By Chris Kiwawulo
WITH only five years left to the deadline of achieving the Millennium Development Goals (MDGs), emphasis is on those countries that are yet to achieve the goals. The UN Secretary-General Ban Ki-moon has called on concerted effort from all stakeholders in order to achieve MDGs by 2015.
However, it is hard to tell whether a country is on track until you examine its progress. Below is assessment of how far Uganda has moved in as far as implementing MDGs 4, 5 and 6 is concerned. The MDGs are; reducing child mortality rate, improving maternal health, and combating HIV/AIDS, malaria, and other diseases.
How the situation was in 2000
The Uganda 2010 MDGsâ€™ country report shows that in 2000 when the MDGs were established, maternal mortality was at 500 deaths per 100,000 births. Today, it has reduced to about 220 deaths per 100,000. The MDG target is about 120 deaths per every 100,000 births.
Similarly, the under-five infant mortality was at 152 deaths per every 1,000 live births but has reduced to 120 deaths per 1,000 live births currently. The target though is 55 deaths per 1,000 live births.
Still in 2000, there were about 35 new HIV infections per every 10,000 Ugandans and about 20 malaria cases per every 10,000 people. It even went to 50 cases by 2004. But the trend has reduced to about 35 cases per every 10,000 Ugandans.
Some 100 deaths due to tuberclosis (TB) per every 100,000 people were recorded in 2003 but the number is now below 100 deaths. The target is to have the deaths drop to 20 per every 100,000 people. The TB prevalence in 2003 was 650 per 100,000 people, but it has also drastically reduced to 300 per 100,000 Ugandans and is expected to reduce to less than 100 per 100,000 people.
A report by the World Health Organisation, UNFPA and the World Bank says Ugandaâ€™s maternal mortality ratio has gone down.
The report notes that Uganda is moving at a slow pace in as far as implementing goals 4 and 5 (reducing child and maternal mortality) is concerned. But the country is on track regarding combating HIV/AIDS, malaria, and other diseases (MDG 6).
According to a 2009 USAID report, the decline in maternal mortality globally is due to improved health systems, increased female education, supervised deliveries, improved antenatal services and increased use of contraception.
The report, which covers the period from 1990 to 2008, says the number of women dying due to complications during pregnancy and childbirth had decreased by 34% from about 546,000 in 1990 to 358,000 in 2008. This also means a reduction in child mortality.
Because MDGs 4 and 5 were found to be on a slow pace, an acceleration framework was designed. The framework calls for access to emergency obstetric care, ensuring skilled medical attendance to mothers at birth, universal access to family planning and antenatal care.
It also suggests improving roads to facilitate access to health units, provision of standby ambulance for referral, car and bicycle ambulances, telephone communication to health units and carrying out public sensitisation campaigns. The framework proponents devised a simple rule: â€œfor each mother, there must be a baby to go back with, and for each baby there must be a mother to go home with.â€
But these still remain a challenge as many health centres still register drug stock outs and shortages of medics, according to a survey by Reproductive Health Uganda early this year.
As a family planning tool, meeting the MDGs will be easier and less costly if contraceptive use increases, according to a 2009 report by United State Agency for International Development. The report notes that if family planning is effectively put in effect, Uganda will save about $198.77m (over sh448bn) between now and 2015. The saved funds can be used to improve other areas like drug procurement and increasing medicsâ€™ salaries.
In order to accelerate progress towards the MDGs, the G8 finance ministers who met in London in June 2005 agreed to provide enough funds to the World Bank, the IMF and the African Development Bank to cancel an additional $40â€“55b debt owed by members of the Heavily Indebted Poor Countries (HIPC) like Uganda. This would help the countries to re-channel the resources saved from the forgiven debt to social programmes like improving health.
When Uganda qualified for HIPC debt relief initiative, its total debt stock before total cancellation was about $3.2b. But its debt burden has grown again from $118m during the first quarter of the financial year 2009/10 to about $265m, according to the draft report, authored by the National Economy Committee of Parliament.
The G8 countries should fulfill their pledge to support poor countries. At their Gleneagles meeting, they pledged to increase official development assistance by $50b and double aid to Africa by $25b by 2010. Presently, the funding gap on commitments to Africa is over $16b. With such challenges, the road to achieving health MDGs is still long.