UGANDA’S PRIVATE HEALTHCARE SECTOR
INDUSTRY SPOTLIGHT
UGANDA’S PRIVATE HEALTHCARE SECTOR Uganda’s healthcare sector takes pride in overcoming obstacles. Now, ongoing developments and investments within the private sector encourage convergence with state healthcare to improve an underfunded yet overcrowded system Writer: Phoebe Harper | Project Manager: Krisha Canlas
T
he progress of the healthcare sector in Uganda resembles a series of peaks to climb and challenges to overcome, much like the mighty Rwenzori Mountains that skirt the country’s southwestern border. What led Winston Churchill to dub Uganda, ‘The
2 | Africa Outlook issue 89
Pearl of Africa’, namely the spectacular variety of landscapes that work wonders for tourism, is conversely at odds with the welfare of its inhabitants. By impeding accessibility to medical facilities and obstructing the distribution of healthcare provisions, for those living in rural areas, Uganda’s topography
UGANDA HEALTHCARE FEDERATION (UHF)
UGANDA’S FACTS & FIGURES Total Population (2020): 42,316,518 (Uganda Bureau of Statistics) Life Expectancy at birth (m/f) (2020): 60.7/65.2 years
INTRODUCTION
presents a natural obstacle. Medical access is frustrated by the distances many are forced to travel, particularly for those households with only the most rudimentary means of transport. Uganda has historically struggled when it comes to healthcare – indeed, throughout the 1980s and early 1990s it was reputed as one of the worst systems in the world. Overwhelming challenges persist to this day, primarily a lack of proper funding and limited access to resources. Approximately half of the country’s hospitals are government-operated, and the largest and most advanced facilities are found within the hilly urban capital of Kampala. It is estimated that just half of Uganda’s population have access to medical facilities, with approximately 70 percent of doctors practising in urban areas – home to just 20 percent of the population. Situated within the Nile basin, where the mighty river finds its source, clean water is a considerable problem in Uganda. According to Water Aid, 21 million people in Uganda live without clean water. The country has long been plagued with a range of maladies relating to a distinct lack of clean water, including typhoid and diarrhoeal diseases that can be fatal. Mass action continues to be taken to combat these threats to the population, as malaria remains one of the leading causes of death in the country. Anti-malarial medicine is generally in short supply, and according to a report released in 2020 from the Uganda Bureau of Statistics, 28.9 percent of the population were carrying malaria.
Venereal diseases, primarily AIDS – known locally as ‘slim’ due to its wasting effects – have wreaked havoc for healthcare in Uganda since the early 1980s when the disease was at its peak. The country has progressed significantly in its treatment and education surrounding the disease, and in 1998, Uganda became the first country in sub-Saharan Africa to report a decrease in the reported numbers of HIV infections. Today, the rate is down to just 6.5 percent, after having initially reached 30 percent of the population. With regards to public healthcare, Uganda was also ahead of most African countries in providing free universal access to state health facilities beginning in 2001. This resulted in an 80 percent increase in visits, with over half coming from the poorest 20 percent of the population. Within the non-state healthcare sector, many privately funded organisations are dedicated to extending and improving local healthcare services and educational initiatives within rural communities, where poor sanitation can be a serious impediment to effective healthcare. In recent years, publicprivate partnerships have been extended to improve healthcare access for vulnerable populations, although the relationship between the two sectors can be a problematic one. As an essential component of Uganda’s healthcare system, the private sector plays a critical role in the delivery of medical services with little financial support from the public sector and governmental bodies. There is a general scepticism towards the sector, resulting from the misguided conflation of ‘private’ and ‘profit’ which has historically been amplified by poor inter-sector communication. As a result, the moniker of private health facilities was changed from PNFP providers (private not-for-profit), to ‘PHP’s – private health providers. Today, over 70 percent of health services are sought from PHPs.
