By Sida Oliver

John Amati sits quietly, gazing at nothing in particular, clenching his teeth as he reels from the pain of a road crash he suffered in December last year.

Amati was hit on December 26, 2022 in Maracha district, on Arua-Koboko road when the driver of a speeding car failed to control it and hit him from behind, sending him crashing about ten metres away from the scene of the crash.

The hit and run crash left Amati for dead, until good Samaritans took him to Maracha Hospital from where he was referred to Arua Regional Referral Hospital for proper management. At the regional referral hospital, x ray scans showed that Amati had broken both his legs below the knees and suffered multiple injuries, with his left arm also broken. He also head severe head injuries which left him dazed.

“I am in deep pain as you can see and I don’t know whether I will stand again. My head keeps on spinning and I have difficulties in turning around because my head keeps on pounding,” Amati said as he frowns in pain.

Both his legs and left arm are on fixators and chances are that he may stay like that for a year before they are removed.

Amati who is a peasant farmer says on the day he was hit, he was from his garden harvesting groundnuts and when he attempted to cross the road, a speeding car hit him from behind and left him for dead.

“I cannot even explain how the car hit me, but the only thing I can remember is something knocking me from behind and I passed out. When I regained my consciousness, I was at Arua hospital and I don’t know how I reached here,” he said.

“In the last three weeks, I have already spent more than Shs5 Million for treatment. I sold my cows to cover some of the costs and I don’t know where I will get the rest of the money,” Amati said while gazing pensively in the air,” he added.

Amati is not an isolated case. Between December 232022 and January 9, 2023, at least more than 500 road crashes took placed across Uganda, killing more than 194 people and injuring another more than 1000 people in the process, according to the official police records. These figures did not include the unreported, which could be much higher than what police has stated.

Josephine Angucia, the West Nile region police spokesperson however said despite the high national figures, the situation in the region was slightly different. She said this time round, fewer road crashes were reported in the region compared to the same period a year ago.

“The truth is that there were fewer cases of accidents registered from 23^rd December 2022 to 5^th January 2023. The case was different in 2021/22 where we had higher figures,” she said.

At the national level, Ms Faridah Nanpiima, the traffic police spokesperson said the figures are alarming. Nanpiina for example said at least 55 people died in road crashes in four days in 206 crashes between December, 23 and 26.

Nanpiima also said on December 28, at least 10 people lost their lives when a Mercedes Benz Actros trailer from Masaka heading to Mbarara side had a rear tyre burst and rammed into oncoming vehicles including a Toyota Hiace and a Mark II Grande, killing 10 people on the spot.

Between December 30 and January, 1, 2023, police also recorded 104 road crashes in which 35 people died and 114 sustained serious injuries.

At the beginning of January, a fatal road crash left 19 people dead and over 20 injured after a bus driver rammed the bus into a stationary trailer near Corner Kamdini along the Kampala-Gulu highway.

A bus registration number UAT 259P belonging to Roblyn bus company traveling from Kampala to Gulu rammed into a stationary trailer registration number UAZ 381A/UBD 318C which was offloading cassava.

Nanpiima said 79 people were killed and 345 injured in 340 road crashes on Ugandan roads in the first week of January.

According to traffic police, the crashes were mostly caused by careless driving including drivers who drift from one lane to the other, driving while speaking on mobile phones and overtaking in dangerous spots.

Majority of Ugandan towns and all highways have single lanes, causing serious headaches, especially while overtaking and also for pedestrians, crossing the roads. Many do not have signs and markings on to guide drivers and pedestrians while using the roads.

This, coupled with indisciplined drivers and other road users pose a serious challenge leading to frequent crashes.

She said in a period of five days between January 9 and 14, 2023, a total of 217 crashes were recorded on roads around the country.

“In the 217 accidents, there were 324 victims, 56 of who died whereas 247 sustained serious injuries,” Nampiima said.

While many families are grieving over the loss of their loved ones, many are also grappling with high costs of treatment of the survivors of the road crashes.

Charles Mukasa, whose wife was hit along Kampala-Masaka road says he is almost giving up on the treatment of his wife. Mukasa says his wife was hit at the beginning of December when she was traveling home.

“On that day, we were supposed to travel together, but my programme changed and the children also decided to wait for me. When my wife left in her own car, she was in high spirit, but what later came through media report broke all our hearts and up to now we cannot explain exactly how it happened,” he says.

“All our plans for the holidays and festive season were crashed. My wife was brought to Mulago and within less than a week, I had exhausted the money on my medical insurance scheme and I had to dip in my savings which I have also exhausted. So far I have spent more than Shs20 million and I don’t know where to turn next,” he said, with wells of tears clouding his eyes.

He said the costs even in government hospitals are high if one requires services that will save lives. Mukasa is crying and rightly so, because a recent report by the parliamentary committee on health found out that government was forking out huge sums of money to treat crash victims in public hospitals.

The report authored by Dr Charles Ayume, the Koboko Municipality Member of Parliament and the chairperson of Health Committee in parliament says government at least spends up to Shs236.3 Million daily to treat road crash victims in critical conditions who are admitted in different public hospitals across the country.

The report says the huge costs eat into the budget of health ministry, which already operates at the bare minimum. Put together for the whole finance year, it brings the total cost of treatment to Shs86.2 billion, which is a big percentage of the national health budget.

Dr Ayume said on average, the cost of treating a critically ill patient (Critical Level 4) is about Shs3.68million a day. He however said if involves surgery, the cost rises to Shs13.9 Million a day.

“The estimates showed that half of the admissions require surgical intervention. In that case, it means that, on average, the government spends about Shs236.3 million per day on treating critically ill accident victims categorized at critical level 4,” he told the legislators in parliament.

