Why we should commend Uganda's Ministry of Health

By Moses Mukundane

The 2017 Uganda Demographic and Health Survey (UDHS) Report that was released recently shows tremendous improvements in most health indicators and healthcare seeking behaviour over a period of five years 2011-2016 especially for the rural population.  My main interest is particularly on maternal and child health.

According to the report, maternal mortality (pregnancy-related deaths) ratio presently stands at 368 per 100,000 live births a sharp decline from 486 per 100,000 live births where it had stagnated for over a decade.

The report further indicates a drastic decline in under-five child mortality (the probability of dying between birth and the fifth birthday) rate from 90 per 1000 live births (2011) to 62 per 1000 live births (2016); Improved immunization coverage (access, utilization and timely completion) particularly for Polio; Bacille Calmette-Guérin (BCG); Diphtheria-pertussis-tetanus (DPT); and pneumonia;  Improved antenatal care and attendance throughout the four (4) minimum recommended trimesters; Increased number of health facility deliveries and under the care of trained personnel; and Improved timeliness in seeking health care at the onset of illnesses with malaria, pneumonia and diarrhea.

Yes, the above ratio and rates for these health indicators are still high (far below the international standards) the reason why Uganda never achieved the targets for the Millennium Development Goals 3 and 4 (for maternal and child health respectively). Nevertheless, tremendous improvement captured in the 2017 UDHS Report needs to be acknowledged and commended.

It is on record that the Ministry of Health (MOH), amidst budget constraints, managed to implement numerous interventions as guided by the health sector strategic investment plans over the years.

There have been efforts to prioritize stewardship, resource mobilization, standards and guidelines development, monitoring and supervision in the health sector. Notable improvements in the health sector are also associated with qualitative and quantitative improvements in human resources for health, procurement and supply of essential drugs, health infrastructure and equipment.

Of great importance is MOH's initiative to establish various strategic partnerships with development partners and civil society organizations. One of such partnerships was through the Community and District Empowerment for scale-up (CODES) project which I believe must have made a contribution towards this health improvement.

A five-year project (2012-2016) was designed to reduce child deaths caused by diarrhoea, pneumonia and malaria—the three of the top childhood killer diseases in Uganda today. The project was developed jointly by Uganda's Ministry of Health, UNICEF and Karolinska Institute in partnership with Advocates Coalition for Development and Environment (ACODE), Child Fund International, Liverpool School of Tropical Medicine, and Makerere University School of Public Health. 

The project helped the Ministry of Health to boost its own capacity to implement policies and interventions that lead to a wide array of improvements in health outcomes, especially concerning the control of the above mentioned childhood diseases. CODES project was funded by UNICEF (Uganda), a grantee of the Bill and Melinda Gates Foundation through the United States Fund for UNICEF.

The project involved 21 districts of Uganda for both "Supply-side" and the "Demand-side" interventions. The supply-side interventions empowered District Health Teams (DHTs) to use evidence-based management tools to overcome management bottlenecks, and it also enforced continuous quality improvement (CQI) in health facilities. ACODE implemented the project's demand-side component that mobilized and galvanized citizens to demand for effective and quality health service delivery, thereby enforcing community oversight and social accountability in the health service delivery in the project districts. 

Thus the aforementioned child and partly maternal health indicators formed part of the supply and demand-side interventions of the CODES Project that used behavioural change communication approaches- particularly, community and health facility dialogues.  I am confident that if CODES project could be scaled-up to all the current 112 in the country, in addition to other numerous Ministry of Health interventions, the health indicators in question would improve further better in the next five years, thereby setting a good stage for the realization of health-related sustainable development goals (SDGs).

Ministry of Health has so far adopted some aspects of CODES supply-side components particularly health data management tools for DHIS 2, but it seems reluctant and non-committed to consider scaling-up aspects of demand-side component of CODES across the county due to anticipated colossal cost implications.

The costing study for project scale-up country-wide commissioned by UNICEF and MOH is underway. Preliminary data indicates that scaling up CODES interventions (both supply and demand-side) to all the 112 districts would require about  UGX 16.7 billion (or US$ 4.94 million)  per annum [Adjusted  for inflation UGX 18.2 Billion (or US$ 5.4 million)]? I feel this is not a scaring figure.

It is possible as long as there is political commitment. Actually, this figure is slightly higher than the present-day controversial presidential handshake of UGX 6 Billion that ended-up in the pockets of only 42 public officers.

The writer is a public health analyst and research associate at the Advocates Coalition for Development and Environment