With a small budget and many emergencies to deal with, in the first years the role of international aid was fundamental to revitalize the Ugandan healthcare system. Even though the international community was willing to assist the country, the reality was the country was facing a sector in near total collapse, with basic infrastructure to rebuild, no equipment, untrained medical staff, unreliable drugs supplies, and rampant corruption.
In the 1990’s the Ugandan Government and the major international donors agreed to work within a framework that would allow strict monitoring and regulating of expenditures in the health sector in order to curb corruption. This approach fostered high-budget programs that uplifted the national healthcare sector and helped Uganda rise from the ashes, but this rise from the ashes was not all upward movement.
The health care system during this time was getting far better, but life expectancy during that time was going down, and for one very good reason. Just a few years before the NRM took over, a new deadly disease was being reported in Uganda, referred to as “slim disease.” This was the start of HIV/AIDS. Within a few years it would reach pandemic proportions with Uganda at the epicenter, often ravaging victims in their most productive years.
Life expectancy during this time fell sharply to 43 years, and could have easily tumbled further if not for the decisive actions taken by the Ugandan government. President, Yoweri Museveni was one of the only African leaders who would talk publicly about AIDS, and insisted that despite the disease being transmitted principally via sexual relations, it would not be a taboo subject. He created AIDS task units within every government ministry and fought the pandemic with one of the only coordinated efforts at the time. Despite Uganda being once considered nearly ground zero for AIDS, the infection rates in Uganda leveled off far faster than they did in almost every other affected country.
During this period, the cooperation between Government and donors produced also some centers of excellence at the international level, such as the MRC/UVRI Uganda Research Unit on AIDS, an internationally recognized research centre on HIV infection and related diseases, that contributed to the development of health policy and practice in Africa and worldwide.
The unit was established in 1989 in Entebbe following a request from the Ugandan Government to the UK Government to contribute to the understanding and control of the HIV pandemic in Uganda.
For the past 20 years the public spending on health has been steadily increasing, from 5.5% of GPD in 1995, to 9.8% in 2013. Likewise, the expenditure per capita increased, from less than $5 per person to $26 per person in 2013.
Thanks to this effort, the Government became gradually more self reliant in terms of health facilities and budget. Public health expenditure rose from about 20% in 1995, to almost 45% in 2013. Public health facilities multiplied. In just 10 years, their numbers climbed from 1,979 in 2004, to 2,833 in 2015.
However, many challenges persist, the main one probably being the underperformance of healthcare professionals. Patients often complain of being dismissed by physicians without being cured, not being attended to for hours, as well as inefficiency and negligence of healthcare workers.
These are serious issues that must be addressed. A key factor leading to underperformance is the short supply of human resources for health, both in terms of numbers and skills. The Ministry of Health’s Health Sector Strategic and Investment Plan 2010/11-2014/15 put these shortcomings at the centre of the government’s action to enhance the quality of health services. A strong recruiting campaign took place, with health workers increasing from 63,872 to 81,982, a staggering 28% increase, in just one year (2014-2015).
The health system faces great challenges. Above all, Uganda’s almost explosive demographic growth is putting under pressure all social services, especially the healthcare sector. With an average 6.3 children per family and higher life expectancy, Uganda’s population is growing at an unprecedented rate. Will the country be able to sustain services for its people despite this growth? The solution goes beyond the management of public healthcare. It involves securing peace, stability, the rule of law, access to quality education and maintaining an environment conducive to sustainable economic growth.
Like the AIDS pandemic, it will take a coordinated government effort with full commitment by visionary leaders.