Law Development Centre
This document on health care in Uganda is written in the context of research studies on health rights with a special focus on HIV/AIDS and human rights in sub-Saharan Africa.
The author reviews the establishment of health care facilities in Uganda, which include large hospitals and private not-for-profit facilities - church-supported hospitals, medium-sized clinics, private for-profit or commercial health units, and self-employed physicians. As stated here, the share is 30% Government (Ministry of Health), 45% not-for-profit, non-governmental organisations (NGOs), and 25% for-profit (private); however, only 49% of households have access to health care facilities. "The distribution of services tends to mean rural areas are underserved and lower income households in urban areas are also underserved as for-profit outlets and crowded government hospitals are concentrated in the towns."
In order to address these issues, the Government of Uganda has developed a Health Sector Strategic Plan intended to address the issues of access by utilising the existing political structure of the country. The document states that due to a perceived lack of sufficient human resources in the health sector, capacity building is one important aspect the government is addressing. Decentralisation is part of the 1995 National Constitution; thus, Ministries are responsible for policy, standards, guidelines, and monitoring of activities, while the direct implementation of the various programmes has been placed in the hands of district officials. As observed here, decentralisation is still in its early days in Uganda, and there is an observed need for improvement on issues like ownership of the programmes, planning cycles, and accountability.
The document describes the disease burden, economic poverty, and the disempowerment of women as a context for the government's health planning. Disease accounts for the current life expectancy, between 45 and 50 years from birth; however, figuring in the impact of the HIV/AIDS pandemic, life expectancy is reduced to 42 years. "An assessment of the burden of disease in Uganda in 1995 demonstrated that 75% of life years lost due to premature death were due to ten preventable diseases. An approximate breakdown is as follows perinatal and maternal conditions accounted for 20%, malaria for 15.4%, acute lower respiratory tract infections 10.5%, AIDS 9.1%, and diarrhoea 8.4%. 38% of under fives are stunted and 25% are underweight and 5% wasted." As stated here, economic poverty is prevalent, with a high association between gender disadvantage and poverty. The marginalised position of women is created by power imbalances within communities.
A 3-, 5-, and 10-year health plan implementation system was set out in 2000. Reported results of the 3-year plan are:
- reduction of distance to health care for patients;
- transformation of Mbarara University Teaching Hospital into a national referral hospital and hospital and health centre construction, as well as mental health facility rehabilitation;
- minimisation of drug shortage through the introduction of credit lines (where districts order drugs directly from the national medical stores (NMS)) and improvement and distribution of clinical guidelines on drug use, as well as establishment of 101 Medicines and Therapeutic Committees (MTC);
- approximately 2,900 health workers recruited;
- the Home-Based Management of Fever (HBMF) strategy designed and implemented in 54 out of 56 districts (involves the training of distributors and thereafter supplying them with anti-malarial drugs), increased use of bednets, and rapid treatment of children have reduced malaria-related deaths; and
- the Uganda National Expanded Programme on Immunisation (UNEPI) implemented to immunise for 8 diseases, resulting in no cases of wild polio virus since 1997, an 85% reduction in measles cases, and no reports of guinea worm cases (of indigenous origin) in 2004.
The focus in the fight against HIV/AIDS and other sexually transmitted diseases was placed on behavioural change communication (BCC), voluntary counselling and testing (VCT), prevention of mother-to-child transmission (PMTCT), care and support including anti-retroviral therapy (ART), and a National HIV/AIDS Sero-Behavioural survey which indicated a decline in the HIV prevalence from a peak of 18 percent in 1992 to seven percent in 2005. In the area of health research, resource prioritisation efforts have particularly focused on HIV/AIDS, as well as the drafting of guidelines for registration of herbal medicines.
A setback to carrying out government health planning occurred in 2003 in the form of insurgency, which resulted in internally displaced persons (IDP) fleeing violent conflict and settling in refugee camps. There was the need for the following provision of medicine and care in the camps:
- Care for AIDS patients was done through education, provision of anti-retroviral drugs, condoms, and VCT.
- Pregnant women received clean delivery kits.
- This was coupled with the provision of emergency sanitation in the camps, control of disease outbreaks, immunisation, and training of health workers and Community Own Resource Persons (CORPs) in the management of common disease conditions.
Because the document is not available online, those who would like to receive the full document are welcome to request it from the contact available below.
Email from Evelyn Aero to The Communication Initiative on March 12 2009.