INTRODUCTION
Total expenditure on health as percent of GDP (2014): 7.22 (WHO’s Global Health Observatory)
Africa Outlook issue 89 | 3
ECUREI CHANGING THE NARRATIVE OF MEDICAL IMAGING, RADIOLOGY AND BIOMEDICAL TRAINING IN AFRICA. aunched in 2002, Ernest Cook Ultrasound Research and Education Institute (ECUREI) is a unique Degree awarding Institution of higher learning specializing in Medical Imaging and Bio-medical Engineering training. It is recognized and accredited by the National Council for Higher Education (NCHE) as well as the Ministry of Education and Sports under the category of “Other Degree Awarding Institutions”. ECUREI also offers patient care services in Mengo Hospital Radiology department. ECUREI is a local Institution named after Dr. Ernest Cook who came to Uganda in 1907 and installed the first X-ray machine at Mengo Hospital in 1910. Dr. Ernest Cook was a nephew of Sir Albert Cook who introduced the first western Medicine Hospital at Mengo in Uganda and East African region. The Idea of ECUREI was conceived when Professor Henry Kasozi received a WHO fellowship at Thomas Jefferson University division of Ultrasound in Philadelphia. He met with Professor Barry Goldberg who offered support in training the first Radiologist in Ultrasound and influ-enced donation of the first equipment ECUREI had. Professor Henry Kasozi one of the Pioneers of Ultrasound in Uganda referred his students Prof. Michael Grace Kawooya and Prof. Elsie Kiguli Malwadde for training in Radiology at Jefferson Ultrasound Institute (JUREI) of Thomas Jefferson University and later an idea of training Radiologists in Africa was born in Uganda.
Students practice Ultrasound on pregnant mother To avert this scarcity, ECUREI started offering the Ordinary Diploma in Ultrasound (ODU) in affiliation with Thomas Jefferson University (USA). In 2003, a higher diploma in ultrasound was introduced, a program that attracted many students from the rest of Africa. In 2005 ECUREI developed and started teaching a Diploma in Medical Radiography (DMR). Due to the cost of operation involved in the training of specialized cadres in the field of Radiology, very few institutions are interested in taking on this task. In Uganda only Makerere University and Mbarara University of Science and Technology among Government institutions has been brave enough to take on this kind of training while other private institutions are only able to offer certificates and Diplomas in Radiology. ECUREI being the only private Ugandan institution offering bachelors and masters’ degrees in this specialty is committed to continue providing the service in an effective and efficient manner that minimizes the cost of training without compromising the quality of programs offered. Due to its pragmatic leadership and management, it has grown to its current stature with its brand reaching many countries across Africa, India and even parts of Europe to attract students. These students come from countries such as Kenya, Tanzania, Rwanda, Zambia, Congo, Burundi, Botswana, Zimbabwe Ghana, Nigeria, Malawi, Zimbabwe, Namibia, India, Netherlands, United Kingdom and Kosovo.
ECUREI’s Niche and Unique position in Africa; Prof. Kawooya Grace Michael (Addressing Graduation Congregation) In the recent years, Ugandan population has significantly increased from about 30 million people in 2010 to 44.26 million in 2019 (Worldometers, 2020), countries within the East African region and Africa in general have also experienced steady population growth with Tanzania at 57.3 mil-lion and Rwanda at 12.21 million. The increased population has led to increase in the disease burden within the region and particularly in Uganda; more people with sophisticated diseases and medical conditions such as HIV Aids, Tuberculosis, Malaria, High infant and maternal mortality rates among others are being registered in the health units. As expected, more hospitals and health units have been established within the region in response to increased disease burden and pandemic outbreaks including the novel COVID 19. According to UBOS (2019), the number of For-profit, not for Profit and government health facilities has increased from 2373 to 2795, from 947 to 1009 and 3084 to 3133 respectively between 2017 and 2018. However, the proportionate increase in the health facilities is far below the proportionate increase in the disease burden and the number of trained professionals to counteract the burden. According to Prof. Kawooya Michael, the number of Health workers especially in the field of Medical Imaging and Radiology were even more alarming in comparison to other specialties.
ECUREI invests in quality research and ensures all student training and patient care services are appropriate and of high quality. ECUREI has state of the art modern Ultrasound, X-ray, Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) equipment which is all used in the training of Health workers plus high quality patient care services. The above equipment is maintained in tip top condition by an in-house Biomedical Engineers. ECUREI was the pioneer of Biomedical Engineering training in Uganda and still has a niche in the same as number one producer of hands on graduates. ECUREI is the only formal Ultrasound training institution in the country and south of sub-Saharan Africa except South Africa. ECUREI seeks to expand and extend her services nearer to her students and patients.
