By Francis Kagolo
FRIDAY (July 11) was for commemorating the International Population Day, but in Uganda the day could have claimed at least 20 mothers who died in the process of bringing forth life. While a good number of countries use the day to cerebrate achievements, July 11 remains a day of lamentations in Uganda.
“As long as our population continues to grow rapidly, we shall not stop lamenting about its negative implications like unemployment, crime and poverty,” says Charles Zirarema, the population secretariat (Popsec) director.
With a fertility rate of 6.2 children per woman, one of the highest in the world, Ugandan women remain vulnerable to dying from pregnancy related complications.
Yet maternal mortality is one of the challenges Uganda had committed herself to reduce by three quarters, between 1990 and 2015, under the UN Millennium Development Goals (MDGs). Just months to the 2015 deadline, the problem is still with us without substantial signs of declining.
According to the MDG progress report released by the ministry of finance in October last year, the proportion of births assisted by trained health workers as well as access to care after delivery have increased.
In spite of this progress, the reports says there has not been significant change in the number of mothers dying in labour and “Uganda is unlikely to meet the MDG target on maternal mortality.”
Under MDG 5, Uganda was required to reduce maternal mortality to 131 of every 100,000 live births by 2015, down from 506 in 1995. All mothers should also be delivering from health facilities with the care of skilled health personnel. But the country still loses 438 mothers out of every 100,000 live births.
This implies that at least 20 die every day mainly from severe bleeding or as a result of obstructed labour. On the other hand, only 58% of the births are manned by skilled medics, according to the report.
Dr. Asuman Lukwago, permanent secretary ministry of health, attributes the problem mainly to the high fertility rate and rapidly increasing population. Besides the overstretched facilities and human resource, Lukwago says many mothers die due to the high frequent and teenage pregnancies.
“You find someone delivery almost every year. Eventually they weaken and die,” Lukwago said. “Health facilities including Mulago are overstretched by pregnant women. That’s why some have to deliver on the floor. Health workers are also not enough to accord them adequate attention.”
Government has over recent years recruited more health workers, improved medicine procurement and distribution and provided additional funds to maternal health. Even then, inadequate staff numbers contribute to 63% while shortage of blood and other supplies accounts for 4% of cases, according to the ministry.
“It is hard to reduce maternal mortality with over 1.2 million new babies requiring huge health care resources every year. Mothers also require huge resources during and after pregnancy,” Dr. Ibrahim Kasirye, a senior research fellow at the Economic Policy Research Centre (EPRC), explains.
“There are more pregnant mothers and babies in hospitals than anyone else yet public investment in healthcare is not growing at the same pace.”
Likewise, Uganda’s efforts to reduce biodiversity destruction, required under MDG 7, have been failed by the high birth rate. The country is on track in halving the proportion of people without sustainable access to safe drinking water and basic sanitation, both in rural and urban areas.
Uganda still loses 438 mothers out of every 100,000 live births.
But the increasing land fragmentation and degradation of biodiversity across the country makes it hard for Uganda to achieve environmental sustainability, according to the report.
“High population growth rate has exerted pressure on forests and other natural resources. Charcoal burning is very disastrous yet the demand for charcoal is growing every day,” says Richard Kimbowa, executive director of Uganda Coalition for Sustainable Development (UCSD).
“Over 92% of the population relies on biomass for their energy needs, principally charcoal and fuel wood. As a result, Uganda’s forest cover was reduced by 37% between 1990 and 2010,” says Kimbowa.
With rapid population growth, the MDG report shows that “some areas are experiencing acute land constraints that have reduced fallowing and accelerated degradation”.
It warns that the declining biodiversity could jeopardise Uganda’s market niche in ecotourism and fisheries as lakes and rivers get silted.
Deforestation is occurring even within protected national reserves as citizens as more people look for land for agriculture and wood extraction for energy.
“Population growth has escalated harvesting of biomass, placing significant pressure on the country’s natural vegetation and contributing to large-scale deforestation,” the MDG report asserts.
Universal Primary Education
MDG 2 required that, by 2015, all children of school going age, boys and girls alike, should complete primary school. In Uganda, the Universal Primary Education (UPE) programme introduced in 1997 has dramatically increased enrolment and reduced inequalities in access to education. The programme has also increased the probability that children start primary school on time.
However, Zirarema argues that the successes recorded in the early days of UPE are being eroded by the skyrocketing number of children which has outstripped the available resources, facilities and teachers.
The commissioner for primary education, Dr. Daniel Nkaada, concurs that “population explosion has hampered the capacity to provide all the requirements in UPE like tuition, salaries and infrastructure”.
