The Post 2015 Development Agenda: What can the Ugandan government do?

Based on my experience of working with persons living with HIV/AIDS in Nakaseke and Luwero in Uganda, my natural instinct as an advocate would be to put a strong emphasis on the sexual and reproductive health of women living with HIV. There are so many challenges that women living with HIV and young girls face – some of them want to have children who are free from HIV, some need family planning interventions, others face stigma in health facilities and many do not have access to basic sexual and reproductive health and rights (SRHR) information that would propel them into being independent happy people who can freely decide for themselves what they want.

Up until recently – about three months ago – there were no HIV test kits in the rural hospitals. This has particular implications for the new intervention known as option B+ – where a women who tests HIV positive and is pregnant is started on anteretroviral treatment (ART) for life. The government of Uganda’s commitments seem to be more generalised for the broader population of women as seen in this statement:

“The government of Uganda upholds its commitment to increase the number of health centre IVs with comprehensive Emergency Obstetrics Neonatal care equipment services from 17% to 50% and the number of health centre IIIs with basic Emergency Obstetrics neonatal care equipment services from 17% to 50%.”

The general feeling in Uganda is that the Ministry of Health and the national medical stores (NMS) should ensure adequate and timely procurement and delivery of Emergency Obstetrics neonatal care equipment and supplies to the health facilities so that 50% of Health Centre IIs and IVs are fully functional. But this has not been achieved since officials from the national medical stores continuously blame the health facilities for not always making timely requisitions and those who make them, for not collecting their allotted portions of medicines in time. The facilities hit back that they do not have transport and fuel facilitation for that purpose. Some of them have to wait until a district official is visiting the capital as that is when he will be directed to use a government vehicle to visit the medical stores to collect their allocations.

However, when it comes to the global agenda, the story is not that bad.  There has been tremendous progress for girls and women under the Millennium Development Goals (MDGs) and credible authorities who attended the Women Deliver conference in Malaysia agree that there are now fewer women living in extreme poverty, maternal deaths have nearly halved and more women have access to contraception. Newborn deaths have declined by 28% and new HIV infections among women are on the decline.

Helen Clark, administrator of the United Nations Development Programme, observed that: “The MDGs have made progress. The process still has two years to run. The member states of the UN have to determine this agenda.  We hope for enthusiasm and momentum out of this conference.”

She continued: “Uganda was a success story in the fight against HIV in the early 1990s and it was good news. But recently I was in Uganda, and observed that infections were going up. The renewed effort in the post MDGs should be to ensure that there are zero new infections for mother to child transmissions and to achieve this we need a lot of commitment from the leadership at the top. We need to reorganise our campaigns with new messages and a focus. The other good news is that governments are now portioning their domestic budget for HIV – it is no longer a Global Fund issue alone”.

Dr Fred Sai, a former advisor on reproductive health and HIV/AIDS for the government of Ghana, is hopeful that a lot can be achieved. “I am glad that an increasing number of women now have access to the sexual and reproductive health services that they need,” he said, “but despite the many impressive achievements and advances, we still have a lot to do. The numbers of deaths are still high and shocking, especially in Asia and sub-Saharan Africa. It is disappointing to note that there is still a debate on whether family planning is a right or not. Women have a right to decide on whether they should have children. We agreed on this in Bucharest in 1974, why should there be a quarrel about this?

“When we give women this chance, we should know that we are contributing to the development of our countries. The importance is not only for women but for their children as well and you shouldn’t be surprised that we say the same things again and again. Christianity has been saying the same things again and again for a very long time”

Some of the Uganda members of parliament at the conference also have their take on the prospects ahead for the MDGs and how the Uganda government should respond. Hon. Chris Baryomunsi MP is cautious. “If we are to achieve some of these targets, the government of Uganda through the Ministry of Finance must be flexible to increase how much money they can allocate to the Ministry of Health. Much as the resources are inadequate, we feel that even the resources which go to the Ministry of Health are not adequately used. For Uganda, strategies for reducing maternal mortality are well documented, and we do not need to reinvent the wheel. We should borrow what has worked in other countries, like employ midwives as community agents to reduce mortality arising out of gaps in emergency obstetrics neonatal care in health centre IIIs and health centre IVs.”

Another member of parliament, Samuel Lyomoki, thinks the failure to achieve the MDGs is due to lack of money and challenges withing the lower level health system like village health teams (VHTs).

He said: “We have proposed to the government of Uganda to increase exercise duty on cigarettes, so that the money raised should go to the Ministry of Health.  We have very poor village health teams, working among poor communities. The aspect of motivation must be addressed. Some villages do not have VHTs. These VHTs are working hand in hand with donor partners – where there are no donor partners to facilitate them, the VHTs are not there.”

Based on some of these remarks and what is evident in the rural areas, it is important for Uganda to address the existing gaps and properly focus to embrace the post 2015 goals. But for now, can the government employ midwives to rural communities for sensitisation when those in health facilities are not motivated? Some of the Ugandan MPs noted that even for some jobs advertised, no health workers have applied to go and work in the rural areas.

It is to be hoped that a private members bill, to be tabled by Chris Baryomunsi to levy money from the tobacco industry and channel the money to health of mothers will bring in some change. It is also good news that the Ugandan MPs at Women Deliver are devising ways to achieve a woman-centred post 2015 development agenda that recognises the importance of sexual and reproductive health and rights in a sustainable environment.