DEMAND AND AFFORDABILITY

I was recently in one of those WhatsApp groups where the conversation went deep into Uganda’s healthcare system. One person raised a concern: They explained that about six or more of their specialist friends are leaving the country to practice elsewhere. Their fear was that this exodus could worsen Uganda’s already fragile healthcare system, especially since specialists, particularly in pediatrics and surgery, are already in short supply.

I offered a different perspective.

I agreed that there is a genuine concern regarding the scarcity of pediatricians and surgeons in Uganda. The numbers are indeed low, and the few available are often in areas where the demand is. However, I argued that the demand for these specialists is more driven by affordability than by pure scarcity. In fact, there is enough supply of specialists to meet the needs of those who can afford their services.

Take C-Care as a perfect example. With 22 facilities across the country, we have tailored our specialist offerings to match the specific needs of each location. In some places, we have full-time pediatricians, gynecologists, and surgeons because that’s where the demand is highest. These are areas with a population that has the financial means to pay for specialized care. On the other hand, in other locations, we might not have full-time specialists in these fields. Why? Simply put, affordability!

In places where the population isn’t able to afford specialized care, it just doesn’t make sense, from an operational standpoint, to station a full-time pediatrician or surgeon. The demand simply isn’t there, and we would be investing resources into something that wouldn’t be financially sustainable. The reality is that demand for specialties is directly tied to the ability to pay for them.

We have used data from reliable resources, and I encourage anyone interested to verify these insights through other sources. To demonstrate the demand and utilization of different specialties in various regions of the country, it’s clear that healthcare needs in urban centers like Kampala and Mbarara are drastically different from those in rural areas like Karamoja or Adjumani. The higher-income groups are more likely to demand specialized services and advanced diagnostics. In contrast, rural populations often rely on general practitioners and basic healthcare services, simply because they cannot afford specialist services.

In areas where the population can't afford specialized care or where stationing a full-time specialist doesn’t make sense, the adoption of rotating specialists who come on specific days or using telemedicine works perfectly.

And here’s the thing: It doesn’t mean the demand isn’t there, it’s just latent. The potential for growth is huge. What we have mastered at C-Care is the ability to understand demand at a granular level in different locations. We know where specialists are needed and where we can make strategic decisions, like rotating specialists or investing in telemedicine, to fill gaps.

For instance, in our facilities where pediatricians are available full-time, they are often booked out for weeks because the demand is consistent, driven by those who can afford it. Meanwhile, in other areas, we have a more balanced approach with visiting specialists or GPs who can still provide quality care to those who need it but cannot afford a full-time pediatrician.

Again, this doesn’t mean that Uganda’s healthcare system is broken, it’s simply evolving. The question we must continue to ask ourselves is: How can we meet the growing desire/need for specialist care without leaving anyone behind? That’s where partnerships, innovations in payment solutions, and strategic planning come into play.

The idea of specialists leaving Uganda is indeed a concern, but it’s also an opportunity for us to rethink how we approach demand and affordability. Rather than bemoan the lack of specialists, we need to focus on how to make specialist care more accessible, even in areas where affordability is an issue. We need to look at the behaviors of individuals as well. Saving for health already looks like a taboo, yet we have very flexible payment solutions such as the C-Care card, which allows you to prepay for future use.

The solution isn’t entirely about having more specialists; but ensuring that we can match the right specialists with the right demand, in the right places, at the right price.

So, as I shared in that WhatsApp group, in fact, I dropped out of the conversation because I knew they wouldn’t quite understand where I was coming from, which I have labored to explain here in more depth. While we cannot ignore the challenges, we can confidently say that specialists are enough to meet the demand for those who can afford it. But we must continue to innovate and strategize to bridge the gap for those who can’t and for the future.

What do you think?

How is it in other countries?