The figures do not include those admitted in private health facilities where the treatment costs are as high five times more than what government spends in its facilities. Many Ugandans, especially those that can afford opt for treatment at private health facilities where services offered are better than the government facilities.

Meagre funds allocated to health care

While Uganda has a comprehensive and expansive essential package of health services, government financing is lagging. The parliamentary committee report pointed out that the primary health care package is still funded mainly through donors at 42% and out-of-pocket payments standing at 41%, creating issues for both sustainability and equity.

In addition, the report says the total health expenditure as a percentage of GDP is only 1.3% against the target of 4%. Data from the finance ministry indicates that in FY 2020/21 and FY 2021/22, the total health expenditure was 1.9% and 2.1% of GDP, respectively.

While the report says based on the GDP for FY 2021/22, the allocation for the health sector for the FY 2022/23 should have been Shs6.4 trillion, on the contrary, the budget was Shs3.5 trillion, leaving an allocation gap of Shs2.9 trillion.

“These statistics reveal that Uganda still lags in realizing the universal health care financing targets, thus calling for health financing reforms while considering the limited fiscal space,” the report says.

Police annual road traffic report indicates thatbetween 2019 and 2021, Reckless and negligent driving caused a combined total of 33,208 crashes, followed by pedestrians who pushed 2,527 crashes.

The report says data obtained from the Regional Referral Hospitals indicate that a total of 5,986 road crashes were registered in admission in 2019/2020 due Motorcycles, 9,708 entries in 2020/2021 and up to 11.452 admissions in 2021/2022.

“The average monthly admissions of 4,0I2 for trauma patients represent about 45.8% of total Regional Referral Hospital overall admissions. Of the 134 daily admissions in the last financial year 2021- 2022, 34 patients representing 25% are critically ill at level 4, 50 patients representing 37.5% are Moderately ill at level 3, and 50 patients representing 37.5%, are in Mild conditions categorized at critical level I,” the report said.

Despite all efforts by the government to reduce and control road crashes in the country, the report says the levels of vehicle-related crashes and admissions have continued to increase every year.

“From our findings, the total admissions due to vehicle causes increased from 8,283 in the financial year2019/20 to 11,517 in the financial year 2021/22. This, from the police report, is mainly attributed to reckless and careless driving by the drivers and carelessness by the pedestrians walking on the roads,” Dr Ayume said.

The study recommends the Improvement in emergency response assistance to road crash victims, proper enforcement of the use of Helmets for Boda-Bodas and passengers on motorbikes, strict and regular Speed Limit Enforcement by the traffic police officers.

The report also recommends heavy fines and punishment for aggressive behaviors, including permanent withdrawal of driving licenses for frequent culprits of over speeding, driving under the influence of alcohol, and reckless driving.

“The government should empower the National Road Safety Council to provide proper road safety coordination functions, to fully implement laws passed by parliament as far as road safety is concerned, conduct road safely research and assessments, road safety audits and bring together the differen1 stakeholders in the fight against reduction of accidents,” the report recommends.

Doctors weigh in with support

Faced with the grim situation across the country, Ugandan doctors under the Uganda Medical Association said it’s time to put all resources together to save lives. Dr. Herbert Luswata, the Secretary-General of Uganda Medical Association the situation calls for urgent attention.

“In the past few weeks, U.M.A has noted with grave and increasing concern, the continued terrible loss of life on Ugandan roads in many parts of the country,” he said.

He said the Uganda Medical Association alongside Ugandans and community stake holders note that this loss of life and great harm from accidents is abnormally high. Dr Luswata said while the World Health Organization global status report on road safety shows that the death rate from RTCs is about 22 per 100 thousand population, data from the Trauma, Injuries, and Disability Unit at Makerere University School of Public Health shows that rate is even much higher in Uganda, standing at 29 deaths per 100,000 population, one of the highest in the world.

“U.M.A will work with her members, and member organizations such as the Emergency Care Society and the Association of Surgeons of Uganda in multi-disciplinary teams to prioritize and optimize Crash Care at RTC sites, in the ambulances and at referral centres. U.M.A and her members will work towards the prevention and mitigation of harm at Crash sites directly to reduce number of deaths at the sites and at referral centers to reduce the long term effects of the injuries,” he said.

Recommendations

Dr Luswata said UMA recommended that every driver be tested before getting their driver’s licence and re-testing and physical examination for Passenger buses and Passenger Service Vehicles and Heavy Goods Vehicle drivers every half a year.

“Examination of eye sight and medical examination of long distance drivers by competent medical personnel at affordable rate may be critical to prevent and reduce the frequency and extent of nasty road crashes. U.M.A calls her members to offer services to support efforts to ensure the medical fitness of drivers and to ascertain good eye sight of drivers of especially large trucks, buses and other passenger service vehicles,” he said.

He said there should be availability of more equipped and timely ambulance services that are equipped not only for transportation but for possible surgical interventions from the crash sites.

“Key areas and hospitals near accident prone places should be equipped with facilities and staff on standby to handle such emergencies. These should be monitored and supervised closely by a/the national or inter-district emergency care authorities,” he said.

The association also said while crashes keep on piling, there has been slow response from the insurance companies to compensate the crash victims. They said this worsens the situation because the cost of treating crash victims are extremely high. They say the amount offered by the insurance companies is too meagre to care for the treatment of the victims.

“The insurance of road users and the resources collected for that effort should be made available to crash victims. U.M.A calls for an urgent revision of the insurance compensation for road accident victims should be revised to realistic amounts from the current 1,000,000 shillings because the cost of trauma care is much higher,” Dr Luswata said.