For the residents of Buliisa district, the past two decades since oil and gas was discovered in the area has brought about significant economic and social transformations to their way of life.
The roads, initially constructed to facilitate oil production, have been meticulously paved, and new schools have been established.
Oil firm TotalEnergies EP Uganda and its sub-contractors, who are operating the Tilenga oil field, have embraced corporate social responsibility and have been actively implementing resettlement action plans (RAPs). As part of their efforts, they have expanded and revitalised some lower health centres in the region.
Roseline Kaahwa, a resident of Ngwedo sub-county, shared with The Albertine Journal that this newfound prosperity has resulted in an unprecedented population surge, which in turn has placed immense pressure on the local healthcare sector.
“Ever since oil was discovered in 2006, there has been a reported population surge as people flock to the area in search of opportunities in the oil and gas industry,” she adds.
Uganda Bureau of Statistics (UBOS) data reveals a significant increase in population, with evidence of them straining the district’s already limited healthcare infrastructure.
According to UBOS data, as of July 2020, Buliisa had a population of 149,300, up from 113,161 in the 2014 national population and housing census.
Approximately 78,300 (52.4 percent) were males, and around 71,000 (47.6 percent) were females. UBOS estimates that the district’s population grew at an average annual rate of 4.86 percent between 2014 and 2020, exceeding the national growth rate of 3.0 percent.
Kaahwa estimates that approximately 90,000 people in the hard-to-reach sub-counties of Kigwera, Buliisa, and some in Ngwedo continue to face challenges in accessing medical services.
Local health centres and hospitals, already grappling with resource constraints, are now struggling to meet the soaring demand for medical services.
Patients often encounter long waiting times, overcrowded wards, and shortages of essential medical supplies.
The scattered population in Buliisa, coupled with hospitals being constructed in areas where the population is not concentrated, results in people not accessing necessary health services promptly.
For instance, the nearest health centres from Avogera Health Centre 3 in Ngwedo sub-county are almost 4 to 6 kilometres away, and they lack the facilities needed to serve the communities of Kasenyi, Kirama, Kisomere, Uduk II, Kibambura, Kilyango, and Avogera villages.
Kaahwa urges the government to establish more health facilities to save residents from incurring expenses when traveling long distances to reach a few existing health centres, which are consistently congested with patients.
She emphasises the need for standby ambulances and additional medical personnel. Kaahwa, who also serves as a village health team member, highlights that the population boom has exacerbated concerns about maternal and child health in Buliisa.
Expectant mothers face difficulties accessing prenatal care, safe delivery services, and postnatal support, raising alarms over maternal mortality rates and the well-being of newborns and infants in the district.
The lack of access to antenatal care has led mothers to resort to traditional birth attendants, despite the latter being banned by the health ministry decades ago.
Health plays a crucial role in human capital and the overall development process of any country. It is vital for boosting economic growth, per capita income, and overall development by enhancing labor productivity.
Uganda’s National Development Plan (NDP) recognises health as a key dimension of human capital development and a priority development area essential for achieving middle-income status and the long-term vision of a modern and prosperous country by 2040.
Environmental health concerns have also arisen due to the activities of the oil and gas sector in the region.
Residents are worried about potential pollution, including water and air contamination, and the resulting health risks.
Addressing these environmental health issues requires increased monitoring and investment in the healthcare system.
On Tuesday, TotalEnergies EP Uganda held a function to hand over an Out-Patient Department (OPD) at Avogera Health Centre 3 in Ngwedo Sub-County.
This event was marked by discussions about the healthcare challenges facing the community, with calls for urgent action to strengthen healthcare infrastructure, recruit and retain healthcare professionals, and establish robust environmental health safeguards.
The refurbished OPD, equipped with critical medical equipment, is expected to provide healthcare services to over 2,000 households in the Avogera catchment area.
Alex Oneni, a resident of Avogera village, appeals to the government to reinforce maternity wards, OPDs, purchase more ambulances, and improve operating theaters.
The most common diseases in the area include pneumonia, cholera, diarrhea, malaria, maternal complications, HIV/AIDS, and typhoid, among others.
One of the most pressing challenges facing Buliisa’s healthcare sector is the scarcity of skilled healthcare professionals.
Many healthcare workers have been drawn to higher-paying positions in the oil and gas sector, resulting in understaffed healthcare facilities ill-equipped to meet the needs of the growing population.
Emmanuel Wamburu, the deputy Chief Administrative Officer, explains that the district’s overall staffing in the health sector stands at 62%, and efforts to recruit more staff have been hampered by salary enhancements in other government departments.
Wamburu notes that the recruitment exercise to fill vacant posts has been postponed to the next fiscal year.
As a result, patients are often referred to Hoima city, which is 93 kilometres away, due to the lack of critical staff and equipment to handle emergencies.
For instance, Avogera Health Centre 3 has 15 workers, including technical and non-technical staff, instead of the recommended 20 for a health centre three.
