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Exploring Options for Teso Health Needs, by Fr Silver Opio
Background
Since 4th June 2016 (significantly a day after the celebration of the Uganda Martyrs), the Iteso in the Diaspora and within Uganda initiated an appeal, The Teso Health Appeal as a response to what could be described as the “Teso Health Tragedy”. The Iteso as a people are experiencing the dire effects of a health system that suffers, not just regionally, but nationally. This has been aggravated by the economic hardship among the Iteso people that makes access to quality health services obviously impossible.
Health is just one aspect for ensuring that a given population is of quality: the other is Education. With these two, it is assumed that economic opportunity is relatively assured in order to provide for the other basic needs such as adequate food, safe water, good shelter and personal care.
Action so far
For the subsequent 8 weeks, a lot of interest has been generated, committees set up, funds (in cash and pledges) generated, options for health response prioritized, and all these with varying differences of opinion. There have even been suggestions that the wider issues affecting the Iteso be addressed this very first time. Yet a consensus seems to have coalesced around two focus channels to deliver on health: a mobile clinic and a state-of-the-art hospital. These have been logically justified: while the former addresses the issue straight away, the latter is a good project for 5-10 year realization.
What I Propose
Each of the two proposals above present their own advantages and disadvantages; strengths and weaknesses; threats and opportunities. The debate has at times been so passionate and emotional that the spirit and the enthusiasm initially generated seems to have fizzled out – with several participants opting out of the forum initially created for the cause.
My proposal is towards the establishment of a Universal Teso Health Insurance Scheme. The task would be to mobilize the more than 2 million Iteso to contribute UGX 10,000 (ten thousand) every year, and be able to access free medical care everywhere any time.
My argument is that while we can establish a state-of-the-art hospital, operations and management can become a nightmare – and would be forced to either charge highly and exclusively to sustain its status, or simply become one other white elephant. (I have my reservations about donor subsidies as in the case of Lacor Hospital). Similarly, running a mobile clinic can turn out such an operational challenge given the terrain and demand across the region (which includes Pallisa).
With 20 billion, the subscribers can access existing quality services both within Teso, Uganda and East Africa. This also means that the existing Health service providers are kept in their business as long as the quality of their service meets the minimum standards (I have the impression that these experts are not going to be excited about supporting THA, or the establishment of a state-of-the-art hospital which will certainly get them out of business – even if they are Iteso themselves!). With assured clientele and scheme, private investors will set up quality health facilities (including mobile) all over the Teso region. Service Providers would have to be prequalified, and vetted/supervised at regular intervals. Feedback would be continuously aggregated from the users of given facilities. They cannot on the other hand charge beyond market rates as this is subject to “unionized” pressure and action from the contributors to the scheme. With time, perhaps the scheme can finance the establishment of one state-of-the-art REFERRAL hospital for the region. Alternatively, a UGX 10 billion reserve in fixed deposits will generate more than UGX 1 billion annually just on interest.
I have observed that the Iteso have already initiated a sort of “Funeral Insurance” scheme which exists in every village as the “Akio Groups”. These groups have operated so well with very rudimentary governance and administrative systems and structures – built on mutual trust – and the members faithfully subscribe (‘buy premiums’) even if they have not had a funeral in the last five or ten years. My assumption is that each and every Etesot/Atesot will afford UGX 10,000 every year: those who are better off, or with support from well wishers, can pay for tens or hundreds besides themselves (just as the pledges have been coming towards THA).
Challenges with this Proposal
1. Provision of credible leadership
2. Dealing with the scepticism within the Teso community
3. Unclear legal, policy and institutional framework within the national context
4. Fear of political blackmail from government and politicians
Conclusion
The challenges posed here in fact cut across the whole appeal, irrespective of the option adopted. But together, we can explore how we can unlock our potential and make a difference – for once.
Fr Silver Opio
Soroti, Uganda