The status of Health in Uganda is at the forefront of the overall development Programme of Government. It is one of the key areas identified in the Poverty Eradication Action Plan (PEAP) which is the guiding document in poverty eradication in Uganda.





The current government policy on decentra-lisation and liberalisation has changed the roles of both central and local governments in health care delivery. Furthermore, the Private sector and its interaction with the public sector have become more prominent. In this respect, government has produced a National Health Policy document and a National Health Sector Strategic Plan for Uganda.

The National Health Policy

The National Health Policy sets out guidelines intended to achieve the overall goal of attainment of a good standard of health by all the people in Uganda in order to promote a healthy and productive life. The overall policy objective is to reduce morbidity, mortality, fertility and ensure a National Minimum Health Care Package (NMHCP) strategy for Uganda.

The overall strategy aims to :
- Continue to promote Primary Health Care as a basic philosophy through the NMHCP,
- Ensure equitable distribution of health services throughout the country. Priority is being given to further decentralisation of the health care delivery system to increase access,
- Provide good quality health care through cost-effective interventions targeted at the most important health problems of the population,
- Maintain a high level of efficiency and accountability in the development and management of the national health system, provide greater attention and support to health promotion, disease prevention and empowerment of individuals and communities for a more active role in health management,
- Cater for the emerging health problems including the care for the elderly,
- Strengthen the existing collaboration and partnership between the public and the private sectors in health, including NGOs, private and traditional practitioners while safe guarding the identity of each,
- Promote and consolidate intersectoral co-operation and co-ordination between the different health related ministries, and development agencies engaged in health development and,
Intensify efforts to promote sustainable additional health financing mechanisms.
The Health Sector Strategic Plan 2000/01 - 2004/05


The Health Sector Strategic Plan (HSSP) has been developed as a collaborative undertaking of the Ministry of Health, Development Partners and other stakeholders. It acts as the Implementation Strategy for the National Health Policy and prioritizes areas of action, set targets and, defines Organisational and Management approaches for the health sector.

The principal aims of HSSP are to :
- Improve access of the population to the National Minimum Health Care Package (NMHCP) with emphasis on increasing effective access for the poor, the difficult to reach and the disadvantaged,
- Improve the quality of delivery of the Package,
- Reduce inequalities between various segments of the Population in accessing quality services.

Special attention will be paid to :
- Training, recruitment, rational deployment, motivation and retention of qualified staff across the country,
- Rehabilitation and improvement in performance of existing facilities while providing new facilities to identified under-served populations,
- Social mobilisation for community empowerment and participation in the management and monitoring of health services and,
- Better coordination and management of resources through ensuring that all stakeholders adhere to the Sector-Wide Approaches (SWAps) code of conduct.



The Uganda National Minimum Health Care Package has nine technical health care programmes namely :

- Control of communicable diseases. q Integrated management of Child-hood illnesses.

- Sexual and Reproductive Health and Rights.

- Immunization. q Environmental Health. q Health Education and promotion.

- School Health.

- Epidemic and Disaster Prevention, Preparedness and Reponses.

- Improving Nutrition.

These programmes are considered as cost-effective interventions with high impact on reducing morbidity and mortality identified under the existing resources. Clearly, there are other emerging illnesses not catered for under the minimum health care package which are potential areas for investment. These include the cardiovascular conditions and Trauma/accidents among others.

The implementation of the National Health Policy will therefore involve Government and other stakeholders including the Private Sector and will inevitably contribute towards good health.

Performance and Achievements made within the Health Sector

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 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.

Although the health status remains poor, there has been signi-ficant improvement as manifested by the following statistics collected through the population census, the 1995 Uganda Demographic and Health Survey and the Uganda National Household Survey 1999/2000 :

- IMR decreased from 122 to 97 between 1991 and 1999.

- Under 5 Mortality also decreased from 203 to 147 between 1991 and 1995.

- The percentage of households with access to safe water increased from 48 percent in 1995 to 57 percent in 2000.

- The percentage of households with safe disposal of sanitary facilities increased from 77 percent in 1992 to 85 percent in 2000.

- Reported Guinea worm cases have decreased from 1,455 cases in 1995 to 322 cases in 1999.

- According to Uganda National Household Survey 1999/2000, there has been an improvement in the welfare of Ugandans between 1992 and 2000. Recent poverty indicators show that the proportion of Ugandans living below the poverty line has declined from 44 percent in 1997 to 35 percent in 1999/2000.

