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Comprehensive Analytical Profile: Uganda

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This analytical profile provides a health situation analysis of the Uganda and, coupled with the Factsheet, it is the most significant output of the African Health Observatory. The profile is structured in such a way to be as comprehensive as possible. It is systematically arranged under eight major headings:
1. Introduction to country context
2. Health status and trends
3. Progress on the Health-Related MDGs
4. The Health System
5. Specific Programmes and Services
6. Key Determinants
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Statistical profile
Introduction to Country Context

Uganda has an area of 240 038 km2, of which 197 323 km2 is covered by land.

The Uganda Bureau of Statistics estimates the population in 2009 at 30.7 million and by the end of the financial year 2015 Uganda’s population will be approximately 37.9 million, increasing the average population density from 133 to 156 persons per square kilometre.[1][2]

A total of 48.5% of the population is male, while 51.5% is female; 88% of the population resides in rural areas.

The population growth rate is estimated at 3.2% per annum; this translates into annual increments of approximately 1 million people.

Health Status and Trends

The overall health status of Ugandans remains poor, with a low level of life expectancy and a high level of mortality. This undermines the efforts and investments for social and economic development.

Progress
Progress on SDGs
The Health System
Health system outcomes

Uganda has a network of delivery of health services at community level through the village health teams that are in their infancy.

However, the country still has very poor health status indicators, with poor quality of health care compounded by an inefficient delivery system.

Leadership and governance

Uganda has the basic infrastructure required for leadership and governance of the health sector. However, the structures are weak and underresourced.

One of the weaknesses is in donor aid coordination and another weakness is in leadership at the district level.

Community ownership and participation
Runyege dancers in Uganda

Uganda's health sector has a well laid out community ownership and participation mechanism with a civil society participating in the highest policy-making organ, the Health Policy Advisory Committee.

Client satisfaction as evidenced by waiting time and consultation time remains poor.


Partnerships for health development
Health information, research, evidence and knowledge

Enabling policies and strategies exist to support the information society. In Uganda, a national information and communication technology policy framework has been in place since 2002. Similarly, mechanisms exist that provide access to health information for lay users as an empowerment strategy to demand high-quality care. Formal capacity-building in information and communication technology in educational institutions at all levels sustainably complements this strategy.

A sector-wide approach adopted in the Health Sector Strategic Plan II 2005/06–2009/10 (HSSP II)[3] incorporates mechanisms that emphasize better use of resources and a common reporting framework for improved planning and accountability. The Health Sector Strategic and Investment Plan Monitoring and Evaluation Plan for 2010/11–2014/2015[4] aims at establishing a system that is robust, comprehensive, fully integrated, harmonized and well coordinated to guide monitoring of the implementation of the Health Sector Strategic and Investment Plan and evaluate its impact.

Health financing system

The Government of Uganda has steadily increased its budget allocation of funds to the health sector. However, it continues to allocate less than 10% of its budget to health care, which is less than the 15% agreed in the Abuja Declaration by heads of African states.

Service delivery

In Uganda, service delivery focuses on a defined minimum package of care, the Uganda National Minimum Health Care Package.

This minimum package of care is delivered through a network of health units and a referral system. However, the challenge is to make the country health system functional in order to provide modern health services.

Health workforce

In Uganda, human resources for health problems have a negative influence on service delivery and thus sector performance. They also have negative implications for the absorptive capacity of the whole sector.

Therefore, the starting point for improving the health sector's overall performance should be improving the staffing levels, as well as human resources for health motivation.

Medical products, vaccines, infrastructures and equipment

Uganda has a framework for management of medical products, vaccines, infrastructure and equipment with appropriate regulatory systems. However, enforcement is still a challenge.

There is an elaborate system for delivery of vaccines in all health units in the country. The vaccine and cold chain system is affected by irregular supplies, compromising its performance.

General country health policies

Uganda has an overall policy and planning framework enshrined in its National Development Plan.[5] The sector planning framework is guided by the National Health Policy[6] and the Health Sector Strategy and Investment Plan.[7]

The key collaborative sectors also have specific sectoral plans.

