Government priority setting has undermined the health sector in Uganda

The recently concluded 43rd session of the Commission on Population and Development (April 12-16, 2010), had an intensive debate on Health, Morbidity, Mortality and Development. Uganda was represented at the meeting, participated actively in the debates and made a statement at the plenary.

It was recognized that while commendable progress had been made in health over the last ten years, much more remained to be done in many developing countries especially the least developed ones to address the ‘double burden’ of infectious and parasitic diseases, emerging and re-emerging communicable diseases, and increasing non-communicable diseases such as hypertension, stroke and diabetes. Maternal and child health had made the slowest progress in the last decade. It was stressed that poverty, inequality and vulnerability have had far-reaching repercussions on the health of many people within and between nations.

The commission stressed that improving health will need to go beyond constructing hospitals and clinics and providing medicines, and adopt a multi-sector approach that includes health education, nutrition, safe drinking water, hygiene and sanitation, environmental protection, reproductive health, training and retention of staff.

Brain drain from the developing countries has undermined the development of the health sector. The Executive Director of UNFPA and other speakers lamented that the brain drain and health worker migration that leave many parts of the world are depleting the human resources that these countries need – “the very parts of the world that need these resources the most due to the many health challenges they face”.

The role of food and nutrition security in advancing the health of nations was stressed. Representative of the Food and Agriculture Organization of the United Nations (FAO) underscored the impact of poor health on agricultural production and food security as well as the impact of hunger and poor nutrition on human health particularly of pregnant women, nursing mothers, young children and the elderly. The Representative further noted that agriculture and trade should be managed in such a way that adequate amount and variety of safe foodstuffs should be available, accessible and affordable by everyone for a healthy, active and productive life. FAO further noted that “Key challenges include inadequate funding for health services in rural areas and the continued lack of nutritional capacities to effectively dovetail agriculture-based interventions with public health measures”.

A close examination of Uganda’s record shows that there are many deficits in the health, agriculture, food and nutrition sectors due to the way in which policies have been set and priorities determined. Since the 1990s, government policy making and priority setting have been driven by the desire to accumulate foreign currency. Accordingly, a shift was made from producing for domestic consumption to external markets in neighboring countries and beyond. Farmers have been encouraged to produce for cash and not for the stomach. Consequently much food especially of the nutritious type like fish, beans, fruits and vegetables or land where they were grown has been taken over by cut flowers for export, leaving little food in the domestic market.

Rising food prices have forced many families to go to bed hungry or to eat one meal a day of cassava or maize with insufficient or no nutritional supplements and serious negative consequences. Under-nourished pregnant women are producing under-weight infants with permanent disabilities, and under-nourished children are developing physical and mental handicaps.

Reduced food supplies in the domestic market have made it difficult for the government to reach a decision on the important issue of school lunches which improve attendance and performance especially of girls who are now dropping out of school in large numbers with implications for early marriage and high fertility and mortality rates for mothers and children.

Low government and household investments in hygiene, housing, clothing especially shoes, safe drinking water and sanitation have contributed to a high burden of preventable or easily treatable diseases such as diarrhea, scabies, jiggers, trachoma etc that are detrimental to many dimensions of development.

The desire to increase remittances as part of overall foreign currency accumulation objective has resulted in massive brain drain of highly trained and experienced professionals including those from the health sector. The impact of this development has been serious especially in rural areas where health service delivery has declined for lack of adequate and skilled staff.

, , , , , , , , , All