Health Sector in Uganda after 50 years; Is there progress?

By Esther Nakkazi

When the Organisation of African Unity (OAU) was held in Kampala in 1975, delegates of the meeting were taken to tour the Uganda Cancer Institute at Mulago referral hospital.

It was a showcase of an effectively and efficiently run Uganda institution with enough equipment, human resource and research that made a break through on liver cancer treatment to the world.

Dr. Charles Olweny, who was heading the UCI at the time, says the place was ‘booming’ so whenever there were guests in Kampala, they were taken to tour the Institute.

“It was hectic but enjoyable. The Institute made its name and we followed up on every patient and knew everything about every one of them.”

Mulago Hospital in the 1960’s was a centre of excellence in East and possibly central Africa, serving as the teaching hospital for the East African Medical School and high-level research centre in cancers, kidney conditions, and malnutrition in children, malaria and heart diseases.

In the health system that the colonialists left in place was centralized; all health workers were interviewed at one central point and then transferred to health centres across the country.

This ensured high staffing levels and the World Health Organisation (WHO) minimum target of 23 health workers per 10,000 population was met.

Each of the 22 districts in Uganda had a hospital and was linked to a place of worship and school in the same neighbourhood offering a total package. The faith-based health facilities were upbeat and committed.

The life expectancy, 50 years ago, in Uganda was 74 years and by 1962 the population was only 7.3 million people growing at 2.4 percent. The age structure was biggest for the age group 15-64 years with 50 percent of the total population.

The population of Uganda was about 7.3 million and Uganda had one of the best health services systems in Sub-Saharan Africa. The health infrastructure was excellent and was regularly maintained.

“Public health services were adequately provided, immunization programmes were active and health workers were well motivated, disciplined and proud to be members of the distinguished health sector,” said Dr. Lawrence Kaggwa a Senior Consultant Surgeon and Consultant in Heath Systems, Clinical services and Health management.

Dr. Kaggwa who was a young doctor in the 60’s and 70’s says the health sector was bed rocked on objective planning, commitment, enforcement of the Public Health Act, dedicated health workers, appropriate budgeting for health with active professional councils.

Ten years after independence, the political turmoil that followed in the late 1970’s and 1980’s led to the collapse of all sectors including health, leading to a brain drain of professionals including health experts that left for dear life or better pay.

But the doctors never came back. Instead it was been an exodus of health workers not only from Uganda but Africa to developed countries looking for better pay.

The infrastructure and equipment broke down with minimal attempts at repair. Planning was quite low and the coping strategy with the health technological development was minimal resulting in a serious lag in catching up with the novel trends then.

Dr. Kaggwa summarized the health sector for over 20 years from 1966-1986, as with a rapid population growth which is not in keeping with the planned health faculties, demoralized health workers and poor culture for repair and maintenance of the infrastructure and equipment.

When he came to power in 1986, President Yoweri Museveni was eager to improve the conditions of scientists and has been promising them better money that would keep them home.

A young scientist at the time, Dr. Fina Opio now the programme manager, staple crops at ASERECA, remembers how after taking over power the President visited Kawanda Agricultural Research Institute (KARI) and spent the whole day listening to them. At the end of the day he raised their pay.

Rehabilitation and recovery of the entire socio-economic sector started in earnest and despite competition for the limited national funds, the health sector received its share and with enthusiasm embarked on a protracted recovery course, but it is now constrained by a bottleneck of rapid population growth 3.3 percent and high fertility rate of 6.7 percent.

The population seems to be doubling every 22 years, for in 1984 it was 14 million and in 2007 it was 29.6 million, which requires appropriate planning for the national income, rate of employment, status of living conditions and sustenance of economic growth. Now the nation has one of the youngest and most rapidly growing populations in the world, half of the 36 million people are youngsters below 15 years. And districts keep being added.

“This is making efficient and effective management of health facilities and planning very difficult, if not impossible,” said Francis Runumi, the commissioner of health services in charge of planning at the Ministry of Health.

The health workforce is also beset with problems low job satisfaction and working conditions. And these are linked to inappropriate deployment, low salaries, inadequate supervision, excessive workloads and poor job security.

The government expenditure on health as a percent of total government expenditure has remained around 9 percent, as it has been for the last decade, well off from the Abuja target of 15 percent. Health workers serve only 12 percent of the population and rural areas are widely neglected.

But there is hope. The salaries and allowances for the doctors at the lower level were increased recently and will be increased even more in the future, as promised by President Museveni in his Jubilee celebration speech to Ugandans.

Immunization has been quite successful. At the moment the health sector performance indices are improving except the Maternal Mortality Rate. The infant Mortality has improved from 76/1000 to 54/1000, the Under-five Mortality from 137/1000 to 90/1000. However, Maternal Mortality remains around 438/100,000 live births, which calls for serious interventions so that births remain as sacrosanct as God willed.

Health has been one of our priority areas in the NRM, said Museveni.

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