Days after an emergency cesarean section at a private clinic, Barbara Kwarikunda experienced excruciating pain.
“I couldn’t eat,” she says. “I would feel pain whenever someone touched me. My stomach was swollen. I felt like something was bursting in my uterus.”
Visits to the clinic didn’t help. An examination at a public hospital revealed that the people who operated on her left cotton and gauze in her uterus. They also slightly severed her intestine, which caused internal leaking. She required another surgery to remove the cotton and cause, and fix the cut.
It isn’t clear if the employee who performed the surgery was licensed to do so. But the private facility where Kwarikunda underwent her emergency cesarean section, Cleveland Specialized Clinic, has been in the spotlight after a local media investigation alleged that the clinic operator, Ken Nyombi, was using someone else’s credentials to practice medicine. The clinic is now closed, and Nyombi is in prison. He was not allowed to speak to the media when he appeared for a hearing.
His case is one of 10 cases under investigation by the Directorate of Public Prosecution for illegal medical practice and related fraud, says Irene Nakimbugwe, the deputy public relations officer and chief state attorney. Other cases, she says, involve incidents at both public and private health care facilities.
Such cases have been on the rise, as the country’s health care system struggles with limited resources and regulatory neglect.
Unqualified medical practitioners exploit loopholes to illegitimately obtain medical licenses, while others run private clinics without licenses. They not only perform basic medical care but sometimes conduct surgeries and other complex procedures, leading to serious errors and patient fatalities. In one case that gained international media attention in 2019, an American missionary without medical training ran an unlicensed center for malnourished children in Uganda, where, according to lawsuit documents, medical procedures claimed the lives of hundreds of children.
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The culprit, according to a 2021 report commissioned by the Inspectorate of Government, is widespread corruption. Unqualified people can often get hired in health care roles by paying bribes. While there are strict rules for licensing health care workers and private clinics, authorities may overlook missing documentation, and politicians can sway recruitment. Pharmacies that don’t meet standards can buy licenses, and inspectors may ignore improper medicine storage — for the right price.
It doesn’t help that regulatory bodies are stretched thin, according to a Ministry of Health report. They lack the resources to effectively implement the requirements, which means unqualified people can easily treat unsuspecting patients for years.
The Uganda Medical and Dental Practitioners Council, which licenses health care workers, did not respond to several requests for comment.
Emmanuel Ainebyoona, the senior public relations officer at the Ministry of Health, says the ministry relies on professional bodies such as the medical council to validate credentials.
“You must be in that graduation booklet of the institution on the date you say you graduated,” he says.
Employers are also supposed to verify academic documents with the issuing institutions before hiring someone, but that doesn’t always happen, says Dr. Innocent Ssemanda, an epidemiologist and researcher at the health ministry. This includes those hiring within the government, he says.
“[People] know that nobody will go to [the Uganda National Examinations Board] to confirm that you are what you claim to be,” he says.
Such loopholes make it possible for an unqualified person to practice medicine with another person’s credentials.
It even happened to Ssemanda. An imposter used his documents and license for over a decade, he says.
In 2020, he says, he went to renew his license, only to find that while the credentials in the government records were his, the photo belonged to someone else. A staff member confirmed that someone else had applied for a license using his academic credentials. He reached out to the medical council registrar, but there was no immediate action. In 2022, after the medical council digitized its system, Ssemanda received an alert that someone had downloaded his license. He visited the registrar’s office and corrected his details. But in 2024, colleagues informed him that someone claiming to be him had attended a Ministry of Health training.
This time, he turned to local media. It triggered an investigation by a local television channel, and authorities got involved. The person allegedly impersonating him was the owner of Cleveland Specialized Clinic, one of the cases under investigation by the Directorate of Public Prosecution and where Kwarikunda received the botched surgery.
In some cases, all one needs to pose as a doctor is a lab coat.
Dr. Warren Namaara, director of the State House Health Monitoring Unit, a government body, says there have been cases where a person will just walk into a public health care facility and start treating patients to make money. They may bribe security personnel for entry.
Most hospitals are understaffed, and health workers are too busy to pay close attention, Namaara says. The current doctor to patient ratio is 1 for every 1,400 people. The World Health Organization recommends at least 2.5 medical staff per 1,000 people.
It’s shocking that anyone could walk into a hospital and start treating people, says Flavia Zalwango, director of programs at the Human Rights Awareness and Promotion Forum, a local NGO.
“How can staff walk in and start offering services to customers, and you don’t know?” Zalwango says.
To root out the problem, everyone, including the public, needs to be involved, says Nakimbugwe, the chief state attorney. They need to report any questionable conduct from doctors in their communities, she says.
The government is already on high alert, says Namaara, adding that the State House Health Monitoring Unit has a toll-free line for the public to report such cases.
“It can’t be ironed out in one day,” he says. “It has to be a sustained effort.”
But Kwarikunda feels it’s on the government to root out fraud. By the time a Ugandan seeks medical treatment, they trust that the government has already verified the person treating them, she says.
Medical malpractice can be costly. Kwarikunda’s botched surgery and related treatment cost her 1.3 million Ugandan shillings (about US$354), which she paid out of pocket.
In January 2024, Peter, who prefers to be identified by only one name for fear of stigma, took his wife to Cleveland Specialized Clinic. She had missed her period several times but had been on contraceptives, so they didn’t think she was pregnant.
The health care worker recommended an ultrasound, which, according to the results presented to them, showed that she had fibroids and required an operation. They sought a second opinion at Kasangati Health Centre.
It wasn’t fibroids. His wife was pregnant and has since delivered a baby boy.
- Apophia Agiresaasi is a Global Press Journal reporter based in Kampala, Uganda.
- Global Press is an award-winning international news publication with more than 40 independent newsrooms in Africa, Asia and Latin America.
