Butabika Hospital has asked Parliament to increase its budget for meals to Shs4.7 billion  up from Shs2.4 billion that has been allocated.

The call was made on Tuesday by Juliet Nakku, the executive director Butabika Hospital while appearing before Parliament’s Health Committee.



Nakku told the committee that 313,000 patients are fed annually at an average cost of Shs6,187 which includes breakfast, lunch and supper.

However, she noted that the ideal cost of feeding each patient should be Shs15,000 for three meals daily, urging Parliament to consider increasing the meals budget.

“The current inpatient numbers are averaging 1200 daily in admission as against the bed capacity of 550. these patients get 3 meals per day which means that we have to improvise within the available budget,” Nakku said.

“There is need to increase this budget since food is part of the treatment and hospital takes full charge of patient feeding,” she added.

On the other hand, the hospital is seeking Shs2.5bn to complete the construction of a 2.5Km perimeter wall fence.

Nakku told the committee that the wall fence is still half done, and as a result, many patients use the undone section to escape from the hospital.

She warned that patients escaping from the facility, may not only pose a danger to the community around, but also endanger their lives.

“This is a big danger to them and the community. We also end up spending a lot of money on fuel to pick them from the roads as they escape,” she said.

 

 

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Seated: Commissioner NCDs MoH-Dr. Oyoo Charles Akiya (2nd R), Executive Director of Butabika National Referral Mental Hospital-Dr. Juliet Nakku (2nd L) and Assistant Commissioner NCDs MoH-Dr. Hafsa Lukwata with researchers and officials from MoH and the World Bank at the Inception Meeting on 13th April 2023 at the Ministry of Health (MoH), Kampala.
 
 

As mental health gains recognition as a critical aspect of overall well-being, a pioneering study is set to delve into its integration in schools, communities and healthcare units across Uganda. 

With funding from the World Bank, this landmark study titled; “Assessing the Extent of Integration of Mental Health Services into Primary Healthcare, Community and Schools” will focus on four purposively selected districts in Uganda – Adjumani in the Northern region, Bushenyi in Western Uganda, Kapchorwa in Eastern Uganda, and Butambala in Central Uganda. 

With the potential to revolutionize mental health practices in schools, this study will through rigorous research and analysis shed light on the implementation and impact of mental health integration initiatives in schools, uncovering new insights that could shape policies and practices for generations to come.

A team of stakeholders at the Inception Meeting.
A team of stakeholders at the Inception Meeting.

Latest data from the international Burden of Disease Study indicates that mental illness and substance use disorders account for 3.35% of the total disease burden in Uganda. According to the latest WHO data, at least 7.4% of Ugandans are affected by common mental disorders particularly depression, anxiety and alcohol use disorders.

Comparable to high-income countries, depression and generalized anxiety disorders in Uganda, are prevalent at 5.3% and 4.1% respectively. Uganda ranks among the top five countries globally with the highest depression prevalence. Poverty, HIV infection, disasters, and adverse environmental conditions are factors that increase the risk and consequence of mental health conditions in Uganda.

It is against this background that the World Bank Group solicited for consultancy services for a nation-wide study to assess the extent of integration of mental health services into primary healthcare, schools and communities.

Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, stated that the study will reveal the prevalence and types of mental health issues in these settings and their impact on community well-being.

This study that will be conducted by a team of mental health experts from the Ministry of Health and Makerere University School of Public Health. This study will assess the availability, access, and quality of mental health services in PHC, communities, and schools.

The study’s Principal Investigator Dr. Nakku further emphasized that the research will assess existing services, identify gaps/barriers, and explore opportunities/challenges in integrating mental health into primary healthcare and schools. This will involve examining policies, resources, support systems, and obstacles to integration.

Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, 2023.
Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, 2023.

Over the last 20 years, Uganda has taken measures to enhance its healthcare system and promote better health outcomes for its population. In 1996, the government-initiated efforts to integrate mental health into primary healthcare, providing training for general healthcare workers to identify and address common mental health disorders.

Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health, emphasizes that there is increased risk of mental health problems among specific sub-populations, including children, the elderly, refugees, and individuals in uniform.

Dr. Lukwata asserts that the government is addressing mental health through policies that highlight its importance as a fundamental component of health at all care levels. These policies promote decentralization, integration of evidence-based services, and partnerships to increase mental health knowledge and service provision.

Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health speaks during the inception at MoH.
Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health speaks during the inception at MoH.

She further stresses that mental health conditions impact individuals throughout their lifespan, affecting quality of life. This includes early childhood, adolescence, pregnancy, adulthood, as well as specific groups such as men in uniform, workplace populations, and the elderly who are at an increased risk for mental illnesses.

