Uganda’s community health system
Uganda’s healthcare system works on a referral basis; if a level II facility cannot handle a case, it refers it to a unit the next level up. Services in public facilities are supposed to be free, but in many cases health workers extort money from patients desperate for services. Often units don’t have the essential drugs, meaning the patients have to buy them from pharmacies or other drug sellers.
The structure of Uganda’s health system, and how it relates to Katine, is detailed below:
Village health teams/community medicine distributors
The first contact for someone living in a rural area such as Katine would be a community medicine distributor or a member of a village health team (VHT). Each village is supposed to have these volunteers but in many cases they are either non-existent or they do not have basic drugs for diseases such as malaria. In Katine, the African Medical and Research Foundation (Amref) project has re-energised the VHT structure through training and giving members bicycles. They still have no medicine, but they can advise patients and refer them to health centres.
Health centre II
According to the Ugandan government’s health policy, every parish is supposed to have one of these centres. A health centre II facility, serving a few thousand people, should be able to treat common diseases like malaria. It is supposed to be led by an enrolled nurse, working with a midwife, two nursing assistants and a health assistant. It runs an out-patient clinic, treating common diseases and offering antenatal care. Of the six parishes in Katine only Ojom parish has a health centre II, which has only recently had a laboratory built for it by the Katine project.
Health centre III
A health centre III facility should be found in every sub-county in Uganda. These centres should have about 18 staff, led by a senior clinical officer, who run a general outpatient clinic and a maternity ward. It should also have a functioning laboratory. Katine sub-county does not, however, have a health centre III because it hosts a larger facility as described below.
Health centre IV
This level of health facility serves a county or a parliamentary constituency. Tiriri health centre IV, located just outside Tiriri trading centre in Katine, is the main facility for seven sub-counties, which make up Soroti county. A health centre IV is a mini hospital. It should have the kind of services found at health centre III, but it should have wards for men, women, and children and should be able to admit patients. It should have a senior medical officer and another doctor as well as a theatre for carrying out emergency operations. Although Tiriri health centre has 34 beds, and sees up to 100 out-patients a day, it has no doctor. It is run by two clinical officers. It has a theatre that does not work because of lack of water, power and other smaller installations.
Ideally, each district is supposed to have a hospital, which should have all the services offered at a health centre IV, plus specialised clinics – such as those for mental health and dentistry – and consultant physicians. Soroti’s district hospital, in Soroti town, is also a regional referral hospital. It caters for the Teso and Karamoja regions, meaning it gets cases referred from other district hospitals.
At the top of the healthcare chain is the national referral hospital, located at Mulago in the capital Kampala. This is where some of the best medical brains can be found, often working part-time at private clinics to supplement their meagre government salaries.
We supported 1000 children in Omugo and Odupi subcounties in health centre 1V and III with micro nutrients and deaworming tablests
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