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Kampala — With more than half of Ugandans seeking treatment in private health facilities, the latest Auditor General’s report has sounded a chilling alarm: the very institutions mandated to regulate private healthcare may be leaving dangerous gaps that put lives at risk.
The Value for Money audit into the Regulation of Private Health Care Practice in Uganda paints a disturbing picture of incomplete databases, missing facilities, weak inspections, ignored closure orders and years-long delays in resolving medical negligence cases.
At the top of the chain sits the Permanent Secretary at the Ministry of Health, Diana Atwiine. Within the Ministry, regulation falls under Dr. Joseph Okware, Director Health Services, Governance and Regulation. On the frontline are the regulatory councils: the Uganda Medical and Dental Practitioners Council chaired by Assoc Prof Joel Okullo and led administratively by Registrar Dr Charles Tusiime; the Uganda Nurses and Midwives Council headed by Registrar Christine Nimwesiga; and the Allied Health Professionals Council chaired by John Paul Okiria with Registrar Peter Nyamutale. Key quality assurance and inspection officers at UMDPC include Dr Tumwine Daniel, Dr Muyanga Mark and Dr Ayub Twaha.
The question now shaking the health sector is simple and terrifying: how did regulation of a sector serving an estimated 54% of Uganda’s population become so fragile?
The audit found that databases for private health practitioners and facilities are incomplete. They only capture professionals and facilities that voluntarily seek registration. That means authorities do not have a full picture of who is practicing and where. Without a comprehensive database, planning inspections, enforcement or policy interventions becomes guesswork.
Even more alarming is the revelation that the Ministry of Health could not reconcile and account for 10,458 registered private health facilities captured in regulatory councils’ databases but missing from the National Health Facility Registry. Ten thousand four hundred fifty-eight facilities effectively floating in a regulatory blind spot.
This data gap undermines oversight, the report points out. It limits the Ministry’s ability to coordinate, monitor compliance, enforce minimum standards and take corrective action. In simple terms, thousands of facilities may be operating beyond effective central scrutiny.
Then comes the failure to gazette licensed professionals and facilities. Over the three years under review, the Uganda Medical and Dental Practitioners Council failed to gazette an annual average of 1,804 licensed private facilities. The Uganda Nurses and Midwives Council failed to gazette 406 annually. The Allied Health Professionals Council failed to gazette 295 annually.
Gazetting is not a ceremonial exercise. It informs the public who is legally licensed to practice. When gazetting is limited, public awareness suffers.
A senior medical practitioner told RedPepper, “Patients have a right to know who is qualified. If you don’t publish that information, you weaken transparency.”
Inspection and supervision — the backbone of quality assurance — were found wanting. The Ministry and councils failed to set clear inspection targets at planning and budgeting stages. There were no clear schedules or documented coverage plans. As a result, inspections and support supervision were inadequately planned and executed.
The audit reviewed inspection reports and found none indicating whether previously identified issues had been addressed. Follow-up was largely verbal, with no documented tracking in reports. Out of 189 facilities inspected, 49 had not taken any action on inspection recommendations. Councils did not maintain a follow-up matrix to track implementation of performance improvement recommendations.
When facilities ignore recommendations and regulators do not track compliance, standards deteriorate.
The most shocking revelation concerns enforcement. All 27 selected facilities that had been recommended for closure were still operating. There was no evidence of reassessment or formal approval to reopen. Non-compliance issues that led to closure recommendations were still observed.
Additionally, out of 39 sampled facilities issued with corrective actions, none fully addressed the recommendations. Thirty-six point six seven percent implemented none at all. Sixty-three point three three percent only partially implemented them.
Speaking to RedPepper about the report, a patient rights advocate did not mince words “If a facility is unsafe enough to be recommended for closure but continues operating, who is protecting patients?”
Complaint handling is equally troubling. Across the regulatory councils, 204 cases were pending before disciplinary committees and tribunals. The average time to resolve complaints was 12 months at AHPC, 37 months at UNMC and 24 months at UMDPC.
Three years to resolve a complaint against a nurse. Two years for a doctor. One year for allied health professionals.
“Justice delayed in medical negligence is justice denied,” a legal expert commented. “For victims, these are not statistics. These are lives.”
The audit also noted limited public sensitization on complaint reporting. While councils undertake some awareness activities, they are not specifically directed toward encouraging aggrieved patients to report complaints.
The overall conclusion is stark. While the Ministry and regulatory councils have undertaken measures such as registration, licensing, inspection and dispute resolution, these have been ineffective in ensuring adequate compliance with standards. Inconsistencies in registration figures, limited gazetting, inadequate inspections, weak enforcement and prolonged complaint handling have compromised regulatory effectiveness.
So who is to blame?
As Accounting Officer, Dr Diana Atwiine bears overarching administrative responsibility. Dr Joseph Okware oversees governance and regulation within the Ministry. The chairpersons and registrars of UMDPC, UNMC and AHPC are directly responsible for operationalizing inspections, enforcement and disciplinary processes.
Defenders may argue that resource constraints, legal limitations and the rapid expansion of private healthcare have stretched capacity. They may point to COVID-19 disruptions and staffing shortages.
Critics counter that planning failures, weak documentation, absence of follow-up mechanisms and non-enforcement of closure recommendations are managerial shortcomings, not merely financial ones.
“When 27 facilities recommended for closure are still operating, that is not about budget,” one health analyst remarked. “That is about will.”
The Auditor General has recommended development of a comprehensive database covering both registered and unregistered facilities, regular updates of the National Health Facility Registry, prioritization of gazetting, joint inspections to reduce duplication, establishment of monitoring and evaluation units, revision of legal provisions to strengthen enforcement powers and improved complaint investigation standards with client charters.
The bigger question now reverberating across Uganda’s health sector is whether it is time to crack the whip.
As one senior doctor put it quietly, “With 54% of Ugandans relying on private healthcare, regulatory failure is not an abstract governance issue. It is a public safety issue. Every missed inspection, every ignored closure recommendation, every delayed complaint potentially translates into compromised patient care. Regulation is the last line of defence between patients and malpractice. If that line weakens, people suffer.”
Ugandans are now waiting to see whether the Ministry of Health and its councils will tighten the system — or whether this audit will become yet another report gathering dust while unsafe practices continue unchecked.
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