Universal coverage
Queen Elizabeth Park

Uganda has a strategy of free health care in publicly owned health units. However, these units experience shortages of supplies and staff, resulting in many seeking care in private units with user fees. The net effect is lack of protection and catastrophic health expenses.

The proposed national health insurance scheme is one of the financing mechanisms to increase universal coverage.

The high geographical coverage of health units is one of the country's strategies to achieve universal coverage.


Specific Programmes and Services
HIV/AIDS

Uganda has in place a multisectoral HIV/AIDS control framework with a programme approach within the Ministry of Health.

Despite previous vigorous efforts to fight HIV/AIDS, the disease still contributes to high morbidity and mortality within the country and its prevalence remains high.[8]

Tuberculosis

Tuberculosis continues to be a major public health problem in Uganda and the country has experienced limited success of the DOTS (the basic package that underpins the Stop TB Strategy) programme amidst the challenge of multidrug resistant tuberculosis.

Malaria

Malaria remains one of the most important diseases in Uganda and the biggest cause of morbidity and mortality in the country. It is responsible for significant economic losses.[9]

Uganda has a malaria control programme, which focuses on policy and implementation framework development and coordination of the Roll Back Malaria Partnership.

Immunization and vaccines development

Uganda has a national programme specifically addressing immunization. Furthermore, the country has achieved major strides in elimination of poliomyelitis and has an agenda of eliminating other immunizable diseases such as measles and tetanus.

There is a high immunization coverage; however, the immunization programme is under-resourced and, as such, unable to meet its major control interventions.

Child and adolescent health

There have been improvements in immunization coverage services in Uganda and a number of policies have been developed for child survival and adolescent health.

However, these services are found in few health units and are not of good quality.

It should also be noted that what affects mothers also affects children and adolescents.[10] Therefore, if problems that affect women still exist, children and adolescent health may only improve partially.

Maternal and newborn health

The health of the mother and her child is still at risk, considering the high HIV prevalence among pregnant women in Uganda. The trend in antenatal care attendance is reversing.

The majority of level IV health centres do not provide emergency obstetric care services, which is one the major reasons they were established. This lack of emergency obstetric care services puts the lives of women and newborn health in jeopardy.[11] In addition, referral mechanisms to enable them to access hospitals are poor.

Gender and women's health

Females in Uganda are disadvantaged and surrounded by many inequities. This situation has been worsened by the culture, for example:

  • teenage pregnancy is among the highest in sub-Saharan Africa;
  • adolescent girls are four times more vulnerable to HIV infection than their male counterparts;
  • HIV prevalence among women is high (7.5%) compared with 5% among men;
  • married women cannot refuse sex or cannot ask their husbands to use condoms.
Epidemic and pandemic-prone diseases

Communicable diseases such as malaria, HIV/AIDS and tuberculosis still constitute the bulk of the disease burden in Uganda.

The established mechanisms in the country (e.g. the national coordination committee, laboratory network, collaboration with Centers for Disease Control and Prevention) to respond to disease outbreaks have created significant improvement. However, many challenges hamper these efforts and further work by the Government of Uganda and its development partners is needed to address disease outbreaks.

Neglected tropical diseases

In Uganda, neglected tropical diseases are still common, although some are targeted for elimination.

The strategy in the Health Sector Strategic and Investment Plan 2010/11–2014/15[12] is to give special consideration to neglected tropical diseases in affected districts and to reduce their burden.[13]

Non-communicable diseases and conditions

Noncommunicable diseases are an emerging problem in Uganda, as is the case in all developing countries.

Unfortunately, Uganda does not have nationally representative data on noncommunicable diseases. The country also lacks a comprehensive noncommunicable disease policy, strategic plan, and standards and guidelines for managing noncommunicable diseases.

This situation puts the country at risk of enhancing the burden of these diseases.

Key Determinants
Risk factors for health

There are a number of risk factors for health in Uganda, the majority of which can be controlled or minimized by changes in people’s behavioural and by enforcing laws.[14].

