Why We Need a University of Health Sciences

Why we need a University of Health Sciences
some statistics
At this period in human history, when so many people live “satisfied” and fulfilling lives, the majority of the world's population is living well below acceptable standards. HIV/AIDS has already claimed more lives in SSA than anywhere else in the world, and malaria reports 300 million cases per year (90% in SSA). Of the 1 million people who die from malaria each year, the majority are poor.

Every day, more than 30,000 children around the world die of preventable diseases, and nearly 14,000 are infected with HIV/AIDS. A girl born in a developed country may have a 50% chance of seeing the 22nd century, while a newborn in many “developing” countries has a 1 in 4 chance of dying before the age of 5.

Of the three MDGs directly related to health: reduce child mortality; improve maternal health; combat HIV/AIDS, malaria, and other diseases, 85 countries with more than 60% of the world's people, are not on track to achieve a significant reduction in child mortality – and immunizations in SSA have fallen below the 50% mark. While the targets for HIV/AIDS and maternal mortality cannot be monitored easily with current international data, it remains a fact that every year more than 500,000 women die as a result of pregnancy and/or childbirth – most of them in the “developing” world where the poor cannot afford medical care or medical care is too far away from them.

The average age of Uganda's 28 million population is 15.3 – the global average age is 28. If Uganda's population projections do reach 30 million by the end of 2007 and a staggering 93 million by 2050, then the current health training institutions will not be able to cope with the increased demands of a currently health-starved population. With 1.3 million babies being born in the course of 2007 alone, the current quality and quantity of health care workforce is woefully inadequate.


Indicator 2004
Physicians 2,209
Physicians (per 1 000 population) 0.08

Nurses 16,221
Nurses (per 1 000 population) 0.61

Midwives 3,104
Midwives (per 1 000 population) 0.12

Dentists 363
Dentists (per 1 000 population) 0.01

Pharmacists 688
Pharmacists (per 1 000 population) 0.03

Lab technicians 1,702
Lab technicians (per 1 000 population) 0.06

Source World Health Organization – Report 2006

In developing countries, the gap between the rich and the poor is increasing at a very fast pace which means that the privileged can generally afford health care, while the minority continues to die from preventable and easily-curable diseases. All this has a toll on economic performance with knock-on effects on every aspect of life, quite apart from the fact that more than half the population cannot generate income and are, therefore, dependent on others.

human resources for health
It is because of these appalling health statistics that policy and planning experts are convinced that human resources for health and related functions must be recognized as the most crucial factor for good health-care delivery. The education and training of HRH, with the express aim of addressing the health needs of the population, is now a matter of extreme urgency.

In policy terms, through the Uganda Health Policy (1999), which aims to reduce mortality, morbidity, and fertility by ensuring access to a minimum health care package (UNMHC Package), the Health Sector Strategic Plans I & II (2000 & 2005), government is committed to ensuring that all Ugandans have access to health care, although there are simply not enough healthcare workers to go around. It is estimated that up to 54% of trained humanpower is currently working in the larger hospitals or healthcare facilities in the city and in towns and a significant number of trained medical personnel are lured to greener pastures outside Uganda in search of better salaries. This leaves the rural areas seriously deprived of a well-trained and adequate healthcare workforce. The Ministry of Health's attempts to re-orient services to Primary Health Care have thus far been difficult. Clinicians who practise as medical doctors in rural areas often enrol for a postgraduate qualification after a a few years of practice and the specializations often chosen are not necessarily those needed on a large scale to implement HSSP II.

In the light of the limited resources available to government, health analysts are convinced that the key to providing adequate health care to the population of Uganda is to establish partnerships between the private and the public sectors. According to recent statistics, while Uganda's PNFP institutions train around 40% of the total health workforce in the country and provide services for a significant percentage of the population, they receive little support given the basket funding policy adopted by many donor countries. The Government of Uganda acknowledges the contribution of the private sector, and through the policy objective of making the private sector a major partner in the health sector countrywide, the National Health Programme stands a better chance of achieving its goals.

That is why I believe that Uganda needs another health-training institution. I will be giving you more information about the university itself next week.

