By Jennifer Acheng
HEALTH ABIM: At Abim Hospital, established in 1969 during Milton Obote’s regime to be a cornerstone of of public health in the Karamoja Sub-region, a quiet but profound burden is falling disproportionately on mothers as the facility grapples with doctor’s leave, leaving significant gaps in patients’ care.
What might seem like a routine challenge for hospital administrators and district officials is translating into immense stress, delayed treatments, and financial strain for the primary caregivers of families, most often, expectant mothers and their babies.
On a humid Tuesday evening, May 18, 2025 23-year-old Agnes Akello from Aninata Parish, Abim Sub-county, cradles an empty bundle of cloth at in Abim Town.
She had gone into labor at dawn, but when complications arose, midwives at Abim Hospital said she needed an emergency C-section due to complication, she recalls as eclampsia.
With no single doctor on duty, she was told to find Shs150,000 for fuel and allowances if she wanted the hospital ambulance to transfer her to St. Kizito Hospital Matany, in Napak district, over 90 kilometers away.
Part of the money would cater for fuel and the driver’s allowance, while the rest would facilitate the midwife accompanying her.
With the emergency at hand, her husband struggled nail and tooth to raise the money, but by the time they reached St. Kizito Hospital in the early hours of the night, her baby was gone
Agnes’ story is not isolated. In the past year alone, at least five mothers and over ten newborns have died in similar circumstances, while more than 300 patients with complications have been referred, many without transport or follow-up care, according to hospital data obtained recently
According to the Ministry of Health’s Annual Health Sector Performance Report (FY 2023/2024), Abim Hospital recorded an Institutional Maternal Mortality Ratio (IMMR) of 421 deaths per 100,000 live births, placing it among the top 15 worst-performing general hospitals in the country, a figure that is significantly higher than the national hospital average.
The hospital, meant to serve over 120,000 people, of Abim and the neighboring Agago, Otuke and parts of Teso districts has been running without a single doctor, as all the doctors deployed at the hospital have been on study leave, for over a year, a vacuum that has drawn grave concern from residents and health activists
When Doctors Are Gone
On September 28th 2024, a 22-year-old Stella Aloyo went to Alerek Health Centre III for labor, where the midwives discovered that her baby was in a breech position and referred her to Abim Hospital.
She arrived with hopes, only to be told that no doctor was available to perform a C-section.
Out of desperation, one midwife familiar to her family called a visiting doctor not officially attached to the hospital, and to her luck, he came and she was operated
According to midwives there, the unnamed doctor, whose qualifications remain unclear, is sometimes summoned to help handle emergencies.
While his intervention saved Aloyo and her baby, it raises questions about informal, unregulated medical care in a government facility.
For mothers who can pay for referrals, outcomes are often different, Mercy Apio, from Orwamuge Sub-county, developed complications during labor but had relatives with a vehicle who drove her to St. Ambrozoli Hospital in Kalongo, Agago District.
“It wasn’t easy,” she says. “But I was lucky. If I had stayed in Abim, my baby would not be alive today.”
But for every mother helped like Mercy, another is stranded waiting for a doctor who never comes.
The System That Fails Mothers
The frustration voiced by these women stems from a deeper problem. Over the years, six doctors were deployed to Abim Hospital. But today, all are either on study leave, interdicted, or have overstayed their leave periods.
The facility is left in the hands of clinical officers, nurses, and midwives, dedicated, but ill-equipped to handle emergency surgeries or life-threatening complications.
This according to experts is more than a staffing issue, it’s a policy enforcement failure. Uganda’s Public Service Standing Orders (Section C–d) stipulate that study leave should only be granted “in the public interest” and not exceed the approved duration without renewal.
Yet, in Abim, several doctors have exceeded their leave periods or are suspected of working in private facilities while still on government payroll a violation that has gone largely unsanctioned.
Apart from Dr. Edson Atwine, who was interdicted in 2024 and charged in the Anti-Corruption Court over allegations of corruption and negligence, the rest have faced no serious disciplinary action.
