Health in Uganda

PEACE AND STABILITY

Uganda’s health sector was dealt a severe blow in 70s and early 80s due to the reigning civil war and anarchy at the time. With the dawn of peace and stability in 1986, the health sector slowly started to recover. The impact could not be realized immediately however, due to the healthcare system and infrastructure nearly having collapsed. The National Resistance Movement (NRM) government started laying the foundation for revamping the health sector. Today the sector has changed tremendously compared to what it was 26 years ago. In 1990 health care in Uganda started getting on track after political stability and economic recovery interventions started taking root following the end of the five-year war that brought the NRM to power in 1986.

Fundamental changes in the economy and in the health sector have occurred since 1986 and this period is viewed as having been the most innovative period in Uganda’s history. The government has opened up new health centers on top of old regional hospitals in an effort to take health services nearer to people. The government policy over the last 15 years has been to construct health centers at every county or constituent and 80% of this has already been done. 

To appreciate achievements, failures and expectations, one needs to look at the entire history of the health sector in Uganda. The period from 1889-1962 saw the establishment of modern healthcare under the British colonial rule; 1962-1970 was the post-independence period characterized by the consolidation of the period of civil infrastructure, expansion and improvement; 1971-1986 was the period of civil conflict and mismanagement, characterized by health service deterioration, neglect and disintegration. From 1986 to date, has been a period of economic and health sector reforms and innovation.

ACHIEVEMENTS AND RESULTS

Fight against HIV/AIDS

AIDS/HIV cases were first recognized in Uganda in 1983, with about 900 cases reported by 1986, rising to 6,000 cases by 1988. Uganda responded by taking an open stance to the epidemic and was among the first African countries to establish a national AIDS Control Program (ACP) and the National Committee for the Prevention of AIDS (NCPA). Working with financial and technical support from WHO, ACP launched and effectively coordinated the first multi-sectoral mobilization campaign through which HIV prevention messages were widely disseminated in the country at a critical time when there was a dearth of knowledge and information about the epidemic. 

By the early 1990s Uganda was among the African countries worst hit by the HIV/AIDS epidemic. However, with strong political leadership from the National Resistance Movement (NRM) under President Museveni, a vibrant civil society, and an open and multi-sectoral approach, Uganda sustained an impressive response to the epidemic. Through the technical oversight and direction of Ministry of Health (MOH), the first national blood transfusion service, the first voluntary, confidential counseling and testing service, the first HIV/AIDS care and support organization and the first national STD control program were initiated in Uganda.  Together these interventions helped to slow down the epidemic. 

To further Uganda's efforts in establishing a comprehensive HIV/AIDS program, the Ministry of Health (MOH) implemented birth practices and safe infant feeding counseling in 2000. According to the WHO, around 41,000 women received Preventing Mother To child Transmission (PMTCT) services in 2001.

Establishment of Malaria Control Program (MCP)

The Malaria Control Program (MCP) was established in 1995 by the Ministry of Health to direct and guide the day-to-day implementation of the National Malaria Control Strategy.
The role of the MCP at central level is to support the implementation of the National Malaria Control Strategy through policy formulation, setting standards and quality assurance, resource mobilization, capacity development and technical support, malaria epidemic control, coordination of malaria research, and monitoring and evaluation. The MCP improves its outreach to districts through zonal Roll Back Malaria (RBM) and Integrated Management of Childhood Illness (IMCI) teams which work closely with the District Malaria Focal Persons.

Establishment of National Tuberculosis and Leprosy Program (NTLP)

The National TB and Leprosy Program (NTLP) is a program of the department of the National Disease Control within the Ministry of Health whose overall functions are to establish country wide quality diagnosis and treatment services for TB and Leprosy and to coordinate the implementation of TB and Leprosy control activities. The key functions of the Central Unit of NTLP are to (i) set policies, standards, technical and operational guidelines, (ii) plan, (iii) conduct training, (iv) ensure procurement and regular distribution of drugs and supplies, (v) technical support supervision, (vi) Partner coordination and overall coordination of TB control activities countrywide, (vii) Advocacy communication and social mobilization, (viii) monitoring and evaluation, and (ix) setting diagnostic and quality standards for central and peripheral laboratories. The TB services are integrated into the general health care system and are further decentralized to community level to ensure active community involvement and ownership.

Construction and Rehabilitation of Hospitals and Health Centers

NRM’s focus in the health sector has been to increase access and the quality of healthcare in the country through provision and utilization of curative rehabilitative medical services. Of particular interest is the monitoring of and development of partner funds channeled to the health sector. During 1986-2012, much progress was made in the health sector. The total number of health units has grown from about 1200 to 2314. The current number includes 109 hospitals, 159 health center IVs, 778 health centers IIs, and 1268 health centers IIs. 

Abolition of user fees

By the late 1990s, there were conflicting opinions about the effect of user fees on access to health services, particularly by the poor and other vulnerable groups, In March 2001, the NRM government abolished user fees in all public health units/hospitals in Uganda except for private wings in hospitals. This led to a significant and immediate increase in utilization of health care services.

Public-private partnership in health: working together to improve health sector performance in Uganda

One of the major reforms in the health sector of Uganda has been in the area of public-private partnership in health. Partnerships in health are increasingly seen as a valuable mechanism for moving faster towards the attainment of national and international health goals. Recent initiatives such as the Global Fund to Fight HIV/AIDS, TB and Malaria and the Poverty Reduction Strategy process contain an emphasis on public-private partnership. Partnership in health in Uganda is a key feature of the National Health Policy and the Health Sector Strategic Plan, and in the sector wide approach processes and structures. 

The government is also providing increasing financial support to this sub-sector and structures have been established to facilitate dialogue (e.g. a partnership office). There is evidence that the current partnership has brought dividends to the whole health sector in terms of increased access, quality, equity and efficiency, although as yet these rewards pertain mainly to partnership with the private-not-for-profit sector and progress is yet to be seen with the other private partners in the sector (for-profit, and the traditional and complementary medicine sub-sectors).