ECUREI Staff prepares patient for CT Scan
The Map of Africa Below shows Countries in Africa from where ECUREI’s graduates have come:
Other programs offered include: 1. Diploma in Diagnostic Ultrasound (ODU) in affiliation with JUREI 2. Diploma in Biomedical Engineering (DBE) 3. Diploma in X-ray pattern Recognition (DPR) 4. Diploma in Health Management and Administration (Dip HAM) 5. Diploma in Early Childhood Health and Education (Dip ECHD) 6. Diploma in Cold Chain Storage and Instrumentation (DCC) 7. Diploma in Medical Radiography (DMR) ECUREI offers programs at Certificate level as follows:1. Higher Certificate of Education (Biological Sciences) 2. Physics Bridging Course (PBC) 3. Point of Care Ultrasound (POCUS) ECUREI is in the best position to deliver the proposed solution of manpower deficiency in Medical imaging due to its reputable profile in radiology patient care services and training expertise. The Institute is serving as the regional Centre of Excellence (COE) for World Federation of Ultrasound in Medicine and Biology [WFUMB] and is the only center in Africa. ECUREI is accredited as training institution in radiology and biomedical engineering by the Uganda National Council of Higher Education (NCHE) in the category of “Other Degree Awarding Institutions” (ODA) and is in position to acquire charter status if it constructs its own home. Professor Michael the Deputy principal of the institute was awarded by the Honorary Membership of the European Society of Radiology (ESR) in February 2019.
ECUREI’s niche as a leader in Medical Imaging training in the whole of Africa has attracted many international students even outside Africa. The graduates are mainly from: Uganda, Kenya, Tanzania, Rwanda, D.R. Congo, Sudan, Zambia, Ghana, UK, USA, India and Holland and all are gainfully employed. The high competitiveness for ECUREI graduates also makes them more mobile than the already highly mobile other health workers and increased brain drain of medical worker. ECUREI constantly loses highly trained staff to High Income Countries which puts on pressure to produce more quality staff albeit with-standing the above constraints. The above highlights the importance of ECUREI for being the only formal Ultrasound training Institution in Uganda but whose graduates are highly competed for both within the country, the rest of Africa and even in the developed world. With time and with the realization of the growing need for other health courses, ECUREI has broadened its training goals to encompass other training fields. Currently, the institute conducts Nineteen (19) academic programs. To date, ECUREI has graduated over 1,638 students (with 61% males and 49% Females) since inception. Currently the following Programs are offered by ECUREI ECUREI offers programs at Master’s degree level as follows:1. Masters of Diagnostic Ultrasound (MDU) 2. Masters of Medical Imaging (MMI) 3. Master of Medicine –Radiology (MMed-Rad) ECUREI offers programs at Degree level as follows:1. Bachelors of Diagnostic Ultrasound (BDU) 2. Bachelors of Medical Imaging (BMI) 3. Bachelors of Physiotherapy (BPT) 4. Bachelors of Biomedical Engineering (BBE) 5. Bachelors of Science in Early Childhood Health and Development (BSc ECHD) 6. Bachelors of Science in Health Administration and Management (BSc HAM) 7. Bachelor of Health Informatics 8. Bachelor of Human Nutrition
For the last eighteen years, ECUREI has been able to attract students within Uganda and all over the world, i.e. Kenya, Zambia, Tanzania, Rwanda, and Burundi among others. In 2018, under the UHSSP, ECUREI was allocated 123 students to be trained in Medical Radiology and cold chain by the Ministry of Health. ECUREI has trained over 1,640 professionals in radiology and biomedical engineering and is affiliated with Thomas Jefferson University of Philadelphia. Alongside other teaching sites, ECUREI is strategically located within Mengo Hospital; a 400 bed capacity hospital in the capital city of Uganda. ECUREI was contracted by Mengo Hospital to operate the Radiology department, and due to our expertise and professional approach, the number of patients that choose to get radiology services [diagnosis] from the Hospital have increased annually from 14,000 in 2006 to 27,000 in 2019. Courses offered at ECUREI are not commonly offered by other Universities; i.e. the availability of Biomedical engineering department whose emphasis is to train Biomedical Engineers and technicians in manufacture, repair and maintenance of medical equipment provides sustainable interventions for medical facilities thus solving societal problems. ECUREI is moving to the next level of advancing imaging training in the region, a number of Xray, CT and MRI machines have been installed in the region causing a dare need to train manpower to manage these machines. Brain-drain to the developed countries has also derived Africa of the few trained Imaging Technologists, Sonographers, Radiographers, Radiologists, Physiotherapists and Biomedical Engineers. As an institution that serves both government and private health facilities, ECUREI is taking up the initiatives to advance training and diagnosis in Imaging in a more focused and specialized way. ECUREI’s intention to set up model training, diagnostics, therapeutical and research laboratory in Africa will not only enhance skills development in medical imaging but also reduce the manpower deficiency in the field of medical imaging to correspond to the growing population countrywide and in Africa at large.
