A strategic partner in pursuing Universal Health Coverage

Aug 27, 2019

To achieve UHC in Uganda, the winning strategy lies more in ill-health prevention and health promotion

By Hamis Mugendawala

In 2015, Uganda, together with other countries committed to the global Sustainable Development Goals (SDGs) agenda. Sustainable Development Goal 3 (SDG3) aims at "ensuring health lives and promoting wellbeing for all at all ages".

Within SDG3, countries have committed to achieving Universal Health Coverage (UHC) by 2030. Universal Health Coverage generally means that every person has access to health services of good quality without suffering costs that would drift them into poverty.

Indeed, the main strategic objective for Uganda's Health Sector Development Plan (HSDP) is to "accelerate progress towards the achievement of Universal Health Coverage in Uganda". The current discourse in Uganda is what strategic actions should we focus on to deliver this rather ambitious UHC agenda?

The National Planning Authority (NPA) conducted a study in 2018 that culminated in a paper: ‘Towards Universal Health Coverage in Uganda; Multi-Sectoral Policy Actions to Accelerate Progress'.

This paper highlights that communicable and non-communicable diseases contribute 60% and 40% respectively of the disease burden in Uganda. In addition, more than 75% of the disease burden can be prevented through health promotion, health education and other preventive actions related to nutrition, sanitation, hygiene, water, road usage and housing.

Therefore, to achieve UHC in Uganda, the winning strategy lies more in ill-health prevention and health promotion, than focusing on hospital infrastructure that deals with ‘repairing' of life.

Even within the health promotion and preventive agenda, we should be asking the question of how optimally and efficiently can Uganda deploy its efforts and resources to achieve maximum results? An important institution that occupies vantage position in preventive healthcare is the school - but mainly pre-primary and primary schools.

The school is very critical in providing an environment for health education and behaviour change communication.

Religion is quite instructive in emphasising the need to ‘train children when they are still young so that when they are old they will not depart from the way they were instructed'. When children are trained in keeping and living in a healthy environment, they will grow up with such instructions, and this will perpetuate behavioural change.

Health behaviours, attitudes, knowledge and values are propagated in schools. For those who have school-going children, you also know that children report home virtually everything that was taught or spoken to them at school on a daily basis. School-going children can also act as a media to communicate health messaging to parents and families.

The school provides a good environment and setting for healthy growth.

There is evidence from research studies in both developed and developing countries, which demonstrates that early schooling has significant causal relationships with regular exercise, low rates of drug abuse, reduced obesity, reduced rates of depression and low rates of daily smoking.

Schools' curricula and programmes address nutrition, sanitation and hygiene, immunisation, water, socio-emotional aspects of learners and physical exercise. Besides, if schools are facilitated, they always feed the children on nutritious meals, engage the learners in creative arts and physical education, maintain proper hygiene and sanitation, provide clean water and in some instances provide appropriate accommodation to the children.

If every school implemented all such programmes, would prevent above nine million young Ugandans in schools from falling sick. This would create impact on efforts towards the achievement of UHC.

In as much as schools are expected to undertake the above programmes, in reality, many schools do not have capacity to do so. They lack adequate resources necessary to run such programmes. In many schools, most of the infrastructure for hygiene and sanitation is dilapidated. In addition, programmes with significant health benefits such as creative arts and physical education and sports are getting limited attention, as schools focus more on academic teaching and passing examination.

Currently, about 92% of all parishes in Uganda have a government primary school and about 9 Million children are in pre-primary and primary schools. The coverage of schools across the country guarantees greater reach and penetration of any health promotion and education programme delivered through the school. Most schools require children to present immunisation cards and child development cards, before they are allowed to enroll. Such initiatives have ensured that almost 100% of children in registered schools are vaccinated against the killer diseases including cervical cancer among the young girls.

Schools are an existing infrastructure and resource that should be tapped and facilitated to revamp hygiene, sanitation, gardening and physical education and sports programmes that address the critical determinants of health and wellbeing. The Government must harness the potential of schools as strong strategic partners in efforts aimed at achieving Universal Health Coverage in Uganda.

The writer is a senior planner at the National Planning Authority.

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