Access to formal healthcare services in rural Uganda: why non-medical social resources matter

Since the 1978 Alma Ata Declaration, there has been growing consensus that the solutions to the challenges of access to formal healthcare in low income countries are as social as they are medical. However, there is limited consensus on how to translate this knowledge into locally adapted solutions that enable vulnerable populations access formal healthcare services. Based on ethnographic fieldwork conducted between 2012 and 2014 in a rural community in central Uganda, this dissertation analyses the contribution of the non-medical resources that enable people to meet the direct and indirect costs of formal healthcare. People’s comments on longstanding friendships, village savings and loan associations, informal transport providers and mobilizing each other to help the needy indicated that these practices help in overcoming problems of poverty and accessing distant health facilities. Terms such as “twekolamu omulimu”, translated as “we mobilize ourselves”, were used to refer to a sense of collective mobilization of resources for meeting the costs of healthcare access especially for those members considered unable to meet health related costs. The idea of “twekolamu omulimu” unfolds a novel perspective on the embeddedness of formal healthcare seeking practices in rural Uganda. The effectiveness of these processes in tackling the everyday obstacles to formal healthcare is premised on their natural characteristics and ability to trigger grassroots initiatives, whereby healthcare access barriers are solved as other problems are solved through social networks. Although these processes lie outside the traditional boundaries of the formal healthcare system, they nonetheless present opportunities for a people-centered approach towards improving access to formal healthcare.