The physical environment
Bujagali

Vector diseases are still a problem in Uganda but almost each vector disease has a programme under which it is managed and a strategy that makes it easy for the disease to be controlled.

Levels of urbanization, water and sanitation provision, and energy exploitation are still low, typical of an undeveloped country.

Uganda has fallen victim to climate change. The country's minimum efforts to address climate issues are attributed to poverty and low income diversity.


Food safety and nutrition

Nutrition is a problem in Uganda, especially among women and children. This situation has been worsened by the emergence of HIV/AIDS.

The Government of Uganda recognizes the importance of a healthy population for economic development and its efforts are reflected in strategies including:

  • the launch of the Uganda National Action Plan 2011–2016,[15] which intends to scale-up multisectoral efforts to establish a strong nutrition foundation for Uganda’s development;
  • the formulation of the Uganda Food and Nutrition Policy;
  • the establishment of the Uganda National Health Research Organization.
Social determinants

The analysis of risk factors shows that, although there has been a reduction in poverty levels, a large proportion of the population of Uganda is still trapped in chronic poverty, health infrastructure is in a poor state, there are still disparities in literacy levels and decision-making between females and males is worse in rural areas.

In addition, science, technology and initiative infrastructure is low.

With regard to epidemics and disasters, a comprehensive surveillance and reporting system has been put in place and has proved useful in managing epidemics.




References
  1. Fiscal space for health in Uganda (pdf 898.08kb). Washington DC, World Bank, 2010
  2. Statistical abstracts (pdf 3.47Mb). Kampala, Government of Uganda, Uganda Bureau of Statistics, 2010
  3. Health Sector Strategic Plan II 2005/06–2009/2010. Volume 1 (pdf 709.68kb). Kampala, Government of Uganda, Ministry of Health, 2006
  4. Monitoring & Evaluation Plan for Health Sector Strategic & Investment Plan 2010/11–2014/15 (pdf 2.92Mb). Kampala, Government of Uganda, Ministry of Health, 2011
  5. National Development Plan (2010/11–2014/15) (pdf 10.01Mb). Kampala, Government of Uganda, Ministry of health, 2010
  6. The Second National Health Policy. Promoting people’s health to enhance socio-economic development (pdf 849Kb). Kampala, Ministry of Health, 2010
  7. Health Sector Strategy and Investment Plan (2010/11 - 2014/15) (pdf 2.91Mb). Promoting People’s Health to Enhance Socio-economic Development, Ministry of Health, Kampala, Uganda
  8. AIDS Control Programme. Kampala, Government of Uganda, Ministry of Health web portal
  9. Uganda malaria indicator survey 2009 (pdf 2.81Mb). Kampala, Uganda Bureau of Statistics; Uganda Malaria Surveillance Project Molecular Laboratory, Mulago Hospital; National Malaria Control Programme, Ministry of Health, and Calverton, Maryland, ICF Macro, 2010
  10. Maternal and Perinatal Death Review Guidelines, 3rd ed. (pdf 1.51Mb). Kampala, Government of Uganda, Ministry of Health, Reproductive Health Division, 2010
  11. Maternal and perinatal death review guidelines, 3rd ed. (pdf 1.51Mb). Kampala, Government of Uganda, Ministry of Health, Reproductive Health Division, 2010
  12. Health Sector Strategic and Investment Plan (2010/11–2014/15) (pdf 2.91Mb). Promoting people’s health to enhance socio-economic development. Kampala, Government of Uganda, Ministry of Health, 2010
  13. Monitoring & Evaluation Plan for Health Sector Strategic & Investment Plan 2010/11–2014/15 (pdf 2.92Mb). Kampala, Government of Uganda, Ministry of Health, 2011
  14. Epidemiology and Surveillance Division. Kampala, Government of Uganda, Ministry of Health web portal
  15. Uganda Nutrition Action Plan 2011–2016 (pdf 2.10Mb) Scaling up multi-sectoral efforts to establish a strong nutrition foundation for Uganda’s development. Kampala, Government of Uganda, 2011