Lubowa Hospital a ‘Black Elephant’ in making – Dr. Obuku

By Richard Kintu

Last month parliament touched off a public uproar by approving the issuance of US$379.7m (Shs1.4 trillion) in promissory notes to an investor to construct an international specialized hospital at Lubowa. The move has continued to divide opinion, with many technocrats supporting the move while others have strong objections. Last week Mulago Hospital Executive Director Dr. Byarugaba Baterana, asked Ugandans to support the Lubowa hospital project; saying it is highly needed in the country to treat non-communicable disease that are on the rise in the country and are expected to be at an alarming rate by 2020. Baterana believes the hospital is also needed to offer competition to Mulago Hospital. His comments came shortly after Keith Muhakanizi, the secretary to the treasury downplayed the project’s financial implications on the country.

Muhakanizi argued that the project represents value for money since the hospital will be managed for eight years and then reverted back to government by the International Specialised Hospital of Uganda Limited which is owned FINASI International Group.

However, medical practitioners from the Uganda medical association believe the Lubowa Hospital project is another white elephant in the making. In an interview with the second opinion, Dr Ekwaro Obuku, the president of Uganda Medical Association (UMA) says he believes there is something sinister in the project than meets the eye. His thoughts are captured in the excerpts of the following interview:

SO: The proponents of the hospital say THAT on top of enhancing Uganda’s medical sector specialized needs, it will promote medical tourism by being a regional medical hub. Isn’t that enough to change your opposition stance?

OE: Our point is that as a country we don’t have the luxury to spend all this money on one hospital yet we have made upgrades on Mulago National Referral Hospital. Mulago is going to provide each and every service that is being planned for Lubowa. Mulago was modified structurally, functionally and strategically to meet the needs of a modern hospital. The idea was that if we are to make Mulago super specialized let’s build four small hospitals: Naguru was built, the Women’s specialized hospital was built, Kirudu and Kawempe were built so already Mulago is decongested.

Secondly, Ugandan doctors have been training in specialized care from India, Canada and they are ready to work in Mulago. The equipment has already been bought; the cancer, heart and infectious diseases institutes were expanded. What is left is the super specialized center which is empty in terms of not being open but the machines are there, just a few things that are needed. Actually, what is left to finish the work is about US$6m only, including US$1.5M that went to heart institute to open a casualty ward. So, all these services they are talking about in Lubowa can be sorted in Mulago by Ugandan doctors.

SO: There is also talk that Lubowa hospital will enable Uganda get the international certification needed to boost our medical sector/tourism….

OE: The accreditation you’re talking about is the Joint Commission International (JCI). I can assure that I have visited hospitals in India that are ranked highly in the world but Mulago is now much better than them in terms of physical structure and others. That means we don’t mean to pump money in Lubowa before functionalizing Mulago. Secondly, the project is too costly. The current budget of the Ministry of Health is Shs2 trillion; so why spend it on a single hospital?

SO: But the secretary to the treasury assured Ugandans that Uganda is financially cushioned given that this money will be recouped after the 8 years….

OE: Even if it is a spread across 8 years we shall eventually pay the loan. But the question is; is it worth it really when we have district hospitals that are still lacking water, electricity and health workers?

SO: So you’re convinced that Mulago can be a regional hub already?

OE: Absolutely! That’s why we don’t see why they are blocking its completion which is on the finishing line.  Someone must be sabotaging Mulago to ensure the project is slowed until Lubowa is passed. You should know that the talk of Lubowa started years ago in 2014 yet Mulago’s opening has been delayed by a year now despite the presence of all the required human capital equipment and space.

SO: How many people are we talking about here that have trained?

OE: The first batch was 100, of which 42 have come back. And these are Field Marshals; not just mere generals in what they are doing and who got direct government training. There are others who trained indirectly as individuals, which makes the number even more.

SO: Were these doctors trained for the upgraded Mulago?

OE: Yes, the 42 are for Mulago.

