough, and conjunctivitis, commonly known as "red/pink eye," which can lead to blindness if untreated. Patients may also experience vomiting and diarrhoea before the appearance of the generalised skin rash.

The Ministry of Health's 2023 clinical guidelines provide clear instructions for managing measles cases, advocating for the isolation of patients "at home or health centre" to prevent further transmission. Symptomatic treatment focuses on managing the fever with painkillers and addressing eye problems with prescribed ointments, always under the guidance of a qualified healthcare professional.

Crucially, the Ministry emphasises the need to increase fluid and nutritional intake for measles patients due to the high risk of malnutrition and dehydration, which can be life-threatening.

Under the care of healthcare workers, patients may also receive vitamin A supplementation and prompt treatment for any secondary bacterial infections with appropriate antibiotics. The guidelines stress that individuals isolated at home or in lower-level health facilities should be referred to a hospital immediately if any complications arise.

Prevention remains the most effective strategy against measles. Key preventive measures include widespread measles vaccination, avoiding contact between infected and uninfected individuals, and dispelling harmful local myths. One such myth, the belief that measles patients should avoid meat and fish, is actively being countered through public education.

Dr. Jane Ruth Aceng, the Minister of Health, has affirmed the Ministry's commitment to increasing vaccination uptake to curb outbreaks.

“I appeal to all the districts to support the efforts –Measles- Rubella (MR) vaccinations which will also be part of the integrated child health days. We need to put an end to this measles outbreak before it spreads to avoid reopening the measles wards because this will be another added burden and yet we have preventive tools with us,” the Minister urged.

Dr. Aceng attributed the current outbreaks to low vaccination coverage and appealed to the public to rely on scientific evidence rather than misinformation.

“I also want to appeal to all of us to embrace vaccination and stop listening to anti-vaxxers (those who are opposed to vaccinations) because focusing on the WhatsApp scientists and anti-vaxxers is what has brought us today. If we had focused on vaccination and reached out to the zero-dose children, we would not be having a measles outbreak,” she stressed.

In response to the escalating outbreaks, Dr. Baganizi highlighted a proactive measure: the "Big Catchup" vaccination campaign aimed at reaching children who have missed their scheduled vaccinations.

"We had over 1.5 million children we had targeted to give the second dose of measles vaccine. The 45 affected districts include Kampala. And if we don’t vaccinate enough children, this outbreaks will continue because they keep finding unvaccinated children or weak immunity as the virus keeps rotating around," he explained.

Dr. Baganizi emphasized the critical importance of vaccination in halting the spread of the disease: “This vaccination was meant to put that to a halt. If this doesn’t happen more and more districts will continue experiencing outbreaks. Unfortunately, measles kills. It is not a simple disease.”

Concerning statistics from the Ministry of Health indicate a worrying trend of increasing numbers of "zero-dose" children – those who have not received essential vaccines against preventable diseases. An assessment report by researchers from the Gavi Zero Dose Learning Hub in Uganda revealed that this number nearly doubled in just two years, rising from 55,000 in 2021 to 96,000 in 2023. This growing pool of unvaccinated children creates a fertile ground for measles outbreaks to thrive, underscoring the urgent need for increased vaccination efforts and public health education.

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Keywords: measles, vaccination, immunization, treatment, disease, prevention, uganda 

New nutrition initiative targets 26,000 vulnerable children in Uganda

By Tonny Abet 

tonnyabet@gmail.com 

In a determined effort to tackle Uganda's persistent challenges with child malnutrition and stunting, the Ministry of Health, in collaboration with UNICEF, has launched an innovative program targeting the nutritional needs of the youngest citizens. The initiative aims to reach 25,950 children across the country with a vital dietary supplement: free egg powder. This nutrient-rich powder, equivalent to the nutritional value of one fresh egg per day, is designed to significantly enhance the diets of young children.

Laura Ahumuza Turinawe, a senior nutritionist at the Ministry of Health, underscored the program's approach: “The egg powder will be mixed with locally available foods like beans and matooke, adding animal-source protein to make diets more diverse and nutritious.” This strategy ensures the supplement is integrated into existing eating habits, maximizing its impact.

