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9th Parliament: Immense challenges ahead

By Vision Reporter

Added 27th February 2011 03:00 AM

PRESIDENT Yoweri Museveni has taken office as Uganda’s ninth head of state, and Uganda’s longest-serving president.
In a nation that was characterised by coups before he came to power, to some people, Museveni is a ‘saviour’.

PRESIDENT Yoweri Museveni has taken office as Uganda’s ninth head of state, and Uganda’s longest-serving president.
In a nation that was characterised by coups before he came to power, to some people, Museveni is a ‘saviour’.

AS new leaders celebrate their election, many Ugandans are hoping health will be among the areas of priority. Frederick Womakuyu analyses where government has done well and where more needs to be done

PRESIDENT Yoweri Museveni has taken office as Uganda’s ninth head of state, and Uganda’s longest-serving president.
In a nation that was characterised by coups before he came to power, to some people, Museveni is a ‘saviour’.

However, as he assumes office for the fourth term, he needs to consolidate what he has done as well as improve some sectors, including health.
As many people countrywide celebrate Museveni’s victory, others are hoping that he can revive the ailing health sector.

According to Dr. Kenya Mugisha, the director of health services in the health ministry, Uganda needs about six new national referral hospitals if it is to meet the health demands of its high annual population growth of about 3.3%, believed to be third highest globally.

“This is beyond the facilities and manpower of Mulago Hospital,” Mugisha adds. Mugisha says as much as Uganda’s economy has been growing at 8% annually, the growth is not keeping apace with population growth.

He says every year, about 1.2 million children are born, which means more money is needed to cater for them.
“However, over the last five years, the national budget allocation to the health sector has not increased significantly,” he laments.

According to the Annual Health Sector Performance report 2007-2008, budgeted public health expenditures amounted to sh17,220 per person annually. But this is inadequate for the provision of quality services. In 2007, the goal was to spend sh30,000 per person.

Uganda needs to spend about sh60,000 per person annually to cover the current minimum healthcare package required. The Uganda Bureau of Statistics estimates that public health budget costs would rise to about sh5 trillion by 2037 annually.

In 2007, Uganda had about 1,150 doctors for a population of about 30.9 million, according to the United Nations Population Fund. One doctor attended to about 26,000 patients in the country, yet the national development goal is to have one doctor for 5,000 people.

To achieve this, Uganda requires about 17,760 doctors by 2037, given the high birth rate. The high birth rate will also have implications on the number of nurses needed.

In 2007, the country had only 7,700 nurses for a population of 30.9 million. There was only one nurse for 4,000 patients yet the national goal is to have one nurse for 1,000.

According to Uganda’s population secretariat in charge of counting Ugandans, the country requires over 88,800 nurses for a population of about 88.8 million Ugandans by 2037.

Uganda needs about 46,977 health workers in public service, of whom only 28,000 are in service. The health ministry’s 2007/08 annual health sector performance report shows that there are only 46% of the required number of doctors.

The number of health facilities should also increase in order to keep apace with the growing population.

According to the Uganda Bureau of Statistics, in 2007 there were 3,045 health centres in the country and over 9,500 patients went to one centre. The Uganda Bureau of Statistics predicates that by 2037, Uganda will need over 9,320 health facilities to cater for the high population.

The health sector is also being hit hard by corruption and misuse of funds. In 2009, the finance ministry accused the health ministry of misuse of resources allocated to them.

Kenneth Magabe, the director of budget in the finance ministry, says workshops and seminars account for 7.3% or sh1.7b of the health budget.

The way forward
Experts recommend human capital and staffing should be doubled in most health facilities to provide adequate care.
Justine Murana, the planner of Sironko district and senior economist, advises that the Government should also adopt a family planning policy to curb population growth.

He warns that if Uganda’s population continues to grow at 3.4% annually, the economic growth must triple that of the population to about 12% to maintain them.

He also advises that more funds should be allocated to the health sector and transparency mechanisms put in place to check against corruption in the health sector.

Areas where government scored highly
Much as a lot more still needs to be done, there has been improvement in the health sector, but a lot more still needs.

The NRM is credited for bringing donors and NGOs on board to revamp the health sector. NGOs have played a big role in providing equipment, health workers and medical supplies, including drugs.

Donors have helped construct health facilities and provided drugs.
Donors have concentrated on eliminating preventable diseases like guinea worms, boosted immunisation for the six killer diseases, contained malaria and HIV/AIDS.

The Government also helped in the formation of the Health Policy Review Commission that consolidated the existing health services by rehabilitating facilities and re-orientating the population to the primary healthcare.

A total of 3,200 primary health workers were recruited to serve in health centres and hospitals, resulting in improved staffing of trained health workers from 10% in 1986 to 68% in 2005.

The overall staffing levels in the health sector improved from 23% in 1986 to 51% in 2010. The number of doctors increased from 400 in 1986 to about 2,000 in 2010.

When the NRM took over power, Uganda was producing only 20 doctors annually at Makerere University and many left for greener pastures. Today, the country produces 250 doctors annually. Makerere University produces about 100 doctors, Gulu University 40 doctors, Mbarara University 80 doctors and others 30.

The number of nurses in the health facilities has also increased from about 700 to 7,700.

The Government constructed over 400 primary healthcare units and upgraded others, resulting in increased access to basic health services from 11% in 1986 to 84% by the year 2005.

The number of health facilities increased from less than 500 in 1986 to 3,045 in 2010.

It also increased per capita essential medicine funding from $0.8 (sh1,885) per person in 2000 to $1.8 (sh4,100) in 2005. According to the Annual Health Sector Performance Report 2007-2008, the budgeted public health expenditures amounted to about sh17,220 per person annually. Uganda’s current budget allocation to the health sector is sh734.67b.

Maternal mortality has declined to about 435 deaths per 100,000 live births from about 600 deaths per 100,000 live births in 1986. The infant mortality has also improved to about 76 deaths per 1,000 live births from 200 deaths per 1,000 in 1986.

Over 72% of Ugandans reportedly live within a distance of five kilometres of a health unit.

Training health institutions also soared. In 1986, there were only three paramedical schools; the Mulago Paramedical School, one in Jinja and the other in Mbale, but today, Uganda boasts of 10 paramedical schools.

The number of nursing schools also
increased from 10 in 1986 to over 32, while the number of universities offering medicine degrees and diplomas increased from one to seven.

The institutions include Makerere University, Gulu University, Mbarara University of Science and Technology, Kampala International University, Kampala University and Islamic University in Uganda and Aga Khan University.



9th Parliament: Immense challenges ahead

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