Uganda, according to Dr. Hafsa invested USD 25m in 2009 to improve mental health facilities and provide training for health workers, with support from the African Development Bank.

“We have set up several health facilities and trained numerous health workers with the support of the African Development Bank,” says Dr. Hafsa. “However, there have been no studies to assess the impact of these investments. Routine data from the Ministry of Health Management Information Systems (HMIS) indicates an increase in new patients treated for mental health conditions.”

She adds that improvements have been made to the structure of mental health care at all levels to increase the number and mix of mental health professionals.

Despite progress, as noted in the 2018 report of the Sectoral Committee on Health, Uganda still grapples with a significant mental health treatment gap of 85%, leaving only 15% of those in need with access to care. Primary healthcare facilities often refer individuals to higher-level tertiary care, and mental health stigma persists, with limited awareness among the general population, as highlighted by the World Bank.

To bridge the gap, WHO suggests integrating mental health services into PHC systems in countries like Uganda. However, challenges such as prioritization, poverty, cultural differences, health system issues, medication supply, workforce shortages, and inflexibility pose barriers to this integration.

A team of researchers, stakeholders including MoH, World Bank, at the Inception Meeting.
A team of researchers, stakeholders including MoH, World Bank, at the Inception Meeting.

Dr. Nakku acknowledges that mental health has received policy priority in Uganda, but gaps remain in delivering services at primary care, community, and school levels, leaving some populations underserved.

“Mental health problems are risk factors for various public health concerns, such as road traffic accidents and injuries. The role of alcohol and substance use in these issues is significant. Integrating mental health into primary health care may be a cost-effective solution with desirable treatment outcomes. There have been efforts to integration. We now want to assess the extent of integration into PHC, communities and schools in Uganda,” explained Dr. Nakku.

The study aims to evaluate the Knowledge, Attitudes, and Practices (KAP) related to mental health care/services among a total of 1380 individuals, including 45 students/pupils from each of the 33 schools. The assessment will focus on both teachers, learners’ senior women teachers, school nurses and matrons.

Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH outlined how the study will use qualitative and quantitative data to comprehensively understand mental health integration in Uganda. He provided specifics on the quantitative component, including the study population, sample size, sampling procedure, and data analysis plans. He stressed that the collected data will yield indicators for developing a composite measure of integration, stratified by primary healthcare, communities, and schools.

Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH speaks during the inception meeting.
Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH speaks during the inception meeting.

“This study is quite interesting because we have primary health care units as a study population. We shall randomly pick study participants from the villages and schools served by the health care units. We also have plans to construct an Integration of Mental Health Services/Care Composite (IMHC) based on scores from the items/indicators of integration at each of the 3 levels. Each indicator present will be scored ‘1’ else ‘0’, and a total score will be obtained as the sum of all individual indicator scores. The proportion of schools/communities/PHC facilities generated will be based on an agreed cut-off,” explained Dr. Fred Makumbi, a Co-Principal Investigator of the MHISU study.

Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study highlighting that mental health was “an integral part of our lives.” Accordingly, she stressed MakSPH’s commitment to increasing mental health knowledge through research and expressed her delight in partnering with Butabika Hospital, citing their history of effective teamwork. “The School of Public Health will document the learnings from this study and this study is not a one-off.”

Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study.
Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study.

Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences, provided insights on the qualitative component of the study during the discussion. He emphasized the purpose of describing and providing context for integration, and how the study team aims to explain trends, relationships, consistencies, and inconsistencies through the numerous question items they have put together.

“We think if we are able to go to very many sub-populations that we have marked out for purposes of collecting this qualitative data, we shall be able to provide context and meaning according to the data sources themselves so that we have better appreciation of what is going on,” says Dr. Muhwezi.

Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences.
Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences.

Dr. Muhwezi expressed excitement to be part of a study that recognizes the value of qualitative data in increasing the wealth of knowledge. “As far as I am concerned, I am very excited about this study because rarely do we get to do studies where the qualitative approach is given prominence like the quantitative approach. I think we will get good information when we come from the field.”

Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health, expressed the Ministry’s keen interest in the upcoming study on Ugandan mental health during an inception meeting chaired on their behalf. He emphasized that understanding the mental health needs of Uganda will lead to better interventions and contribute to achieving Sustainable Development Goal 3 – Good Health and Well-being.

Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health.
Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health.

According to Dr. Oyoo, Ministry of Health will support the study team and that it was eager to learn more about the study and how they can be of service. He expressed gratitude to the World Bank, MakSPH, and Butabika Hospital for their contribution to improving mental health care in Uganda.

