Introduction
Uganda had a well distributed health care system in the 1960s concentrating mainly on curative care. The health sector, like all other sectors of the economy how-ever experienced significant decline from the early 1970s to mid 1980s. The health infrastructure was grossly affected and the only providers of health care services that remained were the Non Governmental Organizations (NGOs) and the missionaries.
The last 18 years have seen great reforms and improvement in healthcare despite a host of setbacks that face the sector. Although the overall health status still remains poor, there has been significant improvement in the management of the major health problems facing the country especially HIV/AIDS and malaria. The current government policy on decentralisation and liberalisation have also increased the roles of both the central and local governments in health care delivery. In addition, the private sector and its interaction with the public sector have become more prominent players in the sector.
|
 |
| © Martin Malunga |
|
|
Management of the sector
The Health Care Delivery System has undergone reorganisation and restructuring in the past decade to improve performance at all levels. The Ministry of Health is responsible for the overall policy making/formulation and setting standards for quality assurance. Headed by a Cabinet Minister and two State Ministers, the ministry mobilizes resources and co-ordinates health services at both the national and local levels. It also monitors and evaluates the overall performance of the sector.
In line with the decentralization policy, some of managerial roles of the sector were devolved to the districts. These include the implementation of the national health policies, health education, vector control and the provision of preventive and promotive as well as curative and rehabilitation services. The local governments also responsible for health education, ensuring the provision of safe water and environmental sanitation and health data collection, management and dissemination.
Existing capacity and provision of health services
There are 1,740 health facilities in Uganda of which 1,226 belong to the government. A total of 465 health facilities belong to NGOs and 49 for the private sector. This represents an increase in the total number of health service providers of about 20 per cent between 2000 and 2004. In total, there are 57 government hospitals, 44 NGO hospitals and 5 private hospitals. In addition, there are 3 private health centres and 41 other private units which include dispensaries, maternity units and sub-dispensaries. Under the Uganda Health Care facility set-up, government hospitals are in 3 categories:
• National referral hospitals which double as teaching hospitals;
• Regional referral hospitals with specialists in limited fields;
• District/rural hospitals manned by general doctors.
There are also health care training institutes which provide over 80% of the manpower requirements for the health sector. Makerere University and Mbarara University of Science and Technology produce a combined number of about 150 doctors per year. These specialize in human medicine, dentistry and pharmacy. There are also many training institutions offering diploma and certificate courses in nursing, anaesthesia, dispensing and occupational therapy, among other courses.
Uganda also has 8 research institutions falling under the umbrella of the Uganda National Health Research Organisation (UNHRO).
These include:
• The Uganda Virus Research Institute, Entebbe;
• The Cancer Institute, Mulago, Kampala;
• The Uganda Tuberculosis Investigation Centre, Mulago, Kampala;
• The National Chemotherapeutics Research Institute;
• The Central public Health Laboratory;
• The Uganda Trypanosomiasis Research Organisation, Tororo;
• The Uganda Joint Clinical Research Centre (for HIV/ AIDS), Mengo, Kampala.
Health Statistics in terms of HDI
Recent indices in the health sector show that there has been an improvement in the welfare of Ugandans. The Infant Mortality Rate (IMR) decreased from 83 to 62 between 1999 and 2003. The under 5 mortality also decreased from 142 to 121 between 1999 and 2003. The percentage of households with access to safe water increased from 57 per cent in 2000 to 61 in 2003. The percentage of households with safe disposal of sanitary facilities also increased from 85 per cent in 2000 to 89 in 2003. Reported Guinea worm cases have also decreased from 322 cases in 1999 to about 35 in 2003.
Although Uganda has achieved a lot of progress in HIV/AIDS prevention with a prevalence rate estimated at 6%, malaria remains the leading cause of mortality and morbidity. The disease is still endemic in about 95% of the country and the other 5% experience seasonal transmission and are prone to frequent epidemics. Cases of the pandemic have increased five-fold from 2,317,000 in 1997 to 12,343,411 in 2003.
Government strategy to improve the provision of health services
In recognition of the role played by the private, but not for profit missionary hospitals and other NGO health service units, government will maintain the financial grant towards these services at 17.72b in the 2004/05 FY. The availability of appropriately trained and well-motivated health workers is also being regarded as an important factor for the delivery of basic healthcare. To this end, government has enhanced salary and lunch allowance for the medical workers. An additional sh38.6b has been provided to maintain the enhanced salaries during the 2004/05 FY.
Latest developments in the sector
Government gets new malaria drug
Government is to drop the use of the Chloroquine/ Fansidar combination in favour of Artemesine combination Therapy (ACT) to treat malaria. Health Minister Brig. Jim Muhwezi announced in June 2004 that ACT, a Chinese malaria drug, has been adopted as an alternative after experts noted the progressive resistance of malaria parasites to the Chloroquine/ Fansidar combination. The new drugs would be procured before the end of this year with the help of the Global Fund. Uganda has been using the Chloroquine/Fansidar combination to treat malaria for over 40 years. In a related development, government plans to push ahead with plans to re-introduce the use of Dichlorodipheny-ltrichlor-oethane (DDT) through indoor residual spraying as the most effective and cheapest preventive measure against malaria. This will be in addition to free distribution of insecticide treated nets to households, targeting pregnant mothers and children below five years.
Free AIDS drug launched
In June 2004, the Uganda government began distributing anti-retroviral drugs (ARVs) to district and regional referral hospitals. A total of 2,700 patients were the first to benefit from the scheme, with first priority being given to the rural poor. Plans are underway to increase the number to 60,000 to 70,000 in two years. So far, most district hospitals had received the necessary training and facilitation. The ARVs worth sh1.8b, were purchased using a World Bank loan. The Ministry of Health plans to boost the programme using more monies from American President George Bush’s AIDS initiative and the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis.
Uganda to study HIV/AIDS
The Ministry of Health is to carry out a national “HIV sero-behavioral survey” to establish levels of transmission of the disease through voluntary testing and counseling before the end of 2004. The study, which will target all Ugandans, will be aimed at establishing the prevalence rates, among other things. Ministry officials hope to use the data to plan appropriate responses to the pandemic that is claiming hundreds of lives per day.
Squaring up to the challenges
Uganda’s quest to provide better and improved health has been met with a number of challenges. Notably, there is under-funding for almost all the key programmes. Depsite increased donor support, community funding schemes have not been forthcoming in raising extra resources to close the funding gap. The scaling up of schemes such as cost sharing have posed even greater challenges as global initiatives are still short of addressing the funding gap.
Secondly, government also needs to scale up funding to Primary Health Care (PHC) programmes. There is ample evidence to suggest that the 40% of the Ministry of Health budget allocated to district health services leaves a lot to be desired as far as funding immunization and basic hygiene are concerned. There is also need to streamline the health indicators used to allocate the funds.
There is also the challenge of reaching out to the poor due to the poor infrastructure and insecurity in some parts of the country. Quite often, health staff have failed to deliver services due to poor staffing, lack of equipment and drugs and insecurity. This is common in many parts of northern Uganda where tens of thousands of people live in undeplorable conditions within the Internally Displaced Persons (IDPs) camps. Conclusion
The “Health For All” campaign is one that needs to be applauded but cannot succeed unless there is concerted effort by both government and the private sector. As indicated above, the major constraint to the sector remains under-funding. Although there is global effort to fund many programmes within the sector, there is still for mobilization of resources by both the private and public sectors. A lot of effort also needs to put into promoting physical access to those areas limited by inadequate infrastructure. Staff development and drug distribution should also be streamlined to increase the levels of utilization. |