It lacks a clinical officer, needs more midwives, lacks a driver, a radiographer to operate the scanning machine, and the district hospital has no substantive superintendent.
Norah Bigirwa Nyendwoha, the Buliisa district Woman Member of Parliament, calls for attention to elevate lower health facilities, especially those at grade 2 and 3, to health Centre fours and general hospital status.
She emphasises the need for increased funding, drug allocations, staffing, and facilities like theaters to handle emergencies.
Bigirwa also stresses the importance of recruiting more nurses, midwives, and doctors to handle the growing number of patients as oil production, expected to bring in more people, draws closer.
Hanington Tibaijuka, the Buliisa district Communications Officer, assures that the government has taken note of the healthcare strain in Buliisa and has pledged to address these pressing issues.
Plans are in progress to improve and expand healthcare facilities, enhance staffing levels, and implement measures to safeguard the environment. The district is expanding more health facilities to enhance accessibility and improve health services.
In response to the growing population, Kigwera has been expanded to Health Centre Grade three, Biiso upgraded to health Centre four, and the district is increasing the recruitment of critical healthcare workers and providing more training.
A recent health services-primary health care report by the Ministry of Health indicates that Buliisa district still has too few health units to serve the ever-growing population.
There are 8 government-owned health centres, and 3 are private, not-for-profit health units. The district has a total of eleven functional health units, of which eight are health center twos, one is a health centre 3, and one is a health centre, a health centre four and one district general Hospital.
To make matters worse Butiaba Health Centre 3 in October 2020 got submerged by floods due to raising water levels on Lake Albert.
The health services at the aforesaid facility were relocated to Butiaba Primary school since pupils had gone home due to the COVID-19 pandemic.
The health centre used to receive 200 patients including those from the neighbouring DR Congo. The facility is going to be reconstructed after the water levels receded.
However, the sudden immigrations of people into the area also presents with it opportunities for investments in the health sector in form of provision of consultancy services, health insurance, health risk assessment, emergency services on oil production site and personnel.
As a result, investors such as City Medicals Ambulance which runs another branch in the neighbouring Hoima City has since established shop, along the paved Hoima-Biiso-Wanseko road.
Diana Atwine, the health ministry permanent secretary said two years ago that the government plans to upgrade health centres in the oil-rich region to the levels required of them to deal with an influx of people generated by the oil activities.
Atwine said health and safety constitute a key component in the oil and gas operations. Meanwhile, Kaahwa wants the government to increase budgetary allocation to the health sector by 40% to meet patients’ needs.
“What about investing more resources in a robust Primary Health Care (PHC) system?” she asked.
The World Health Organisation (WHO) reported in April, 2021 that about 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.
Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
Achieving the targets for PHC requires an additional investment of around US$ 200 to US$ 370 billion a year for a more comprehensive package of health services.
At the UN high level UHC meeting in 2019, countries committed to strengthening primary health care. WHO recommends that every country allocate or reallocate an additional 1% of Growth Domestic Product (GDP) to PHC from government and external funding sources.
According to the WHO, PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment.
A need to act
Experts say an influx of people in a certain area comes with vices such as prostitution which also leads to teenage pregnancy-early marriages and sexually transmitted diseases, among others.
They feel strategies must be recalibrated to help address this issue such as implementation of programmes for disease prevention and control in areas facing an increase in demand of health services.
Robinah Kiiza a population expert said this should include ramping up vaccination campaigns, sanitation improvement, and efforts to control the spread of infectious diseases.
Others are health Insurance and financial access which will ensure that people have access to affordable healthcare through health insurance or other financial assistance programmes. Reducing the financial burden of healthcare can encourage more people to seek medical attention.
Public-Private Partnerships where the ministry of health collaborates with private healthcare providers and organisations to expand healthcare access.
“Public-private partnerships can help leverage additional resources and expertise. Develop emergency medical services and systems to provide rapid response in critical situations like in the case of Buliisa experiencing high population growth rate comes in handy,” she said.
However, John Kusiima a sociologist says there are strategies to address and mitigate the negative impact of teenage pregnancy such as comprehensive sex education, implement comprehensive sex education programmes in schools and communities.
According to him, these programmes should provide information on safe sex, family planning, and the consequences of early pregnancy, promote gender equality and healthy relationships.
Access to Contraceptives should prioritised through ensuring that adolescents have access to affordable and confidential reproductive health services, including contraceptives.
Kusiima, hopes this can help young people make informed decisions about their reproductive health and delay childbearing until they are ready.
He also calls for a need to empower girls: promote girls’ education and empowerment. He notes that when girls have access to education, they are more likely to delay pregnancy and enter the workforce.
Records from the Bunyoro sub-region, where Buliisa is situated, reveal that in the 2021/2022 financial year, there were a total of 70,357 cases of teenage pregnancy. This accounted for 14.3% of all pregnancies during that period.
Political will has been flagged as crucial for the success of healthcare initiatives. Involvement of communities in decision-making and healthcare planning. Engaging the local population can lead to more culturally sensitive and effective healthcare programs.