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Uganda's steady path to longevity and progress

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Added 15th May 2018 07:45 PM

The dramatic early childhood survival improvements pushed Uganda’s longevity from the 48 years recorded in 1991 to 63 years in 2014.

Uganda's steady path to longevity and progress

The dramatic early childhood survival improvements pushed Uganda’s longevity from the 48 years recorded in 1991 to 63 years in 2014.



By Kisamba Mugerwa

The question of "population" will continue to mesmerise, scare and puzzle people for many years to come. I have often heard people calling for continued high fertility in Uganda because a large population is good for the country in terms of a large market, defence and general political importance among others.

It is a fact that Uganda has had a very high fertility rate, averaging around seven children per woman, over the last 50 or so years. Coupled with declining mortality, this has produced the considerably large population of nearly 40 million people that Uganda currently has.

Although there are already some signs of a fertility decline, this population is projected to grow even higher to about over 70 million by 2040. In other words, whatever happens to Uganda's fertility today, even if it drastically dropped to replacement level, the large population size is assured and will continue to grow for many years to come.

Despite the general excitement with numbers, however, it must be noted that the critical issue with Uganda's population is not its size, but rather the structure, stemming from the source of growth. The growth of Uganda's population has been solely from natural increase, i.e. the excess of births over deaths. Over the years, the high fertility has led to preponderance of children in the population relative to the older, productive population giving rise to a population with a high child-dependency burden. This is why Uganda's population is one of the youngest populations in the world, with more than 50% aged below 15 years.

In the beginning, the Government was pursuing a population-responsive policy, largely investing in the amelioration of the effects of adverse population dynamics particularly fertility and mortality. This policy saw to increased spending on immunisation and other child health programmes as a response to the very high infant and child mortality at the time. These programmes were supplemented with reproductive health programmes to respond to the high fertility and the attendant high maternal mortality but also to further augment successes realised in child health interventions.

The population-responsive policy approach led to successes in drastically reducing childhood mortality although maternal mortality still remained stubbornly high. Infant mortality dropped from 122 recorded in 1991 to 43 in 2016, representing an impressive 65% drop.

Maternal mortality, however, declined more modestly from 506 in 1988 to 368, decline of only 27%. The dramatic early childhood survival improvements pushed Uganda's longevity from the 48 years recorded in 1991 to 63 years in 2014.

As is typical with population-responsive policies, fertility remained unchanged for a long time. It first showed signs of a significant downward turn in 2011 when fertility was recorded as 6.2. To date, it has declined from the 7.1 children per woman recorded in 1988 to 5.4 in 2016, a decline of only 24%. This continuing high fertility is, at least partly, the explanation for the persistently high maternal mortality. The slow decline in fertility is due to the fact that population-responsive policies depend on ideation changes to bring about change in fertility. Typically, ideation changes take longer to take root and often span over generations. For example, that with the dramatic decline in infant and child survival, couples will start demanding fewer children.

The increased child survival, coupled with persistently high fertility, has led to a large segment of young people. The young people and youth, i.e. aged between 15 and 30 years make up about 43% of the population while 78% are aged 30 or below. Cognizant of this fact, Uganda Vision 2040 pronounced this young population as an important resource to be mobilized in the country's socioeconomic transformation drive in what came to be known as harnessing the demographic dividend. This is defined as "an opportunity for economic growth and development that arises as a result of changes in population age structure which are likely to happen when fertility rates decline significantly, prompting the share of the working-age population to increase in relation to previous years".

The larger working-age population can structurally enable a country to increase GDP and raise incomes. This economic benefit that can arise out of a country's taking advantage of its changing population age structure by adopting clear, focused and sustained policies that empower the country's working population and its potential labour force to become the engine of economic growth of the country.

Realising the dividend will, therefore, not be automatic. It will call for concerted efforts on the part of various actors in the different walks of life. To this end, the second National Development Plan, one of the six expected in the operationalisation of the 30-year Vision, proposed a move from the erstwhile population-responsive policy to a population-influencing type of policy.