Among the six doctors officially deployed are Dr. Edson Atwine, interdicted in 2024 over corruption and negligence, Dr. Godmercy Abelle, currently on study leave, Dr. Harriet Achaa, partially available, Dr. Olanya Denis, newly added to the team, Dr. Okengo Anthony, whose leave expired but hasn’t returned and Dr. Kenneth Kahunda Okumu, the Medical Superintendent, is partially present but handles administration, not patients.
The Maternity Wing Crisis
At the heart of the doctor’s crisis lies the maternity wing, once the pride of the facility, now the epicenter of grief.
Midwives say they are overwhelmed, working long hours under pressure and without the necessary support from doctors. They report delivering between 10 and 15 women every day under strenuous conditions.
A midwife at the maternity ward who preferred anonymity for fear of reprimand says in emergencies such as obstructed labor, ruptured uterus, or pre-eclampsia, they are often forced to refer patients they could have helped if a doctor were present.
According to the hospital’s records, the maternity ward accounts for most of the emergency referrals, and nearly all maternal deaths reported in the last year.
Overall, the hospital receives about 300 to 400 patients daily through the Outpatient Department (OPD), placing immense pressure on the few remaining health workers.
St Kizito Hospital Feels the Strain
In a recent visit to St. Kizito Hospital Matany in Napak District, I set out to verify growing reports of increased patient referrals from Abim Hospital and found firsthand evidence of the mounting pressure.
Parked at the emergency unit was a grey double cabin pickup truck bearing marks of Abim district, confirming what Matany hospital staff had told me earlier, the driver, had arrived alongside a midwife, transporting a mother along with her two premature newborns. Tragically, one of the babies had died just before reaching Matany.
Nearby in a causality ward lay a 46-year-old Michael Ochoria from Kawang village in Alerek Sub-county who was attacked by a stray buffalo while working in his garden.
The animal trampled him, leaving him with a severely torn abdomen and he was rushed to Abim Hospital in critical condition, but with no doctors available to perform emergency surgery, nurses referred him to St Kizito Hospital Matany.
Matany administrators say they receive three to five referrals from Abim daily, most involving expectant mothers or accident victims.
Expectant Turning to Traditional Birth Attendants
With the available health facilities unable to effectively provide reliable maternal and emergency health services, some expectant mothers are turning to Traditional Birth Attendants (TBAs), a practice once discouraged by the Ministry of Health.
In Atunga Sub-county, a 75-year-old Ceasaria Apio still assists women during childbirth, just as she has since the 1980s.
She works with what she has in her hands, herbs, and basic tools, a razor blade, thread, and millet porridge for recovery in case of complications.
Hospital Under Strain: More Than Missing Doctors
The absence of doctors is only the tip of the iceberg. A closer look at Abim Hospital reveals a string of issues; When I camped at the hospital, attendants in wards were ordered by 5:30am to fetch water in jerrycans from outside sources to fill in blue drums for ward use due to persistent water scarcity, care givers were then instructed to clean the filthy bathrooms themselves often without protective gear, failure to do this attracted a punishment.
As night falls, the wards remain dark, electricity remains unreliable, In emergencies, caregivers and midwives on night duty in most cases resort to mobile phone torches and other lighters to illuminate deliveries.
There is currently only one functional ambulance serving all the health facilities within the 13 administrative units of Abim District, including the main hospital, If that vehicle breaks down, the only fallback is the Ministry of Health’s COVID-19 distributed double cabin car which is ill equipped to handle referral emergencies.
Established in 1969 during the administration of President Milton Obote, Abim Hospital was once envisioned as a cornerstone of public health in the region, however, over the decades, it has steadily deteriorated due to a string of issues.
In 2015, the facility especially drew national attention when opposition politician Dr. Kizza Besigye visited and famously described it as “unfit for human use“, citing the absence of running water, beds, medicine, and basic hygiene. something that sparked a nationwide uproar
Earnest Ayen, Abim’s District Youth Chairperson in 2024, led a public health exhibition campaign to expose the hospital’s condition. Posters highlighted shortages of doctors, drug stock outs, and crumbling infrastructure.
