Nebbi Municipality has been operating without any Health Centre III in its three divisions and without a municipal hospital since it attained municipality status on July 1, 2017, defying a Ministry of Health policy that requires at least one Health Centre III per division.
Without a Health Centre III, Nebbi lacks essential services such as maternity care, laboratory services and resident doctors for its estimated 49,191 residents.
For treatment, residents rely on the private not-for-profit Angal Hospital, located about 21.6 kilometres away, or other nearby health units that provide similar services at a high cost.
Nebbi General Hospital, which serves as the nearest public referral facility, is overwhelmed by patients from Nebbi, Zombo, Pakwach, Madi-Okollo and parts of eastern Democratic Republic of Congo, leaving many residents with limited options and increased transport and medical costs.
Acting Public Health Officer Angel Piwun said the municipality’s health staffing situation has collapsed due to the absence of functional health facilities.
“We only have preventive staff. We cannot treat the sick. My work is very difficult,” Piwum said.
“We currently have no medical workers at the municipality. There is no place for them to work. This situation is getting out of hand.”
Under national health policy, every sub-county or division is expected to have a Health Centre III within a five-kilometre radius.
A Health Centre III provides inpatient services, including maternity care and laboratory services, and is typically managed by a senior clinical officer, serving about 20,000 people.
A Health Centre IV offers additional services, including emergency surgery and blood transfusion, overseen by a senior medical officer.
Deputy Mayor and Council Business Leader Howard Musa said the municipality had acquired land in Abindu and Thatha divisions for the construction of health facilities, but the projects remain stalled.
“We have land at Abindu and Thatha divisions measuring about four acres. These lands have been idle for more than five years now. Even now we are ready to start, but the issue is delaying at the ministry,” Musa said.
In 2022, Nebbi Municipal Council recruited 53 medical workers intended to serve at the planned division health centres. However, their payment was halted six months later due to the absence of functional facilities.
“We faced a lot of pressure from health workers for their payments. These workers were ready to work, but we could not continue because we had no duty posts,” Musa said.
In 2023, the Ministry of Health directed that 47 of the medical workers be absorbed by Nebbi District Local Government, with the wage bill transferred.
Seven remained at the municipality, but one has since died, leaving six without active deployment, while the principal medical officer is currently acting as the District Health Officer for Nebbi.
Ministry of Health Senior Communications Officer Emmanuel Ainebyoona said the Health Infrastructure Department is responsible for designing and upgrading health facilities nationwide but is currently constrained by limited funding for new construction.
“We are only doing upgrades of health units this financial year. No money was allocated for new constructions yet,” Aneibyona said.
“We have to wait until the new financial year to ascertain which districts or municipalities will be given priority.”
He added that the absence of a budget line for new Health Centre III facilities has affected rollout plans in several areas.
Constructing and equipping a standard Health Centre III in Uganda typically costs between Shs800 million and Shs1.2 billion, while upgrading a Health Centre II to a Health Centre III ranges between Shs400 million and Shs600 million.
With no functional Health Centre III in any of its divisions, residents continue to queue at Nebbi General Hospital or seek expensive care from private clinics, a situation that local leaders warn is worsening the health burden on already struggling communities.
