Finding and Fixing Health Deficiencies in the Hardest to Reach Places

Jae and Ibrahim interview locals at a trading post to find out if they are satisfied with the area's health services.

Hello everyone, webale and welcome to the Empower Through Health blog!

We’re excited to start bringing you regular updates on all of ETH’s activities, and we think you’ll agree that some exciting things have been happening. We have overcome several challenges over the last few weeks, and our perseverance is finally starting to pay off!

Our momentum towards building a public-private partnership with the Mayuge District government stalled over the past several months. The land that the government was offering was right off of the main highway, less than 5km from an existing health center, so the need in that area was not as high as we want for our center. For these reasons, the ETH Board of Directors concluded that it makes sense to go in a new direction, looking for an area with greater need and a district government that is more eager to collaborate with us.

So our thinking was, to capture the greatest need we could map out the existing health centers in Busoga region, look for gaps, then go and talk to people in these areas to find out what challenges they face when it comes to acquiring healthcare.

To quantify the need of health facilities, we mapped all of the existing government health centers in the region and found villages with significant access gaps. The red dots represent existing health facilities, and the blue dots represent our potential proposed locations for a new health facility. Top blue dot: Mpunde; Bottom blue dot: Nawaka.

Everyone we talked to told us pretty much the same story: the government health resources are woefully inadequate, and the hurdles that people in these villages face to get healthcare are extensive. In order to even reach a health center, these villagers have to borrow money from friends and family for transport to facilities that likely will be be out of the medicine they need and will then refer them to another location. At the next health facility, rinse and repeat. It is not uncommon for people to be referred to three or four different health facilities before ever receiving any treatment. This process can take time and cost money that these people simply don’t have when facing life-threatening illnesses like malaria or HIV.

Jae, Scott, and Ibrahim talk with villagers about what challenges they face in their access to healthcare, while taking maruwa (moonshine) at the local bar.

Many of these remote villages are quite difficult to reach by car or motorcycle, with the roads becoming all but impassable after any one of the frequent downpours during the rainy season. Another big issue we noticed is that people will be referred to privately run health centers when supplies are exhausted at government facilities; the problem is that treatments at these health centers tend to be unattainably expensive for the typical villager, and can cost as much as several month’s income for a subsistence farmer.

While we were in the village of Mpunde, one of the sites we were investigating, we saw that the need for health services was great. The nearest health facility is over an hour away, so transport to somewhere that far becomes either really time-consuming or prohibitively expensive. After discussing with villagers we learned that the government actually identified this village as the place with greatest need in the district, and planned to build a health center in there, but the money dried up and services were never provided. When we met with the village leadership they were very enthusiastic about working with us to begin a health center there.

The village chairman showed us a building that we could rent so that, after a few renovations, we can begin providing healthcare as soon as possible. We also met with the leaders of the local primary school, who also were eager to conduct programs collaborating to improve the education system in the village.

Ibrahim explains our plan to provide health services to the local leadership in Buyende district.

Because Mpunde is located in an incredibly remote area, in a sub-county that lacks even a single health facility, and because there is already vacant infrastructure that we can readily use to provide health services, we feel that this is the perfect location for us to begin our health center project. The existing building will allow us to begin providing the community with many of the most vital health interventions quickly, through an affordable insurance scheme that ensures even the poorest of the population will have access to care. We have signed a lease of this building, begun the repairs, and drafted a budget of necessary supplies to start operating. I can’t wait to keep you all updated with this project, and to let you know about other exciting developments from the ground here in Uganda. Thank you so much for reading and please check back soon!! -Scott Blackwell, Field Director of Operations, ETH