The proposed policy initiative is designed to outline a package of policy actions, as the prerequisites to harnessing of the dividend, to guide the course of population dynamics over the next thirty years. These were pronounced as: 

(i) Rapid fertility decline; the decline has to be rapid because there is only a brief window of opportunity (30 - 50 years) within which the change in age structure can perform the economic "miracle";

(ii) Definite infant and child mortality decline; 

(iii) Massive investment in education of both boys and girls; and

(iv) Concerted investment in appropriate skills development (human capital).

The basic premise therefore is, targeted investment in the current young people in order to reap the benefits in future.

Although Uganda's population is still very young, the socio-economic developments outlined above ill ensure that a greater number of these people will start surviving to older ages. Due to the investments that will have been made earlier in life which led to productive and rewarding working lives, the older segment of the population will also be assured of living in decent retirement. This development has been referred to as "reaping the second dividend".

This is because this population segment will not only be non-dependent, but it is actually likely to continue contributing to economic growth for a much longer period. On the contrary in case we do not invest in the youth population during the window of 30 years, time does not wait and they will become a burden to the country in the old age demanding for excessive social protection programmes.  

The above analysis has shown that Uganda's population has been driven by only two components of population change, fertility and mortality with international migration being virtually insignificant.

However, developments in the region are continuously pointing to the fact that migration is the new frontier area for Uganda's demographic development. Over the decades, several waves kept on pushing some people from neighbouring countries into Uganda. These ranged from episodes of political instability to searching for educational and economic opportunities.

These moves were largely ignored at the beginning because they were intermittent, involved relatively small numbers and were mostly viewed as temporary dislocations. During much of that period, refugees straying into Uganda's borders were swiftly transferred to designated refugee camps away from the general population until such a time when they could return to their respective countries.

Two developments in the past ten years call for a re-examination of migration, particularly immigration, as a factor in Uganda's demographic and socioeconomic development.

The first is the growth and expansion of political instability in the region. Instability has increased in terms of the countries affected as well as the numbers of people that are forced to move to Uganda. These have ranged from Burundi, DR Congo, Kenya, Rwanda and South Sudan and the numbers involved have now reached over one million.

The second development lies in Uganda's change in its refugee policy. There has been a departure from the previous policy of confining all refugees to refugee camps to instead let them exist in communities of their first contact.

This is particularly so in border communities where the refugees and recipient communities have some close ethnic affiliations. This is a policy for which Uganda has received international commendation because of its more humane approach to the refugee issue.

These developments have potentially far reaching implications which have to be carefully considered when developing future population policies and programmes. First and foremost, it is noteworthy that with this new approach to the refugee issues, the line between refugees and immigration in general is becoming increasingly blurred. It may not be possible any more, or even desirable, to hold refugees away from the general population and therefore exclude them from discussions on immigration issues. 

Consequently, the new thinking on immigration is that it is a development issue. This new thinking, which is consistent with Uganda's new policy stand on refugees, implies that countries must devise ways for all those people who arrive within their borders to be deployed for development purposes. These people, regardless of circumstances of their arrival, will generally fall in two categories. There will be those that are highly skilled either in technical skills or entrepreneurship, and those that are generally unskilled.

The country's economic growth strategy can be strengthened by prudently utilizing the two kinds of immigrants. For the highly skilled, the country will be benefitting from their enterprise and productivity without having invested in their formation while for the unskilled, ensuring that they are economically engaged and able to contribute taxes will be cheaper and more beneficial to the country than keeping them in a dependent state.

The Leadership has to be commended for Uganda's impressive progress to date as recounted above. However, the above review is also testimony to the fact that population responsive policies can only achieve so much. In order for the country to benefit from the full potential of its demographic force, the leadership must consider population-influencing policies in the areas of fertility for quality, like determining the optimum level of fertility, and immigration, the country's new frontier factor.

The writer is the chairperson of National Planning Authority 


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