www.ecurei.ac.ug Africa Outlook issue 89 | 5
INDUSTRY SPOTLIGHT
Interview: Uganda Healthcare Federation (UHF) Uganda Healthcare Federation (UHF) have been redefining and consolidating the country’s private healthcare sector since 2010. Through the understanding that improving Uganda’s healthcare is a collective endeavour, their unifying vision demonstrates that there really is, strength in numbers
Grace Ssali Kiwanuka
INTERVIEW
Executive Director at the Uganda Healthcare Federation (UHF)
We find that dialogue amongst all categories and stakeholders fosters creative solutions to several mutual and at times persistent challenges,” comments Grace Ssali Kiwanuka, Executive Director at the Uganda Healthcare Federation (UHF). UHF was born from a need to consolidate and unify PHPs (private health providers) and healthcare professionals across Uganda. An affiliate of the East Africa Healthcare Federation and now a key contributor to the Ministry of Health, particularly concerning public-private partnerships, the federation was established as the representative umbrella body for Uganda’s private healthcare sector in 2010. The body’s aim remains to this day, to improve quality healthcare within the private sector across Uganda, with an emphasis on affordability and accessibility. Ms. Kiwanuka found her way into the sector after working across the globe for prestigious organisations including Saatchi and Saatchi, and skincare brand Olay.
6 | Africa Outlook issue 89
“I stepped into the Uganda private health sector as the Customer Care Manager at a health insurance company charged with membership retention and growth,” she tells us. It was this invaluable experience that introduced Kiwanuka to the challenges of the “fast-paced” private sector, equipping her with the necessary skills to eventually excel at UHF. “It was interesting work trying to understand the challenges of private healthcare, struggling with the bottom line, challenges around patient needs… examining clinical shortcomings and addressing technical issues,” Kiwanuka comments. Transitioning into consulting work after a decade at leading medical service provider AAR Healthcare gave Kiwanuka the opportunity to direct her efforts where they were most needed. “I enjoyed the freedom of selecting challenging projects that required a deep understanding of the intricacies of the functioning of the private sector,” she comments. Subsequently, Kiwanuka was invited to join the board at UHF by then Director, Dr. Ian Clarke. After initially accepting a role as interim Executive Director, she has stayed there ever since. UHF now advocates for increased capacity within the sector and champions the interests of private healthcare on international forums and as a member of wider organisations, such as EAHF and sister federations in neighbouring countries including Tanzania, South Sudan, Ethiopia, Kenya and Rwanda.
UGANDA HEALTHCARE FEDERATION (UHF)
UHF OBJECTIVES • To be an all-inclusive membership association that appropriately represents all non-state health sector players in Uganda • To contribute to development of health sector and related legislation and policy • To offer ongoing valuable member services • To establish a network of health sector working relationships • To implement contracts that support and enhance the Uganda health sector
The Federation’s remit is wide and an impressive roster of organisations benefit from representation and advocacy under their patronage. “UHF has a membership of over 59 health-related associations and organisations representing different types of private health facilities, a full range of health professionals delivering private healthcare, social franchises, private medical training institutions, private pharmaceutical manufacturers, distributors and retail pharmacies. UHF membership also includes civil society partners such as organisations representing community health mobilisers and health consumer advocacy,” she explains. Kiwanuka goes on to outline the Federation’s crucial role, particularly in bridging the gap in communication between the public and private components of the sector. “UHF’s core activities focus on building private sector capacity to offer affordable, accessible and quality healthcare services; coordinating private sector groups activities around key health Africa Outlook issue 89 | 7
INDUSTRY SPOTLIGHT
UHF: AT A GLANCE Our Vision To be the representing, reference and advocacy body for the non-state health sector in Uganda.