The program will be implemented in four distinct phases, initially focusing on the Tooro sub-region districts of Kamwenge, Kyegegwa, Kyenjojo, and Kasese. This region, despite its reputation for abundant food production, grapples with stunting rates hovering around 40 percent, making it a critical area for intervention.

Detailing the initial rollout, Ahumuza explained, “For the next six months, we will distribute egg powder free of charge in Kamwenge through Village Health Teams, providing weekly supplies to households.” This community-based distribution system leverages trusted local networks to ensure the supplement reaches the intended beneficiaries. The announcement was made on May 5 during a media engagement addressing the national nutrition landscape.

While UNICEF has provided crucial initial funding for the procurement of the egg powder, the long-term sustainability of the program hinges on community involvement. Recognizing potential affordability challenges once the free distribution phase concludes, Ahumuza highlighted a key strategy: encouraging families "to rear chickens and sell eggs to local producers, fostering a self-sustaining cycle." This approach aims to empower communities to maintain improved nutritional practices independently.

Samalie Namukose, the Assistant Commissioner for the Nutrition Division, emphasized the program's broader cultural objective: “We want families to see eggs as a staple for children. One egg a day can significantly improve a child’s growth.” By normalizing egg consumption from an early age, the initiative seeks to create lasting positive dietary habits.

The selection of the Tooro sub-region as the program's starting point is strategic. As Namukose explained, “We chose Tooro to investigate the underlying causes of malnutrition in a region with abundant food. This program will help us identify and address these factors.” Understanding the paradox of high malnutrition in a food-rich area is crucial for developing effective and tailored interventions.

This new initiative represents a significant stride in Uganda's ongoing efforts to reduce malnutrition and stunting among its children. The lessons learned during the implementation in the Tooro sub-region will be invaluable in shaping future scale-up efforts across the nation.

On a broader scale, Namukose provided an encouraging overview of the national nutrition situation, stating, “Nationally, Namukose said, there has been some improvement in the nutrition situation in Uganda, even in Karamoja. First of all, stunting has reduced from 29% to 26% among the children under five, and for those who are underweight, we have managed to reduce from 14% to 10%,” She further affirmed the government's commitment to continued progress, "noting that they are increasing efforts to reduce these further.” The new egg powder initiative is a key component of this intensified effort.

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Keywords: Nutrition, Uganda, Malnutrition, Egg, Powder

A-z of watermelon growing by Abet

 

By  Abet Tonny

Tony's A to Z of growing watermelon (reviewed on April 10, 2023)

I am a melon farmer based in Uganda, East Africa. I am going to share with you my lived experience of growing watermelon, in 5 minutes!

Watermelon is one of the sweetest fruits in the same family as pumpkins and cucumber. They are very vigorous growing plants that mature from 65 days to 90 days depending on the variety. In Uganda, the fruits from hybrid seeds range from 7 to 14 kgs.

Guinness World Records says the world's heaviest watermelon was grown by Lloyd Bright of Arkadelphia, Arkansas, in 2005. It weighed 268.8 lbs. (122 kg), according to Jessie Szalay

Every time people come to me showing interest to grow watermelon, they are all thinking about finding a suitable swampy area to launch the life-changing production. But I tell you, reader, just because watermelon has great water content does not mean it grows in water the plant does not grow in water-logged areas. For watermelon originated from South Africa's Kalahari desert.

Well, the soil requirement for watermelon is simply sandy loam with good drainage. Swamps and water-logged areas do not favor melon growth.

Watermelon does well even under rain-fed farming. If you receive heavy downpours at least once a week, you can be sure to get some good harvest, too! However, during the fruiting season, the water requirement for the plant goes up. Having irrigation pumps will greatly help in this situation in case of areas with very scanty rainfall. The Solar water irrigation pumps are cheaply available with SolarNow (Check out). Though a little risky, in normal rainy seasons, relying on rainfall will still work for watermelon production.

Let us talk about Varieties.
There are several varieties of watermelon in Uganda produced by different seed companies but as a farmer, I recommend Sukari F1 from East African Seeds, the best with a higher yield per acre and relatively better disease resistance!
Sukari F1 can yield as high as 30 tons of melon per acre. Others are Jubaili seeds, and Jaz F1, among others. They can be found in most agro-input shops across the country at varying sizes and prices -from around Shs50,000 for seeds in small tins to over Shs300,000 for seeds in big tins. 