The campaign generated noise on social media and caught the attention of district leaders, but little changed.
District Leaders Admit Failure But Claim Progress
As public concern grows over the absence of medical doctors in Abim District, local leaders continuously admit the problem but urge calm saying efforts are underway to address the crisis, though tangible results remain elusive.
Godfrey Okello, the District Secretary for Health and Education, acknowledges that most of the government-assigned doctors are currently on study leave.
However, he maintains that the few health workers still on the ground are doing their best under difficult circumstances.
Okello has since maintained that the district has resolved to suspend further study leave and recall those already away, yet implementation has been slow, and the public is yet to see this fully take effect. No official recall letters have so far been issued to the absent doctors despite the repeated assurances.
In a phone interview recently, the Abim district Chief Administrative Officer (CAO) Moses Opio also confirmed the situation but downplayed the severity saying it’s not at the crisis level as people are claiming.
Opio explained that his office has already taken steps to address the prolonged absence of doctors, noting that doctors like Dr. Anthony Okengo, whose leave period has expired, have been written to and are expected to resume duty soon.
To prevent future disruptions, Opio says the district has resolved tohalt all new studsy leave approvals for health workers in the near term, a decision he says aimed at easing pressure on the overstretched hospital.
Despite these promises, many in the community remain unconvinced. With no doctors currently attending to patients at the hospital, residents continue to rely on nurses, midwives, or traditional birth attendants.
According to the Uganda Public Service Standing Orders (2021), medical workers such as doctors must formally apply for study leave by submitting a written request detailing the course, institution, and duration. The application is first reviewed by the District Health Officer (DHO), who assesses the relevance of the course to the health sector needs and advises on whether the absence can be managed without affecting service delivery.
The final approval is then granted by the Responsible Officer, typically the Chief Administrative Officer (CAO) for district hospitals. Proceeding on leave without written approval, overstaying, or failing to return is considered misconduct and may lead to removal from the payroll, disciplinary action, or recovery of public funds.
In Abim the political leaders say the doctors are out for leave irregularly, but the question remains, who cleared them for leave?
Policy Enforcement Failure
Simon Peter Olum, a health policy analyst and Executive Director of ADYOFU, an NGO based in Abim, says the situation at Abim Hospital reflects a broader national governance crisis rooted in weak enforcement and oversight.
Olum emphasized the importance of tightening supervision of staff, and prioritizing the advertisement of more positions particularly for clinical officers who are essential in rural settings.
He also highlighted staff retention as a persistent challenge, stressing that many health workers are reluctant to remain in upcountry postings like Abim, which continues to strain healthcare services in such underserved areas.
Budget Without Impact
In the current financial year 2025/26, the Government of Uganda allocated the lion’s share of the district budget, Shs5.41 billion toward staff salaries under Primary Health Care services in Abim District.
Despite these significant budgetary allocations, health experts argue that there is little evidence of value being realized on the ground, For instance, government continues to spend over Shs400 million annually on salaries and allowances for the six doctors officially deployed at Abim Hospital, This expenditure, they say, isnot commensurate with the services delivered.
Multiple attempts, efforts to obtain comments from the District Health Officer and the District LCV Chairperson were futile as both officials failed to honor several scheduled interviews, leaving key questions about accountability and future plans unanswered.
When contacted, Ministry of Health spokesperson Emmanuel Ainebyoona said he was not aware of the current situation at Abim Hospital, but advised that the matter be followed up with the local authorities, particularly the hospital director and Chief Administrative Officer, who are directly responsible for the facility’s operations.
In Abim, where a hospital stands without doctors, every birth and every emergency become a gamble between life and loss, a reminder that health care should not depend on luck, but on leadership that truly cares.
This Article was produced with support from African Centre for Media Excellence (ACME)
