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Bringing Health Care to Rural Uganda
Village-Run Clinic Provides New Model of Success
 Listen to Part One of Joanne Silberner's report.
Listen to Part Two of Joanne Silberner's report.
 Watch a slideshow with music and photos about life in Buhweju.
May 20, 2002 -- Global health experts say diseases that overwhelm Africa's poor must be treated, or else economic and political progress in those developing nations will remain stalled. But efforts to provide care have not succeeded. The African continent is littered with the wreckage of good intentions -- international projects that started with pomp and hope and then died as foreigners lost interest.
Now, in Uganda, executives of an American health care plan are in partnership with local activists, trying to create something that will last.
For All Things Considered, NPR's Joanne Silberner reports they are building a health care system that is paid for and run by the people it serves.
Easy access to affordable medical care is nearly unheard of in rural Uganda. There are no local emergency rooms or ambulance services. To see a doctor, rural farmers often have to hike for miles. And for serious problems, the ill are carried on makeshift stretchers by their friends and family -- a bumpy trip that can take hours.
But what's happening on a mountain top in southwestern Uganda could change that. In a tiny village named Buhweju, local health care organizers and American executives from a Minnesota-based HMO called HealthPartners are celebrating their second year together with the dedication of a new health clinic building.
The local organizers are funded by the U.S. Agency for International Development. But what the Ugandans and Americans are building relies on grassroots support. It's a health co-op where members pay a fee every four months. In return, they get medical care when they need it.
The co-op is finishing up a bright, new brick building that will replace the dark, mud-floored shack the clinic workers have been using.
At the celebration, there is singing and dancing, lots of speeches, and the inauguration of a new ambulance service. The entire village is on hand.
The average life expectancy in Uganda is 43 years. In a way, the ceremony is celebrating a chance to beat those odds. Medical services in the nation of 23 million are spotty at best.
Some cities and large towns have hospitals run by international charities. Government-run facilities offer very basic care for free to some people. But in the village of Buhweju, people have a place close by, with medical supplies, a doctor and two nurses.
Medical needs in Uganda are so great that it’s tempting for international aid groups to simply pay for the construction of hospitals and clinics, says George Halvorson. He used to run the HealthPartners co-op the Uganda model is based on.
On his first visit to the country, he saw almost-new facilities standing empty and unused. One of them was full of goats. Halvorson has come to believe that charity isn’t the answer.
"The people who are being charitable give up, get tired, find a new charity, move on," says Halvorson. "When that happens, the programs die. There's a saying in one of the Ugandan languages... when the white faces leave, the care goes away. We think that's a bad model."
On the other hand, the co-op in Buhweju is growing; it now has more than 200 families -- about 900 people. For a family of four, a year's membership costs 48,000 Ugandan shillings, or about $29 a year. For that, they get basic health care, such as treatment for malaria, pregnancy, dysentery and accidents. But not for AIDS; the co-op members have decided that they can't pay for such expensive treatment and still keep the fees affordable.
Halvorson and others in the program are convinced the health co-op concept can only work if Ugandans themselves are in charge.
"It's local control, local decisions," he says. "That gives people a sense of empowerment and control, and we think that's important. We think that's one of the reasons why some of the people are working so hard to make the program a success."
The Uganda Health Cooperative now has 12 co-ops running in the country, with about 2,500 members. Health officials in the Ugandan government recognize that the country doesn't have enough money to support a strong, central health care system. They're watching how the co-ops work, looking to see if they could provide a model to build on.
Other Resources
• HealthPartners
• Uganda Ministry of Health
• The United States Agency for International Development
• Facts about Bushenyi province, where Buhweju is located
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