Before I forget, you should always go for hybrid seeds, they are a little expensive to buy but will generate a great smile on your face during harvest as the yields are 5 to 10 times higher.

And now, the real process of production

Land clearing
In case you have trees in the garden, cut them down. Watermelons need direct sunlight for some good hours daily, meaning they will not grow well under shade. Last year, I lost a lot of money for refusing to cut down trees in the garden, you can avoid my mistake. The next thing is to clear the bushes.

Plowing
Successful land clearing will ease this step, the purpose here is to loosen up the soil for better drainage. This can be done using tractors, ox-plow, or even the usual hand hoes.

Making raised beds
The raised beds keep heat which watermelon craves to grow well. It also eases the protection of vines as you spray, and easy harvesting. For those using irrigation, it is good to make the raised beds flat atop. The beds should be 1.5 to 2 meters wide leaving a pathway.
The spacing between rows should be 2m and between plants should be 1m

Planting
You can add DAP fertilizer in the hole 15cm (about the length of a mathematical set ruler) deep and 15cm wide then cover with soil before planting. Place 1 or 2 seeds on the surface of each hole at different points, then push them with your finger at 1.5 cm depth. Then cover with a little soil. If you sow the seedlings very deep, they might not germinate.

Management
Farming is just like any other job or business. Absenting yourself for more than 2 weeks may amount to a big loss. Watermelon requires a lot of care, it is susceptible to several pests and disease attacks. You always need to monitor your garden at least once a week. Even the workers you employ can get jealous, they understand the value of what they are working in (they know watermelon brings a lot of money), and perhaps your payment to them per month or labor session is very low or unsatisfying as it happens in any natural world. With your serial absenteeism, these casual workers on the farm can or may harm your plants with high doses of pesticides or fertilizers that may burn the plants (investment). They can even plot to steal the fruits so your periodic visits and presence in the farm can break a number of those bad intentions.

In management, be sure to do the following; mulching, watering, weeding, spraying, insecticide application, fertilizer application, and placement of traps for fruit flies.



Harvest and Marketing
Watermelons normally start flowering at 6 weeks and by the 10th week, you can start harvesting your fruits. Harvest only mature fruits, you can tell if it's mature if it changes color at the bottom by becoming creamy white and if it produces a bam sound when hit in the sides. Harvest the fruit with its stalk to extend its shelf life. There are always ready markets for watermelon especially for Kenya market suppliers for Ugandan farmers. There are also great local markets for the melon in urban areas, however, be keen not to sell on credit. Selling from the farm is the most convenient but you get more money when you reach your urban markets.

 In an acre, over 4000 fruits can be produced. The farm prices in Uganda for watermelon (good size) swing around 3,000/= and this translates to (4000X3000) = 12,000,000. Twelve million Uganda shillings can be got from an acre of well-managed watermelon garden.


The writer is an experienced farmer, writer, and representative of YPARD

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Uganda's Nalubale Dawa Covid vaccine research underway -Museveni

Museveni takes a Covid jab

By Tonny Abet

President Museveni has said Ugandan scientists are developing Nalubale Dawa (ND) Covid-19 vaccine as a local innovation to increase fight against the pandemic.

"The vaccines are getting more available globally, however, we are working hard on our own vaccine which we shall call Nalubale Dawa. I thought about (using the name) Kiira Dawa but because the car people had taken the Kiira (name), I think we should leave Kiira to them and maintain Nalubale (Dawa)," he said.

He said this today night during his address to the nation on Covid-19 and security.

The President had earlier last year said Ugandan scientists would get the Covid-19 cure or vaccine earlier than developed countries.

Since the outbreak last year, the coronavirus has infected about twelve hundred thousand people and killed over 3000 people in the country.

In his address, the President said Uganda is banking on Covid-19 vaccination to fully reopen schools and economy in January next year. He said the government will reopen the economy whether people are vaccinated or not.

Over 6 million out of 15.5 million doses of the vaccines acquired by government through donations and direct procurement have been administered.

 The government is racing to vaccinate at least 21.9 million Ugandans to contain the pandemic.