A 2012 report by a commission of inquiry into the mismanagement of UPE funds recommended an increase in capitation grants from sh8,000 to sh15,000 per child to cater for the high inflation rate.
The ministry of education went ahead and tabled the proposal before Cabinet but the request is yet to bear fruit till now. Instead, Government had mooted a plan to cut the grants by sh200, from sh7,000 to sh6,800 per pupil to take care of the annual increments in enrollment. Primary school enrollment currently stands at 8.2 million pupils from 2.5 million in 1996.
Consequently, there is high dropout in UPE. The MDG report says Uganda has moved slowly and will most likely not achieve the millennium goal of 100% pupils’ completion of primary schooling. The completion rate currently stands at 67%.
Combat HIV/AIDS, Malaria and other diseases
According to the report, Uganda is on track to achieve universal access to HIV/AIDS treatment for those who need it. The report also shows Uganda has started reversing malaria incidence as required under MDG 6.
The share of the population with advanced HIV receiving antiretroviral therapy (ART) increased from 44% in 2008 to 62% in 2012. This progress prompted the ministry of health to expand ART eligibility in 2011. Under the new criteria adults with HIV can initiate treatment much earlier, while all pregnant women and children below two years of age and TB sufferers are automatically eligible.
A dog shares food with children in Aukot village.
This meant the country is on course to achieve the target of providing ART to 80% of those in need by 2015, had the US and other development partners not cut aid for HIV/AIDS this year.
However, Uganda still ranks poorly in combating the spread of HIV/AIDS, after the prevalence rose again, from 6.4% in 2006 to 7.3% today. The Uganda AIDS Commission (UAC) estimates that majority (37%) of new infections are from having multiple sexual partnerships.
Even then, Dr. Lukwago says the HIV prevalence could have reduced had it not been because of the high birth rates.
“We want to stop mother-to-child transmission of HIV. But the problem is that there are many women giving birth every year which also increases the number of infections.” Indeed, UAC says 35% of new infections are due to mother-to-child transmission.
Eradicating extreme poverty and hunger
The MDG report shows Uganda achieved the first target of eradicating extreme poverty in 2010, seven years ahead the 2015 deadline. The national poverty rate declined from 56.4% in 1993, to 33.8% in 2000 and again to 24.5% in 2010, according to the report.
The report also shows that Uganda has achieved a sustainable national debt through global partnerships, necessary for development. The report nevertheless recognises the increasing income inequality even as national poverty rates decline.
Is a big population good for the economy?
Using China as an example, some officials argue that Uganda’s big population is good for the economy. That it creates large markets and, therefore, positively contributes to economic growth and development.
But Makerere University’s economist, Prof. August Nuwagaba, says Uganda’s population in its current form and the rate of growth are not assets for growth, but liabilities. He says China’s growth is not because they are large in number, but mainly because they are able to pay for the available goods and services.
“Uganda’s population is largely young, dependent, unskilled and, therefore, uncompetitive. There is low human capital formation and very low productivity,” Nuwagaba explains.
Zirarema also warns that unless the rate of population growth reduces, it will be hard to achieve the middle-income status which the Government envisions in the next 26 years. He advises Government to invest more in improving the quality of its people in form of education and health to achieve the desired development.
“We have not planned for our young population properly. Whatever money is put in the youth fund programme cannot keep pace with the rate at which the youth are increasing,” Zirarema said, warning of increased unemployment and crime if the population continues to grow rapidly.
Other factors to blame for MDG failure
Besides the rapid population growth, Julius Mukunda, the coordinator of the civil society budget advisory group, also blames Uganda’s failure to achieve the MDGs of poor allocation of resources and lack of prioritisation.
Citing the budgets for health, water and sanitation which are “wanting”, Mukunda argues that the Government has failed to prioritise sectors that would contribute to achieving the MDGs.
“Despite having a National Development Plan (NDP) which would help us achieve the MDGs, we go ahead and allocate more money to different sectors not following the plan. It becomes extremely difficult for the Government to achieve the MDGs,” he said.
“Besides, we are poor at implementing plans. You cannot keep promising to build a women’s hospital at Mulago for three years and expect to curb maternal mortality.”
Zirarema calls for concerted efforts to address unmet need for family planning which now stands at 34%.
“We need family planning outreaches to sensitise Ugandans on the dangers of high population especially in the rural areas where it is hard to access health facilities. We also need to deal with stock-outs of family planning supplies,” he said.
The other magic bullet, according to Zirarema, will be enhancing access to education – making sure that children, especially girls, go to school and complete at least tertiary level.