How disconnection of water disrupted hospital operations

On June 1, 2023, the National Water and Sewerage Corporation (NWSC) disconnected Entebbe Regional, Naguru, and Hoima hospitals due to their failure to clear outstanding water bills totaling Shs 1.9 billion.

The bills, seen by The Observer, showed that Entebbe regional referral hospital owed Shs 488 million, Naguru hospital owed Shs 1.3 billion, and Hoima hospital owed Shs 150 million.

NWSC’s decision came after extensive discussions with officials from the ministries of Health, who oversee all hospitals in the country, as well as that of Finance, Planning and Economic Development. NWSC blamed Health ministry permanent secretary, Dr Diana Atwine, for her failure to settle the water bills for these three hospitals and other facilities. In response, she accused the ministry of Finance of not releasing the necessary funds.

However, on June 7, Dr Silver Mugisha, the managing director of NWSC, announced that they had decided to reconnect the three health facilities.

This decision was made following input from Prime Minister Robinah Nabbanja, Health minister Jane Ruth Aceng, minister of Water and Environment Sam Cheptoris, and the Permanent Secretary/Secretary to the Treasury Ramathan Ggoobi. NWSC emphasized the importance of agreeing on a concrete payment plan by June 30, 2023.

The disconnection of water not only impacted service delivery but also compromised hygienic conditions. The Observer visited two of the affected health facilities: Entebbe Hospital and China-Uganda Friendship hospital Naguru.

Naguru hospital was established between 2009 and 2012, with the Chinese government contributing about US$8 million (Shs 303 billion) to build it as a gift to the people of Uganda. Kampala Capital City Authority (KCCA) donated the five acres of land where the hospital stands today.

The hospital provides various services, including in-patient care, outpatient care, diagnostic services, specialized curative care, prevention and rehabilitation, community outreach services, and management and support services.

During an interview, a caregiver at Naguru hospital mentioned that water was reconnected on Wednesday, June 7, 2023, after a week of being without running water. She explained that they initially thought the water disconnection was temporary but realized it wasn’t the next day. This situation caused unexpected expenses as they had to buy water for washing and bathing, with a jerrycan costing between Shs 500 and Shs 1,000.

She mentioned that the hospital later fetched and filled tanks for patients and caregivers to use for washing and bathing. They had to carry water in buckets from the reserve tanks for use in the washrooms and toilets. Additionally, she expressed frustration at the hospital’s high prices for drugs, including basic ones like paracetamol, compared to external pharmacies.

Another caregiver at the emergency ward mentioned that it took her a while to realize that water had been restored at the facility. She said it was the first time in over two days that she saw water flowing from the tap. Without water, they relied on a person washing cars nearby to know that the water had been reconnected.

A nurse, who preferred to remain anonymous, stated that they had been informed about the water disconnection and that the hospital’s management was discussing plans to fill the hospital tanks. She mentioned that the hospital couldn’t operate without water, but due to the disconnection, some sections of the hospital had to be closed, with only the emergency ward remaining functional.

Services such as caesarian section deliveries were referred to Kawempe hospital, and surgical services were suspended. With the water reconnected, the operations were expected to return to normal.

The disconnection not only affected critical service delivery but also had an impact on the hospital’s cleaning staff. A cleaner at Naguru hospital said that NWSC’s decision had doubled her working hours from one and a half hours to almost three hours.

She had to spend more time fetching water from the harvesting tank to level two, where she performed her cleaning duties. Despite the increased workload, she expressed relief that the water had been reconnected.

It was also discovered that the hospital’s management had been paying Shs 250,000 daily to fill three water-harvesting tanks for patient and caregiver use in the emergency and other wards.

Despite the suspension of critical services, several patients were forced to sleep on the floor outside the theater while waiting for their appointments. Entebbe regional referral hospital, originally established by British colonialists as Entebbe Grade B hospital, underwent expansion and reconstruction between 2013 and 2016 with a $7 million (Shs 26 billion) donation from the World Bank.

Following the completion of the expansion, the facility was upgraded to a regional referral hospital. The hospital serves a population of over 3.8 million patients from Wakiso, Mpigi, Butambala, Entebbe, Kalangala, and Mukono districts. It provides a wide range of services, including maternity care, general surgery, orthopedics, pediatrics, radiology, laboratory services, immunization, and internal medicine.

After the water disconnection, Richard Tumwesigye, a senior administrator at Entebbe hospital, informed the media that several services, such as surgeries, had to be suspended because they required water. He emphasized that without water, it was not possible to operate on patients or maintain functioning toilets.

Tumwesigye revealed that the hospital had already remitted Shs 120 million to NWSC, which was their annual allocation for water utility. However, their water usage amounted to Shs 240 million, indicating a significant shortfall in the allocated budget.

A nurse confirmed the water disconnection but mentioned that the hospital relied on reserve tanks for a short period before being reconnected. She explained that the hospital had over 12 water tanks, but they couldn’t sustain the demand for more than a day. In response, the hospital had planned to rely on emergency water from the police fire brigade to keep some departments operating.

A staff member responsible for laundry services acknowledged the water disconnection but initially thought it was a temporary situation. She instructed patients to collect water from the tanks. However, as complaints about the lack of water in toilets and taps increased, the hospital had to rely on reserve and water- harvesting tanks. Fortunately, the water supply was restored within a day.

A caregiver at Alison Elliot ward mentioned that they heavily relied on a water tank within the ward as the taps had dried up. They fetched water from the tanks for laundry and other activities. Regarding medication, the hospital procured most drugs from external pharmacies, but doctors remained available.

Patrick Ocailap, the deputy secretary to the Treasury, attributed the delay in payment to slow cash flows and a mismatch between demands and available resources. He acknowledged that several facilities had outstanding arrears, but the sensitivity of the health facilities involved attracted more attention.

The ministry of Finance managed to mobilize additional funds to settle the water bills, leading to the reconnection of the facilities.

In response to the situation, the ministry of Finance recommended installing prepaid meters for water in government institutions, particularly sensitive ones like health facilities. This measure would ensure that budget allocations accurately reflect the previous year’s consumption, reducing the risk of recurring problems.