Changing patterns in the organization of the venereal diseases and treponematoses service in Uganda.

Concern for venereal disease (VD) in Uganda led to the building of a special hospital in 1912-13 to provide treatment. This was later to become the national reference hospital, now called Mulago Hospital. Within a few years more VD treatment centers operated by trained indigenous clinical assistants were opened. These centers formed the basis of the future expansion of the general medical services in some parts of Uganda in the 1920s. In regard to the present VD services, they cannot be described in isolation. There are no special VD services in Uganda except in the largest hospital. To understand how and where these services are provided requires a description of the relevant parts of the organization of Uganda's health services. Currently, Uganda has a reasonable network of health services throughout the country. These are primarily provided by the government and are organized on a regional and district basis--hospitals being situated in the main towns with health centers, dispensaries, and aid posts serving the rural areas. All basic health services provided by the government are free of charge. Private practitioners are concentrated in the main towns. There are also some missionary medical units and a few provided by industry. Rural health centers and dispensaries form the backbone of the health services and cater to over 90% of the population. These are frequently understaffed with mostly well trained general duty medical auxiliaries but laboratory facilities and supplies of appropriate drugs are inadequate. VD is diagnosed and treated in all the medical units mentioned, mostly on an outpatient basis by auxiliaries with no special training in this area. Some important developments in the VD service in recent years include a reawakening of interest and a beginning of the recognition of the problem, the establishment of a few centers on a scientific basis, and the appointment of a specialist at the Mulago Hospital. As there are several problems more important than VD which require personnel, money, and materials, the possibilities for improvement in VD services within the existing framework are limited. Specialist and all but simple laboratory services will continue to be confined to the capital city of Kampala for some time to come. The bulk of VD patients in the remainder of the country will continue to be seen by the auxiliaries in the district hospitals and the rural medical units with variable amounts of supervision by doctors within the existing framework.