Dr. Hafsa Lukwata speaks during the inception at MoH.
Dr. Hafsa Lukwata speaks during the inception at MoH.

The Executive Director, Butabika National Referral Hospital, Dr. Juliet Nakku has appealed for a budgetary allocation of Shs5 billion in the 2023/2024 budget for completion of the facility’s concrete perimeter wall.

She made the appeal while presenting the hospital’s ministerial policy statement before the Health Committee on 03 April 2023.
“The wall is five kilometres and we have only constructed under half of that. We no longer get construction budget,” Nakku said.

She stressed the need to construct the wall as a means of avoiding rampant incidences in which patients escape and end up drowning in the nearby swamps.

She also warned that failure to complete the wall leaves room for continued encroachment on the hospital’s land.

She revealed that out of the 408 acres of the land, only 283 acres are left.  

Dr Nakku said the hospital needs to complete the perimeter wall

 

The Committee Chairperson, Dr Charles Ayume pledged to take up the matter with the Minister of Finance.
“I know the ministry does not want to hear about construction budgets but these are special patients and we need to protect them,” Ayume said.

Hon. George Bhoka (NRM, Obongi County) said the security of patients and staff should be prioritised.
“We need to reconsider financing the completion of the perimeter wall,” Bhoka said.

Maracha East County MP, Hon. Ruth Lematia urged government to put measures to stop encroachment on the hospital’s land.
 “Whatever they [hospital management] have asked for is modest. We should help the hospital grow,” she said.

Hon. Yusuf Nsibambi (FDC, Mawokoto County South) advised the hospital’s management to reclaim the encroached land through bonafide ownership and administratively cancel the titles that were issued by the Uganda Land Commission.
“A wall alone may not deter the encroachers. The Executive Director should re-open the hospital’s land that was given out irregularly by the Uganda Land Commission,” said Nsibambi.

Butabika Hospital is a mental teaching and research facility that offers specialised mental health care and limited general outpatient services.

A joint study conducted by Butabika National Referral Mental hospital and Makerere University has found that more Ugandan women are battling severe anxiety and depression than their male counterparts who are mostly affected by alcohol abuse.

2,067 people were sampled from the districts of Kapchorwa, Adjumani, Bushenyi, and Butambala where participants were selected from both schools, those seeking health services in lower health facilities and the community.

According to the released results; 39 per cent of the women suffered severe anxiety against 24 per cent of males. When it came to depression, 12.6 per cent were women and 5 per cent men. The study was meant to assess the extent of integration of mental health services into primary health care, communities, and schools in selected districts in the country.

 



According to Prof Fredrick Makumbi, a lecturer at the Makerere University School of Public Health who was one of the researchers on the study, generally, for every three people, one had severe anxiety and when they went ahead to assess people’s attitudes about mental illness, a number of the respondents believed that mental illness is behavior-related.

 



Dr Juliet Nakku a senior consultant psychiatrist at Butabika hospital who led the study team says their results show a high prevalence of mental illness and a high need for medication as nine out of every ten people they surveyed believed that medication can be effective in helping them, although only a few were enrolled into care citing long distances, inadequate facilities and drug stockouts as part of the deterring reasons.

 



Also, nearly four in ten people believe the mentally ill are in danger partly because a significant number of people still seek care from religious leaders or traditional healers before going to the hospital. 9.3 per cent were found to be seeking treatment from religious leaders and another 5.3 per cent from traditional healers.

Nakku says as a solution, there is a need to incorporate mental health services in community programmes to give it the attention it deserves like other key diseases such as HIV that are affecting a large number of people. She says having social workers in the community could go the extra mile to help link people who need treatment interventions into care.

 

Butabika National Referral Hospital is currently struggling with a high rate of abandoned patients and calls for a National mental Health Survey.

According to the deputy executive director of the facility, over 80% of the patients at the facility have been abandoned by their families contributing to the low recovery process.



According to Dr. Brian Mutamba, the unfortunate situation is hindering the recovery process of these individuals and making it challenging for them to reintegrate into the community.

This lack of care and attention has a significant impact on the mental well-being and progress of the patients.

The hospital authorities have also pointed out that the widely reported figure of 14 million Ugandans suffering from mental illnesses was taken out of context.

To gain a comprehensive understanding of the prevalence and types of mental health disorders in the country, they are urging the need for a national survey.

Mental health disorders continue to be a significant concern globally, and Uganda is no exception.

It is essential for the government, healthcare professionals, and society as a whole to recognise the importance of mental health and work towards creating a supportive environment for individuals affected by these conditions.

The situation at Butabika National Referral Hospital highlights the urgent need for a multi-faceted approach to address mental health challenges in the country.