With a population of 32 million, and women giving birth to a average of seven children each, Uganda continues to struggle with one of Africa’s highest fertility rates. The country also has a long way to go in attaining a truly responsive approach to sexual and reproductive health (SRH) interventions for all.
The fertility rate is risky to the economy and also signals danger for women who are reliant on traditional birth attendants as many of them still prefer to deliver outside the designated health facilities.
Despite the need and interest in improving healthcare across the board, as stated in Uganda’s public led sector policies, budget allocation to the health sector since 2009 has not increased significantly. In some cases, funding to health has slightly reduced meaning the meagre resources that would have been channelled to ensuring mothers deliver safely is not available. This is an unfortunate development because any reduction in the budget allocation adversely affects crucial SRH services.
The budget estimates for Uganda in financial year 2010/2011 show the portion of health sector allocations within the total budget was 10.2%. This is indicative of a slight reduction with what had been offered in 2008/09 when 10.7% was allocated. Given this trend, the much acclaimed commitment to allocate 15% of budget to health, which the Ugandan government signed up to in 2001 under the Abuja Declaration, remains a hard struggle.
Available statistics from the Uganda Ministry of Finance, Planning and Economic Development show that the country has made progress in broad areas within the health sector. The statistics indicate an increase in availability of basic medicines and 90% immunisation rates of children against major killer. In addition, we are told that infant and maternal mortality rates have been reduced to 54 per 1000 persons and 352 per 10,000 persons. However, the healthcare system still requires major improvements in access to quality basic healthcare if some of these figures can be believed.
While reading the 2012/2012 national budget, Maria Kiwanuka, the Uganda Minister of Finance, Planning and Economic Development, placed emphasis on strengthening institutional facilities.
“Government’s objective is to address poor child and maternal health weaknesses in the drug management system, inadequate health infrastructure and personnel constraints,” she said.
Government focus is also placed in motivating and retaining health workers through gradual salary increases and construction of staff houses and the construction of regional facilities in Karamoja, Kirudu and Kawempe. In addition, there is talk of the rehabilitation of referral facilities. There are also specifics mentioned such as solar powered fridges, emergency obstetric care, lifesaving medicines and kits, family planning equipment and improved mechanisms for conducting maternal and pre-natal death audits.
The government’s wish list also has the aim of: “Protecting children from pneumonia and diarrhoea by mitigating the effects of HIV/AIDS through undertaking prevention strategies such as ABC, Safe Male Circumcision, and elimination of mother to child transmission (PMTCT), while enrolling an additional 100,000 people infected with HIV/AIDS on Anti-Retroviral Treatment.”
The only problem with all these good ideas is that they are sweet to the ears but are never fully implemented.
The success of SRH rights and provision of an integrated range of services in Uganda has also benefited from public and the private partnerships such as the one between the Infectious Disease Institute and Mulago hospital, which provides a range of services exclusively to persons living with HIV/AIDS. Other organisations such as the International HIV/AIDS Alliance and Marie Stopes International are implementing maternal and family planning based interventions for specific communities in Uganda and beyond.
One of the observable challenges to SRH (and even rights) in Uganda, which an integrated approach for greater impact can address, is the fact that there has always been an uneven share of donor funding allocated to disease areas such as HIV/AIDS and malaria. In most cases the focus is on treatment not prevention. This leaves other areas unattended to such as family planning, SRH rights, cervical and breast cancer screening and the strengthening of institutional networks for increased and equitable access of services for hard to reach areas.
There is also retrogressive legislation, based on embedded stereotypes, and biased approaches to the provision of SRH and other services in Uganda and other African countries. A case in point is the threats to LGBTI and the lack of an open door policy to engaging sex workers.
While people are encouraged to bury their heads in the sand it will always be very difficult to provide services to all without discrimination. Without an openness towards tackling disease and health hazards, sickness will remain in key populations and everybody, including those who chose not to act, will eventually be affected.
James Kityo is reporting from Integration for Impact 2012, which is taking place in Nairobi, Kenya this week (12 – 14 September).