INTERVIEW
Our Mission To bring all private (non-state) sector stakeholders under one umbrella body for the purpose of advocating policy change, promoting and championing the interests of the private health sector.
interventions; consolidating and representing private sector interest in health policy and planning; lobbying and advocating for policy change that benefit their members and facilitating public-private dialogue on key policy issues.” Today, the Ugandan Government increasingly recognises the role of the private sector in national development and poverty eradication through the implementation of various national policies, such as the National Health Policy and the National PublicPrivate Partnerships in Health (PPPH) Policy. The conflation between public and private can be an additional source of complication for the sector. “There is always an assumption that works in public facilities will simply be replicated in private facilities, yet the structures and operations are quite often very different,” she comments. Cohesion is key – fragmentation within the sector as a whole can represent a serious impediment to development and undermine collective efforts towards the general advancement of Uganda’s healthcare. The potential for increased capacity is evidenced by the progress of the private sector in recent years as it has enjoyed exponential growth and become an exciting, dynamic field to work in - as Ms. Kiwanuka confirms. “The rate of growth in the private sector is at over 400 percent in the last 15 years – this is not just a reflection of the breadth of investment going into health, but this growth also considers developments in the ICT, pharmaceutical and manufacturing subsectors that are outstripping the trends in our human resources in health growth.” As one of the hundreds of non-governmental organisations within the sector, UHF’s unique, unifying vision sets them apart.
8 | Africa Outlook issue 89
“No other body has a sole focus on bringing the private sector together. There is also no other entity with a focus on lobbying and advocating in the interests of the private sector with all activities, programmes and initiatives solely targeting building capacity in the private health sector, creating networking opportunities and exploring areas for collaboration and convergence especially with the not-for-profit sub sector,” she adds. By establishing a network united by one body, UHF overcomes geographical complications and casts its net wide. “While UHF is based in Kampala, we reach the rest of the districts across the country through our members, therefore we are able to implement activities with minimal operational cost pressures and can promise longevity beyond programme life because we use existing teams and structures,” Kiwanuka informs us. Another way in which the federation tackles the three major problems facing the sector; namely medical access, underfunding and a lack of resources, is to procure financial support. “Access to affordable financing has hampered the development and growth of Uganda’s private health sector. UHF has been engaging development partners and with support of the Ministry of Health and the Ministry of Finance, the federation is in the early stages of establishing a revolving fund to pilot availing micro-loans to private health businesses. The loans will be for equipment or facility improvements guided by a quality improvement plan. We believe that with financial support the Uganda private health sector not only improve quality but to expand the scale and scope of services available through the private sector.”
Loans will be for equipment or facility improvements
A TRUSTED BRAND When in need of regional or international medical evacuation services, you can count on AMREF Flying Doctors to provide reliable, specialized patient transfer. AMREF Flying Doctors provides fully equipped air ambulances, with experienced medical personnel on board, to ensure optimal care of patients. OVER
OVER
800
300
PATIENT TRANSFERS ANNUALLY
COVID-19 PATIENT TRANSFERS SINCE MAY 2020
FOR INQUIRIES CONTACT
+254 20 699 2000 emergency@flydoc.org
www.flydoc.org
INTERVIEW
INDUSTRY SPOTLIGHT
Overcoming the pandemic Of course, Uganda has not been spared by the omnipresent coronavirus and the pandemic has impacted the country’s healthcare services significantly. At the time of writing, Uganda has recorded 40,300 cases, resulting in 334 deaths. “The pandemic has not been as disruptive for the federation as much as it has been for our members. It has actually been a time when we have found ourselves more relevant than ever before,” explains Kiwanuka. This is when the benefits of a representative umbrella body become obvious, specifically its crucial role in safeguarding and advocating for the interests of its members. “Our members are experiencing business closures due to lack of clients, increased costs in doing business to be compliant with infection prevention and control measures coupled with drops in revenue for periods longer than they can sustain,” she tells us. UHF’s response to the pandemic has been proactive in ensuring the sector’s representation within the country’s strategic response. “As the federation we have been lobbying the Ministry of Health for inclusion of the private sector
10 | Africa Outlook issue 89
“The pandemic has not been as disruptive for the federation as much as it has been for our members. It has actually been a time when we have found ourselves more relevant than ever before” in the national response, supporting members that have expressed interest in contributing to the national response to be heard and assisted. We have also secured support from ThinkWell, IFC World Bank and AERC to build capacity to respond to the pandemic through knowledge sharing and information sessions as well as development, including a cascade of training and IEC materials tailored for the private sector,” Kiwanuka informs us. Ensuring that their members are kept as wellinformed as possible is essential. The federation’s accessible approach encompasses not just rights to healthcare, but crucially also extends to education - arguably the most effective preliminary route to preventing and managing disease.
