On a humid Tuesday evening, in Abim Town, 23-year-old Agnes Akello from Aninata Parish, Abim Sub-county, cradles an empty bundle of cloth. She had gone into labor at dawn, but midwives at Abim Hospital said she needed an emergency C-section due to complications, she recalls, as eclampsia.
With no single doctor on duty, she was told to find UGX 150,000 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 dead. 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, all on study leave, for over a year, a vacuum that has drawn grave concern from residents and health activists.
When Doctors Are Gone
At Alerek Health Center III, 22-year-old Stella Aloyo went into labor on September 28th, 2024. Midwives there discovered 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 on.
According to midwives there, the unnamed doctor, whose qualifications remain unclear, is sometimes summoned in emergencies. While his intervention saved Aloyo and her baby, it raises questions about informal and 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 before 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, who was interdicted in 2024 for corruption and negligence; Dr. Godmercy Abelle, currently on study leave; Dr. Harriet Achaa, partially available; Dr. Denis Olanya, newly added to the team; Dr. Okengo Anthony, whose leave has expired but who has not yet returned; and Dr. Kenneth Kahunda Okumu, the Medical Superintendent, who is partially present but focuses on administration rather than patient care.
The Maternity Wing Crisis
At the heart of the doctors’ 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 without adequate support from doctors. They report delivering between 10 and 15 women each day under extremely strenuous conditions.
A midwife at the maternity ward who preferred anonymity for fear of reprimand by her superiors says that in emergency cases 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
During a recent visit to St. Kizito Hospital Matany in Napak District, I went to verify reports of increased patient referrals from Abim Hospital and witnessed firsthand the mounting pressure. At the emergency unit, a grey double-cabin pickup truck with Abim district markings was parked, confirming what hospital staff had told me. The driver had arrived with a midwife, transporting a mother and her two premature newborns. Tragically, one of the babies had died just before reaching Matany.
Nearby, in the casualty ward, lay 46-year-old Michael Ochoria from Kawang Village in Alerek Sub-county. He had been attacked by a stray buffalo while working in his garden. The animal trampled him, leaving a severely torn abdomen. 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 in Matany. Matany administrators say they receive three to five referrals from Abim daily, most involving expectant mothers or accident victims.
Turning to Traditional Birth Attendants
With available health facilities unable to provide reliable maternal and emergency services, some expectant mothers are turning to Traditional Birth Attendants (TBAs), a practice once discouraged by the Ministry of Health. In Atunga Sub-county, 75-year-old Ceasaria Apio continues to assist women during childbirth, as she has since the 1980s. She works with what she has: her hands, herbs, and basic tools—a razor blade, thread, and millet porridge for recovery in case of complications.
The absence of doctors is only the tip of the iceberg. A closer look at Abim Hospital reveals a string of systemic issues. During my visit, attendants in the wards were ordered by 5:30 a.m. to fetch water in jerrycans from outside sources to fill blue drums for ward use due to persistent water scarcity. Caregivers were then instructed to clean the filthy bathrooms themselves, often without protective gear. Failure to comply could attract punishment. As night falls, the wards remain dark. Electricity is unreliable, and in emergencies, caregivers and midwives on night duty often rely on mobile phone torches and other improvised light sources to carry out deliveries.
The district currently has only one functional ambulance serving all 13 administrative units, including the main hospital. If that vehicle breaks down, the only fallback is the Ministry of Health’s COVID-19 distributed double-cabin vehicle, which is poorly equipped for emergencies. Established in 1969 during President Milton Obote’s administration, Abim Hospital was once envisioned as a cornerstone of public health in the region. Over the decades, however, it has steadily deteriorated due to a range of challenges.
The facility gained national attention in 2015 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—a statement that sparked a nationwide uproar.
Youth Leaders Raise Alarm
In 2024, Abim’s District Youth Chairperson, Earnest Ayen, led a public health exhibition campaign to expose the hospital’s conditions. Posters highlighted shortages of doctors, drug stockouts, and crumbling infrastructure. The campaign gained traction on social media and caught the attention of district leaders, but little change has followed.
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 to halt all new study leave approvals for health workers in the near term, a decision he says is 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 course’s relevance to the health sector and advises on whether the absence can be managed without affecting service delivery.
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, political leaders claim that doctors are on 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 these underserved areas.
Budget Without Impact
In the current financial year 2025/26, the Government of Uganda allocated the lion’s share of Abim District’s budget—UGX 5.41 billion—toward staff salaries under Primary Health Care services. However, despite these significant allocations, health experts argue that little value is being realized on the ground. For instance, the government continues to spend over UGX 400 million annually on salaries and allowances for the six doctors officially deployed at Abim Hospital.
Experts say this expenditure is not commensurate with the services delivered. Despite multiple attempts, efforts to obtain comments from the District Health Officer and the District LCV Chairperson were unsuccessful, as both officials failed to honor several scheduled interviews. This has left key questions about accountability and 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 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 becomes a gamble between life and loss—a stark reminder that healthcare should not depend on luck, but on leadership that truly cares.
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