Of the many beautiful tributes and eulogies last week in memory of the late Dr. Margaret Mungherera, I was especially struck by what was said by two key figures in Uganda’s ruling establishment.
Former Vice-President Specioza Wandira-Kazibwe wanted Margaret’s body in parliament. After all she was a national hero, Specioza rightly observed. Prime Minister Ruhakana Rugunda, who delivered President Yoweri Museveni’s mabugo (donation towards funeral expenses) of Sh. 10 million, announced that Parliament would hold a special session this week to honour Margaret’s contribution. These were very encouraging gestures.
However, the question is what purpose honoring Margaret in parliament serves. If it is an opportunity for the legislators to pontificate about the wonderful woman that Margaret was, and the honour she brought to Uganda through her international acclaim, the session will be a meaningless ritual that will go with the wind and fade with her memory.
If, on the other hand, the legislators seize the moment to debate and act upon Margaret’s vision, ideas, hopes, demands and recommendations, they will earn high approbation from a public and profession that are desperate for better investment in health maintenance and care.
The prime minister and the former vice president, both of them medical doctors, ought to seize the moment to galvanize parliament and the executive to do what Dr. Rugunda told the mourners at All Saints Cathedral on February 9.
“I urge the medical profession to take a leaf from her way of doing things and to see that health practitioners work under better conditions,” Dr. Rugunda said.
While the health professionals must pick up Margaret’s fallen baton and demand their rights, they have severe constraints on their ability to shape the conditions under which they work. Their welfare, especially their remuneration, work tools and staffing support, is entirely at the mercy of the executive and legislative branches of the government.
Happily, the tone that was set by Dr. Rugunda and Dr. Kazibwe, suggests that these two colleagues are willing to work with the profession to realize Margaret’s dreams. Ruhakana and Specioza know the hard work, long hours, high personal risks and the mental and physical stress that is the life of the majority of doctors. Ugandan doctors are reaching breaking point, a message that Margaret shared numerous times.
We shall count on Ruhakana and Specioza to lead the government and the country to reset the health care funding agenda. At a minimum, the Margaret Mungherera Session of Parliament should resolve to do four things.
First, in keeping with the Abuja Declaration of April 2001, to which Uganda is a signatory, the Minister of Finance should be compelled by law to allocate at least 15 percent of the annual national budget to health care. (The current health spending in Uganda is about 8 percent of the national budget.) This will require the governors of the country to make the necessary lifestyle adjustments to free funds for the public interest. There is plenty of fat that can and must be trimmed from the political and state control budgets without undermining national development. The MPs must start with their own emoluments, allowances and other entitlements.
Second, legislation to create a health care professionals salary review committee should be immediately passed. Health workers, including medical interns, must get compensation that is appropriate for their relative value to the country. The idea that a member of parliament deserves pay that is ten times that of a senior consultant doctor was one of the things that riled Margaret most. You honour her by changing these anomalies, not by giving eloquent speeches about her terrific achievement of being elected president of the World Medical Association.
Third, equitable distribution of resources, giving as much importance to the people of, say, West Nile and Kigezi as those of Kampala area, must be an entrenched national policy. Health care workers in upcountry hospitals and health centres should be given the right tools, staffing support and remuneration that ensure easy recruitment and retention of the best professionals in those areas. All citizens must enjoy access to the same publicly funded health care services. This will entail severance of the practice of sending “VIPs” abroad for treatment, while the voting masses await their own premature deaths at home.
Fourth, a bill to re-instate cost sharing should be tabled and handled with bipartisan support, free of attempts to score political points by any of the parties in parliament. This, along with a national health insurance program, is an essential element of good, affordable and sustainable health services for all citizens.
As though her inner voice was telling her that her life was coming to a close, Margaret gave a moving keynote speech at a meeting of the Kenya Medical Association that was held in Kisumu in April 2016. Using her subject, “Keeping Alive and Well: A balancing act for doctors,” she told the story of her cancer, the realities of a physician’s life, and called for a paradigm shift in the physicians’ self image and expectations. Her personal story is deeply moving and sounds a strong warning to each and every one of us.
This video recording shows Margaret valiantly looking out for her colleagues’ welfare even as she faces a critical personal illness. She ends her speech with a ringing request: “Don’t feel sorry for me.”
It was vintage Margaret, giving a powerful farewell message that must be heard and acted upon by all doctors and state policy makers. It should be heard by the assembled MPs before their speeches begin. Then they should feel sorry, not for Margaret, but for the citizens of Uganda.