Donor funding cuts undermine orthopedic care for Ugandans
by Yudaya Nangonzi · The ObserverThe National Union of Disabled Persons of Uganda (NUDIPU) has raised an alarm over a steep decline in donor funding for assistive devices and rehabilitation services for persons with disabilities (PWDs).
This funding shortfall threatens the sustainability of public orthopedic workshops, which are crucial for providing prosthetics, orthotics, and other essential assistive devices in Uganda. NUDIPU CEO Esther Kyozira voiced her concerns during a dissemination event for findings on the status of orthopedic workshops, held on Monday at Eureka hotel in Kampala.
“The reduction in donor support has exacerbated the challenges faced by persons with disabilities. With Uganda’s commitment to disability inclusion and the 2030 Global Rehabilitation Agenda, it is imperative for the government to invest in assistive devices to ensure a dignified life for PWDs,” Kyozira said.
A report titled “A Comprehensive Assessment of Uganda’s Orthopedic Workshops” revealed significant disparities between government and private orthopedic workshops across 12 districts, including Jinja, Kampala, Mbale, and Gulu.
While private workshops are better resourced and equipped, government-run facilities are plagued by insufficient funding, inadequate infrastructure, and outdated equipment.
The report highlighted the critical lack of skilled personnel and resources in government-operated workshops, leaving many unable to meet the growing demand for assistive devices. These challenges are compounded by the increasing number of Ugandans acquiring disabilities later in life and turning to unregulated online sources for help, often falling victim to fraud.
CALL FOR INTERVENTION
Dr Carolyne Maholo, a senior researcher and lecturer at Kyambogo University who led the study, emphasized the urgent need for government intervention.
“Most assistive devices are supplied by NGOs whose funding has dramatically declined. Without government support, the sustainability of rehabilitation services is at risk,” Maholo noted.
She cited the case of an NGO in Northern Uganda that has been supporting the orthopedic workshop at Gulu regional referral hospital but now faces funding constraints. The hospital lacks the resources to maintain these services once the NGO withdraws.
Rehabilitation services in private facilities remain unaffordable for many, particularly those in rural areas with limited access to alternative options. Maholo called on the government to fulfill its disability inclusion commitments by allocating sufficient resources to sustain and expand orthopedic services.
NUDIPU’s Kyozira urged stakeholders to act swiftly, reminding them of Uganda’s pledge at the 2022 Global Disability Summit to enhance disability services.
“The time is now to prioritize investment in rehabilitation services and assistive devices, ensuring that every Ugandan living with a disability has access to the tools they need to lead a dignified life,” she said.
KEY FINDINGS
Despite a nationwide pool of approximately 6,000 rehabilitation professionals, the report highlights their heavy concentration in urban areas, leaving 60 per cent to 70 per cent of health facilities without rehabilitation services at lower levels of care.
The most common conditions requiring rehabilitation include musculoskeletal disorders, neurological impairments, and mental health challenges. Children with developmental disorders are particularly vulnerable, facing limited access to critical services.
Overcrowding and inadequate facilities exacerbate the challenges, with some therapists forced to share limited working space. For instance, Lira regional referral hospital’s physiotherapy and occupational therapy units operate in a single shared space, while its 22-year-old orthopedic oven is stored on the veranda, exposing it to weather damage and theft risks.
ACCESSIBILITY AND INFRASTRUCTURE GAPS
Mulago hospital, Uganda’s leading health facility, offers adequate space for rehabilitation services but still struggles with accessibility for people with mobility challenges. While ramps, wide doorways, and sufficient lighting were present in most facilities, accessible toilets, bathrooms and modified fittings like taps and switches remain scarce.
Communication resources, including sign language interpreters, braille materials and ICT tools, were also absent in both public and private facilities, limiting inclusivity. Outdated and poorly maintained equipment is a widespread issue. Public orthopedic workshops often rely on machinery that is no longer functional or lacks readily available spare parts.