INDUSTRY SPOTLIGHT
INTERVIEW
As such, UHF are putting to good use several technological advancements that have been developed against the backdrop of the pandemic. “We are now focused on leveraging the innovations and technology that has resulted from the pandemic pressure. We are looking to use these to improve not only safely providing quality health services, but to expand the scale and scope of services available through the private sector and the necessary efficiencies that will enable continuity of essential health services at community level in the COVID-19 context,” Kiwanuka explains.
This is evidenced primarily through UHF’s free access e-learning platform which is used to enforce corporate social responsibility practices. “We strive to equip the platform with Ministry of Health approved content. We have ensured it has modules that will appeal to both the technical and non-technical and we continually engage partners to share content with us to digitise and upload.” Kiwanuka goes on to comment how the implementation of this technology has already made significant developments in the sector, specifically with the collation of invaluable data to analyse and identify specific needs or areas of improvement within private healthcare. Strides made within the private sector have opened up crucial avenues for strategic development, specifically newfound possibilities of critical self-evaluation and analysis within the federation.
12 | Africa Outlook issue 89
“The federation has grown the team specifically to broaden our activities beyond quality of care generally to put a lens on supporting the private sector...”
“I am particularly proud of the progress made in catalysing the private health sector to take up selfassessment. At UHF, we have been championing self-assessment as a resource-efficient alternative to prescriptive support supervision that has historically been a fault-finding activity. Through self-assessment, the private health sector has been empowered to better prepare for regulatory compliance and now has a better understanding of standards and quality assurance for quality improvement in service delivery,” she explains. “UHF has coordinated over 700 facilities to selfassess voluntarily across the country and is in the process of enrolling a further 1,300 private facilities in the recently upgraded digital platform. Through the Self-regulatory Quality Improvement System (SQIS), the health sector now has a central repository of data and statistics to better understand the profile of the private health sector,” Kiwanuka concludes. This data has been put to good use in order to further the education of federation members and partners, culminating in the aforementioned e-learning tool to provide information on various aspects of service delivery including business and finance management.
e-learning tools provide information on various aspects of service delivery
UGANDA HEALTHCARE FEDERATION (UHF)
Another example of the importance that UHF places on education are their initiatives launched in partnership with private funders. “We are currently working with support for the IFC World Bank through the Global Financing Facility to train as many private health sector workers on the provision of essential health alongside the management of COVID-19. This is particularly exciting because our focus is not on empowering large urban facilities, we are targeting community level facilities where vulnerable populations ordinarily consume services,” Kiwanuka comments. The federation is two years into another ongoing project – a five-year plan dedicated to improving Maternal Child Health and Nutrition Activity in private facilities. “What is unique and inspiring about this activity is that it is enabling us to influence key touchpoints in private facilities that are often neglected in programming such as strengthening leadership and governance through health system interventions such as monthly dialogue platforms for the private sector. We are spearheading improving data reporting in over 900 private facilities into the national database, no other programme has had a lens so closely focussed on the private sector,” she informs us.
Currently, UHF continues to expand its everincreasing network, extending its all-encompassing reach across the country whilst honing in on the most prevalent issues. “The federation has grown the team specifically to broaden our activities beyond quality of care generally to put a lens on supporting the private sector in relation to malaria, TB, supply chain plus maternal, child health and nutrition services,” Kiwanuka comments. As our conversation draws to a close, Kiwanuka comments, “This is health – there is always something and we are in constant flux as priorities and policy shift.” Of course, it is a constant battle, but the sector is nothing if not robust. Uganda Healthcare Federation (UHF) P.O. Box 22947, Kampala, Uganda Plot 110 Bukoto Street, Kampala info@uhfug.com www.uhfug.com
Africa Outlook issue 89 | 13
UGANDA HEALTHCARE FEDERATION (UHF) P.O. Box 22947, Kampala, Uganda Plot 110 Bukoto Street, Kampala info@uhfug.com www.uhfug.com
PRODUCED BY AFRICA OUTLOOK MAGAZINE