The Cost of Inadequate Ambulances to Families in Agago

When Beatrice Adong, 29, a mother of three, went into labour with her fourth child, she knew it was another battle between life and death.

Her contractions started at 10 p.m. in Lanyirinyiri village in Lira Palwo sub-county, Agago district,  47 kilometres from Kalongo Hospital, the only hospital in the district fully equipped to handle complicated births.

When her husband called for an ambulance, he was told it had taken a patient to Kitgum General Hospital, 82 kilometres away, and would return the next day. 

“Our only option was to use a boda boda. With the bad roads, every pothole we hit felt like I would split into two,” Adong said.

Adong gave birth just about 100 meters away from the hospital gate. Luckily, both she and the twins survived.

Adong’s story is common in Agago district. In 2023, the district recorded 21 maternal deaths, with a great portion attributed to delayed access to emergency obstetric care, according to research by the National Institute of Health.

Samuel Okiror, the Acting DHO in charge of environmental health, revealed that the district currently has only one functional ambulance, which is always stationed at Patongo Health Centre IV.

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According to the Health Alternative Policy Statement for the 2025/26 Financial year, Uganda has one ambulance per 200,000 people, twice the 1:100,000 recommended by the World Health Organisation. 

Agago district has 307,235 people, according to the 2024 National Housing and Population Census report. This implies that the ambulance-to-patient ratio is higher than the national figure and the WHO recommendation.

This only puts the lives of patients at more risk, but affects them economically, as they resort to using boda bodas, which are unsafe and expensive.

“For a patient who is critically ill to reach the main hospital, sometimes you have to use up to shillings 200,000,” said David Olanya, a resident of Lira Palwo sub-county.

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With only one ambulance serving the entire district, many well-wishers now render ambulance services using personal vehicles. But these are uncomfortable and inadequate.

Jimmy Akasa Mokili, a retired soldier, said he has on several occasions been woken up in the middle of the night to transport expectant mothers or sick people to the hospital, sometimes, more than 100 kilometres away.

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Miria Omara Okidi, the chairperson Agago district health committee, said she has also been offering free ambulance services to mothers for the past five years.

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An ambulance census done in 2019 by the Ministry of Health shows that Uganda at that time had only 178 public ambulances out of the required 460 to support the health sector. 

Although the census showed that there were an additional 172 in the private sector, only a few individuals in the country can afford to pay for them.