SO: The other argument is that having the Lubowa Hospital will save the country a lot of money that is spent on flying people abroad for treatment…

OE: It’s not good to assume that human behavior will change overnight. Let us not build a hospital because we think all of a sudden Ugandans will stop flying abroad. Remember there are those that still fly out because they feel headache, some are still going for delivery. Does all that need super specialized care? What will change human behavior is improving trust in public hospitals so that Ugandans can be attended to in hospitals. Trust can be improved if there is right equipment and the human resource and supplies. Right now there’s the right equipment, the human resource is not exactly right because many are still lacking and then the supplies run out. We need a mechanism to bridge the running out supplies. People must begin to pay over the table; not below the table. If you want blood why can’t we make that payment over the table other than the black market? If that money is collected in the open you will see the buffer stock of drugs. Also, people paying for drugs will demand for accountability but right now anybody in charge of a health facility will just say that drugs are over and there’s nothing the public will say. For now Lubowa is a want and Mulago is a need. Mulago is a 900-plus bed while Lubowa is just 300 beds but with a higher cost. And you cannot talk about saving forex when you’re giving money to a foreigner: it’s a contradiction. Why not give the project to a Ugandan investor? How can one say they are saving money and they give a foreigner US$300 million? Secondly, is that land even worth US$5m? Unless it’s from planet Mars! They (foreigners) are just going to take that money to their own country and that is capital flight.

SO: What then do you believe could be the motive behind the rush with Lubowa?

OE: I’m not sure what is going on but I do not think it is set to achieve the objectives which are being portrayed. If we are to analyze Lubowa In light of Uganda Airlines, I think someone is looking for money for other things. The nature of having huge projects which are not necessarily and immediately beneficial , requiring a lot of tax payers money, passed in a manner that suggests that due diligence hasn’t been done to the dot means there’s something more than meets the eye; it’s very suspicious.

SO: But there has been a persistent concern of misdiagnosis by Ugandan doctors; don’t you think a hospital of Lubowa’s stature can help mitigate this problem?

OE: Is this hospital going to treat all Ugandans? For instance is a Ugandan in Loro village where I come from ever come to Lubowa? Then, is one hospital of 264 beds going to treat 40 million Ugandans because there’s poor diagnosis? The truth is that for every 100 people you see, one you will get the diagnosis wrong because of various reasons. Sometimes you don’t have the test you need to do the diagnosis and even if you have the test you need, some diseases are too complicated. Even in Britain there are medical errors. Haven’t you heard of someone who was circumcised when actually they should have removed his kidney because of wrong papers? Or when they remove the right kidney instead of the left? So one case should not make us decide against the other 99 which are successful.

SO: So, in short you conclude that this hospital could be another white elephant project?

OE: It’s not just a white elephant; this one is a black one because a white elephant can be made and it’s empty. A black elephant on the other hand is empty and they have even stolen the money.

SO: What do you suggest should be done in this dilemma, as head of the Uganda Medical Association?

OE: My honest view as a researcher in public policy is that the best accountability agents are the people themselves and the best way to improve interest by the people is by providing for direct payments. Even if it’s Shs500, you will always demand for a service you have paid for. There is absolutely no need for Lubowa Hospital; let’s just open Mulago and assess our capacity and wait. Let us strengthen the regional referral hospitals by sending there our specialists and our doctors, midwives and nurses. Let us strengthen the district hospitals and then take Mulago to accreditation of JCI.

SO: But you are advocating for a payment mechanism well aware that most Ugandans are poor…

OE: Although Ugandans are said to be poor, they are already paying: either they pay a private pharmacy without necessarily consultation fees, or they pay the traditional healer who always asks for chicken, goats. That’s a form of payment. The other form of payment they do is when they reach the hospital and have to bribe from the gateman, nurse to the doctor. The other form payment they do is by reaching the hospital and they are told that there are no drugs. This extortion of money from the patient in any way is what we refer to as the cost of health care despite the presence of free health care. The facilities don’t actually provide the free health care like they say because you end up paying for everything anyway.