For instance, Arua’s workshop faces equipment breakdowns linked to power inconsistencies and limited technical expertise for maintenance. Many workshops depend on donations from civil society organizations to acquire new tools. However, as donor funding diminishes, facilities are increasingly compelled to improvise with locally available materials, such as using jerrycan cuttings to produce cervical collars and back support devices.
GOVERNMENT PROCUREMENT
The report also revealed that orthopedic workshops are frequently excluded from government procurement lists, forcing them to rely on their limited resources to meet demands.
Despite having trained personnel and equipment, the lack of essential supplies renders many workshops non-operational. Rehabilitation professionals expressed frustration over inadequate support, with one official noting the reliance on improvised materials to address critical cases in the absence of proper supplies.
In workshops such as Lira and Soroti, production of assistive devices has significantly dwindled. Maholo, a senior researcher, emphasized that the diminishing donor support and exclusion from government budgets have left orthopedic workshops unable to meet rising demand.
This persistent neglect threatens the sustainability of Uganda’s rehabilitation services, leaving vulnerable populations without access to life-changing support.
STAFF SHORTAGES UNDERMINE REHABILITATION SERVICES
The report highlights significant staffing shortages in Uganda’s rehabilitation facilities, exacerbated by the newly approved government structure. Many workshops and sections operate with just one to three staff members, and some are left with only a single employee. This chronic understaffing has been worsened by personnel leaving for further studies or transitioning to other medical fields, leaving critical roles vacant.
In Arua, for instance, the rehabilitation facility operates with only one physiotherapist after a colleague’s retirement, and the position remains unfilled. To address the gap, the facility has resorted to recruiting and paying interns from their own limited resources.
However, the sole physiotherapist was on leave recovering from an accident at the time of the research, leaving operations reliant on temporary support. Soroti’s facility faces similar challenges, relying heavily on interns who work diligently in hopes of securing permanent roles.
Meanwhile, Gulu’s ophthalmology unit has seen a decline in service quality due to staff transfers, and Arua continues to grapple with an acute shortage of ophthalmologists. These staffing gaps not only strain remaining personnel but also compromise the quality of care provided to patients.
DONOR DEPENDENCE
The report underscores the unsus- tainability of relying heavily on donor support to fund assistive devices and rehabilitation services. Some facilities, driven by desperation, have resorted to using substandard products, raising concerns about the safety and efficacy of care.
Private facilities, including prominent centers such as CORSU, CURE, and Katalemwa Cheshire Services, are also feeling the pinch as donor funding becomes increasingly scarce.
Dr Moses Muhumuza, the medical director of CORSU hospital, emphasized the need for government-led solutions. CORSU, which operates with 30 per cent donor funding, faces limitations as most donors restrict their support to specific items and services.
“The best orthopedic workshops should be government-led, not left to private entities,” Muhumuza noted.
He highlighted that fabricating a single wheelchair locally costs approximately Shs 1 million, a price unaffordable for many Ugandans. Without government intervention or donor funding, private workshops cannot sustain full-fledged operations. Muhumuza called for tax waivers on machinery used in orthopedic workshops to reduce production costs.
“Most spare parts for orthopedic devices are categorized as general machinery and taxed heavily. Applying for a tax waiver from the Uganda Revenue Authority is bureaucratic and often delays the release of urgently needed equipment,” he explained.
RECOMMENDATIONS FOR A WAY FORWARD
To address the gaps and improve rehabilitation services, the report recommends that the government prioritize sustained investment in orthopedic workshops, including upgrading infrastructure, recruiting skilled staff, and reducing reliance on donor support. Additionally, removing tax barriers on essential machinery could lower production costs and expand access to assistive devices.
Despite a contested decline in disability prevalence from 12.5 per cent in 2016 to 5.7 per cent in the 2024 Uganda Bureau of Statistics census, the demand for quality rehabilitation services remains high.
NUDIPU has challenged the new figures, underscoring the urgent need for robust and sustainable disability support systems. Without strategic government intervention, Uganda risks leaving many persons with disabilities underserved and unable to access essential care.