The People Behind the Scenes

BEHIND THE SCENES AT THE PROPOSED INTERNATIONAL UNIVERSITY OF HEALTH SCIENCES

Although there have been positive moves in recent years towards tackling large-scale epidemics such as HIV/AIDS, and despite the significant involvement of NGOs and other donor organizations in the health sector, the healthcare workers crisis is not going away. This is a long-term issue, and it has become increasingly obvious within the health sector that solutions to this problems require a more ‘joined-up’ approach, which will both harness expertise across relevant sectors and work in harmony with government policy makers.

But it is not only the government and NGOs who have been involved in building capacity for healthcare and tackling the crisis in human resources for health in Africa. Some private individuals working independently, have made a significant contribution. Two such people: Dr Ian Clarke and Professor Deirdre Carabine have each been working in Uganda for fifteen years and more, and have pioneered projects in the fields of healthcare and tertiary education. In 2006 they came together to combine their expertise with a plan to establish a university of health sciences. Their combined vision is to develop a centre of excellence in training for the Ugandan healthcare professionals of tomorrow.

Dr Clarke first came to Uganda with his family in 1988 under the auspices of the ‘Church Mission Society’, an Anglican mission. This was in the immediate aftermath of the bush war in the ‘Luweero Triangle’(1981–1986). The area was known at that time as ‘the killing fields of Africa’ and many of the dead had been left unburied, leaving skulls and bones in heaps by the sides of the road. What began as a makeshift clinic under a tree grew over a period of five years into a hospital. By the time he left Luweero and CMS, Dr Clarke had established a fully-fledged Hospital: Kiwoko Hospital, which has continued to grow and now has over 200 beds, a nursing school, a laboratory technician’s training school, a large community health programme, and a community-based training centre for doctors and medical students.

Dr Clarke then moved to Kampala as a private individual where he set up International Medical Centre, a small private clinic. While his target group in Luweero had been the rural poor, in Kampala he focused mainly on the developing urban middle-income group. His rationale was that Uganda had suffered from a breakdown of its health services because of many years of dictatorship and civil war. As a result there was little on offer in terms of sophisticated medical facilities. When he had come to Uganda a decade earlier, few people had a sufficient income, but during the late eighties and early nineties he witnessed the development of an urban middle-income group. If such people were able to pay for their healthcare, Dr Clarke could then use the income to improve services available across the board. Just three years later he was able to establish a small thirty-bed hospital, following which he set up a health management organization called IAA Healthcare. The income from IAA enabled him to open a purpose-built, one hundred-bed hospital in 2005.

The hospital now not only operates on the basis of providing healthcare for patients of IAA and fee-paying patients, it also operates a charity (public) wing: Hope Ward (www.hopeward.org) which is funded through partnerships with local companies and other sponsors. With a mission to provide complex medical care for those who could not otherwise pay, this ward has focused on the treatment of such conditions as acid burns, cancer, victims of road traffic accidents, care for sufferers of HIV/AIDs, complex gynecological surgery (vesico-vaginal fistula repair), and victims of the war in northern Uganda who require reconstructive surgeries.

Dr Clarke is now CEO of International Medical Group (IMG) which as an umbrella organization for the hospital, IAA Healthcare, a nursing school, and a health management institute which mainly teaches short courses in areas related to healthcare. IMG also has a building division, specializing in the building and equipping of hospitals and clinics. The group now employs over 500 people in the hospital and its eight satellites clinics, including a clinic in Juba, South Sudan. IMG uses its structure and capacity to carry out community projects in the fields of Voluntary Counselling and Testing (VCT) for HIV, anti-retroviral treatment and community health. Through the work of Kiwoko Hospital and IMG, Dr Clarke has been at the forefront of raising standards of healthcare within Uganda for almost 20 years.

Professor Deirdre Carabine is no stranger to the establishment of educational institutions and has been a pioneer in university building for the past thirteen years. She first came to Uganda in March 1993 when she was recruited to assist in the establishment of Uganda Martyrs University. Along with her pioneer colleagues, Prof. Carabine took responsibility for the rehabilitation of what was a seriously run-down former teacher training college in Nkozi on the Ugandan equator. This hard work finally paid off when 80 new students arrived to attend lectures in October 1993. However, it wasn't all sunny days and blue skies: having lost all her worldly possessions and lecture notes in a Kenyan container heist, she had to start completely from scratch - but the University grew from her paper, pen, and infectious enthusiasm for learning. These efforts finally paid dividends as the first group of students began to pass through the University with a solid commitment to self-improvement and a veracious desire to learn.

