Health Officials: Abuse of Referral System Hampering Service Delivery

Officials at the Ministry of Health are asking Ugandans seeking medical care to respect the referral systems, failure of which they say is causing drug shortages and unnecessary congestion.

The Permanent Secretary in the Ministry of Health, Dr Diana Atwine said on Monday that the issue of patients crowding facilities like Mulago national referral hospital with minor illnesses is causing paralysis in service delivery.

“This has demotivated some of our specialists who decide to leave the country because they have not focused on the specialities they trained in,” Dr Atwine said during the monthly breakfast meeting with the press on Monday.

“We are misusing the skills of the specialists in whom we have invested a lot of money to train,” she said.

In the medical practice, a referral can refer both to the act of one health facility or medical practitioner sending you to another facility or practitioner in order to be effectively treated. It can also reference to the actual paper authorizing this.

Patients who skip the hierarchy of the referral system have brought about imbalances in drug distribution since higher referral facilities run out of drugs while the lower facilities are over stocked.

Dr Atwine revealed that government is making plans to fully equip the regional referral hospitals to increase their capacity to handle medical cases for which patients refer themselves to Mulago.

She added that in Kampala alone, the Ministry of Health is in the process of upgrading some of the health facilities to general hospital status in order to decongest Mulago.

On his part, the Director General of Health Services at the Ministry of Health, De Henry Mwebesa said: “We have health centre 3s, 4s, general, regional and national referral hospitals. Each of those has a designated service delivery which it can provide”.

“If you have flu, cough or malaria, you can be handled at the Health Centre 3. There is no point for you to move to a general hospital when you just have malaria or diarrhea that could have been treated at a health centre 3,” he added.

Dr Jackson Amone who is the Commissioner for Clinical Services explained that the referral system also involves referring patients from public to private health facilities. He cautioned the public against visiting private health facilities for checkups when they have not been properly referred.

He partly attributed the abuse of the referral system to the lack of information on the part of the general public regarding the capacity of Uganda to handle different complex medical issues.

“People still don’t know that we have centres of excellence here. They go to Nairobi for fertility related cases yet we have the best facility in Entebbe that works effectively,” he said.

He acknowledged that issues to do with inadequate funding, the lack of equipment and infrastructure, inadequate staffing levels and inefficiencies in transport partly account for patients continuing to refer themselves.