These improvements can be attributed to sound macroeconomic policies that have resulted in an annual average growth of GDP of over 5 percent as well as increases in people's incomes. In addition, improvements in government allocation to the health sector, introduction of Safe Motherhood Initiatives, intensification of the Immunisation Program and people's involvement in the management of health services all contributed to this performance. The above impro-vements notwithstanding, the resource constraints of government limits it to focussing on only those key areas as identified in the National Minimum Health Care Package. This further leaves many of the curative services as potential areas of investment in the health sector.

Table 1 : Number of Health Units by Ownership

Facility

Government

Non-
Governmental
Organization

Private

Total

Hospitals

57

44

5

106

Health Centre

179

68

3

250

Pilliative Care

1

1

-

2

Other*

989

352

41

1382

Total

1226

465

49

1740

Source : Ministry of Health * The category ÒOthersÓ include dispensaries, maternity units, sub-dispensaries and dispensary-maternity units (DMU).

Availability of Health Facilities

There are 1,740 health facilities in Uganda of which 1,226 belong to government, 465 for NGOs and 49 for the private sector. This represents an increase in the total number of health service providers of about 15 percent (233 units) between 1996 and 2000.

Government hospitals are in three categories :
- National referral hospitals which double as teaching hospitals,
- Regional referral hospitals with specialists in limited fields and,
- District/rural hospitals manned by general doctors. These comprise of all the government hospitals not mentioned above.

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. The rest are owned by either government or NGOs.

Training

Health care training institutes continue to provide about 80 percent of the manpower requirements of the health sector in Uganda.

Research Institutions

Research plays a crucial role in informing policy and creates a culture of evidence based planning and decision making. In Uganda, there are 8 research institutions falling under the umbrella of the Uganda National Health Research Organization (UNHRO).
These include :
  • Uganda Virus Research Institute, Entebbe.
  • Uganda Cancer Institute, Mulago, Kampala.
  • Uganda Tuberculosis Investigation Centre, Mulago, Kampala.
  • The Natural Chemotherapeutics Research Institute. n Central Public Health Laboratory.
  • Uganda Trypanosomiasis Research Organization, Tororo. n Uganda Joint Clinical Research Centre (research on HIV/AIDS/ STD), Mengo, Kampala. n Uganda Heart Institute, Mulago, Kampala.

The UNHRO provides guide-lines and is also responsible for administration of the above named Research Institution.

Professional Councils

It is important for an investor who is interested in the health sector to know the roles and functions of Professional Councils existing in the country. There are four statutory Professional Councils whose responsibility is to ensure good professional practise and quality of care.
These include :

  • Medical and Dental Practitioners Council,
  • Nurses and Midwives Council,
  • Allied Health Professional Council and,
  • the Pharmaceutical Council.
Health Commissions and Pharmaceutical Institutions

There are two Health Commis-sions and two Pharmaceutical Institutions in Uganda. The Health Commissions comprise of the Health Service Commission and the Uganda AIDS Commission. The former is responsible for overseeing the National Health system in terms of appointments and training while the latter is charged with the task of prevention and control of AIDS in the whole country.

Pharmaceutical Institutions include the National Drug Authority (NDA) and National Medical Stores (NMS). NDA is responsible for ensuring the availability at all times of essential, efficacious and cost-effective drugs to the country's population. The NMS on the other hand, is charged with the procurement of medical supplies for the government health services.

Arrangements are underway for government to sell off some of its shares to the private sector. Investment opportunities are abound in the pharmaceutical industries to supply the drugs to health care providers.

Manpower in the Healthcare Industry

Since 1996, there has been a restructuring and reorganization of the health sector. As a result, there are currently 18,102 health workers in the health sector compared to 19,849 in 1996. About 70 percent of these health workers are in government health facilities while only 2 percent are in the private sector. The rest of the health workers are in NGO institutions. Forty seven percent of the health workers are in government hospitals while 43 percent are in government health centres. In the NGO sector, 60 percent of the health workers are in NGO hospitals. There are only 269 medical specialists in the country. It is important to note that the private sector has slowly but steadly increased its participation in health care delivery. Given the number of specialists in the country, the private sector stands to fully utilise this existing resource in advancing specialised health care delivery, especially in those areas not targeted for funding under the Minimum Health Care Package.

Financing Healthcare in Uganda

According to the National Health Accounts for Uganda for the financial year 1997/98, the major sources of funds for the health sector in Uganda are the Donor community, Government and the Private sector. Donors contribute about 43 percent, while government and the Private sector contributes 20 and 37 percent respectively.