As a committed educationalist, Prof. Carabine worked hand-in-hand with the then Vice-Chancellor Professor Michel Lejeune to ensure that their students had the same rigorous training as students anywhere else in the world. The benefits of insisting on quality and professionalism in the field of education have paid off. From humble beginnings, the university on the equator has now gained a solid national and international reputation. By the time Prof. Carabine left Nkozi in 2006, the University boasted seven faculties and a growing research profile. Prof. Carabine was instrumental in starting an Institute that offers various diploma, BA, MA, and PhD programmes attracting students not only from East Africa, but also from the US, the UK, and Europe. It is her hope that International University of Health Sciences will attain the same reputation in record time.

Dr Clarke and Prof Carabine may have worked in different sectors, but they have shared a passion for ensuring the delivery of quality essential services to Ugandans. In 2006 Prof. Carabine and Dr. Clarke realized that in partnership, they could utilise their combined experience, along with the facilities and medical expertise of IMG staff, to make a difference to the problems facing healthcare education within Uganda. This partnership bore fruit when in February this year IMG was awarded a ‘letter of interim authority’ by the Uganda National Council for Higher Education. This letter gave IMG the permission to plan for and set up a fully-fledged university. Thus, the proposed International University of Health Sciences (IUHS) was conceived.

The proposed university will hopefully open its doors to its first cohort of students in January 2008 and will initially operate from International Hospital Kampala. This newly-constructed building is excellently suited to housing a first-class tertiary education facility: the site has sufficient space for the university's lecture rooms, meeting rooms, seminar rooms, a resource center (library and computer facilities), staff and student common rooms, and staff offices. The facilities of the hospital will also be used for clinical courses (laboratories, theatres), ensuring that the expertise of IMG staff as well as that of visiting doctors/surgeons to its public wing, is used to enhance the standards of the educational provision. The current School of Nursing and the Institute of Health Management operated by IHK will together form the core pioneer faculties of the university and the university will grow to include a School of Health Policy and Planning, a School of Medicine, a School of Paramedical Studies, an Institute of Tropical Medicine, an Institute of Alternative Medicine, and a School of Postgraduate Studies and Research.

The future is an exciting one for this new university and its establishment will benefit many. The Ugandan education sector will benefit, as the healthcare professionals of tomorrow will have the opportunity to study within a new centre of excellence. The hospital and its patients will also benefit as International Hospital Kampala becomes a centre for medical research and training, attracting both talent and funding. Not only this, the Ugandan government will benefit as it becomes better placed to reach the UN Millennium Goals related to health through this increase in national medical expertise. Finally, the whole of Uganda will benefit as the number of qualified healthcare professionals entrusted with the future healthcare of the country increases to meet the need.

IUHS: Making a difference to health care in Uganda

The University Project is Launched!

International Medical Group (check our website on www.img.co.ug), which operates International Hospital Kampala and International Air Ambulance, has been granted a “Letter of Interim Authority” by the Uganda National Council for Higher Education for the proposed International University of Health Sciences. The “Letter of Interim Authority” allows the proposed university to put in place all the structures necessary for a quality university to run optimally prior to applying for a Provisional Licence from the NCHE.

The guiding principle of the institution: “Making a difference to health care in Uganda”, reflects the commitment to professionalism, quality, and service already embedded in the operating practices of International Hospital Kampala and International Air Ambulance.

Given the acute shortage of healthcare workers in the country – and given the population expansion projected for the next 10 years – this private initiative, which was inspired by the Ministry of Health's recent policy on Human Resources for Health, will boost the number of well-trained healthcare professionals so that Uganda will be better placed to meet the Millennium Development Goals related to health, the Health Sector Strategic Plan II, and the Uganda Minimum Health Care Package requirements.

IMG has recruited Professor Dr Deirdre Carabine (formerly Deputy Vice-Chancellor and Director of the School of Postgraduate Studies at Uganda Martyrs University) to set up the International University of Health Sciences. Her experience, and the long experience of Dr Ian Clarke and his colleagues at International Hospital Kampala, will ensure that IUHS will grow to provide the human resources capable of making a real difference to the way health care is provided in Uganda today.

The university project was officially launched by Honourable Dr Stephen Mallinga, Minister of Health and Ms Aine Hearns, Head of Mission, Embassy of Ireland Kampala on Friday 4 May at International Hospital Kampala in the presence of many VIPs and medical personnel from around the country.

Next up: look for a profile of Ian and Dee.