Focus Should Be On Improving Health Services

Irene Achola

1 July 2011

opinion

Over the years, the healthcare system in Uganda has deteriorated. In the 1960s-1970s, Uganda ranked behind South Africa among African nations that were on international standards developing lists. It is disheartening that in the 21st Century where Ugandans need better health services, this has not been provided. Despite the international commitments like the Abuja Declaration to improve health service provision, not much has been done to improve health services in the country.

Similarly, funding for the sector has stagnated between 9 to 10.5 per cent for the last four financial years which is still less than 15 per cent to meet the agreed Abuja target. This means the allocations made to the sector do not factor the increasing inflationary pressures as well as other exogenous factors like the recent economic downturn which reduces the real value of the resources.

The recent World Children Report reveals that Uganda is still experiencing poor health indicators; under -five mortality has remained at 128 per 1,000 live births, ranking Uganda at 19th out of 190 countries studied. It further indicates that Uganda has the second highest rate of infant mortality rate in the East African Community after Burundi. Amidst the above indicators, there is rampant expiry of drugs particularly at the districts which further raises questions on the functionality of the current health delivery system.

In a just-concluded Public Expenditure and Service Delivery Survey in the health sector undertaken by Advocates Coalition For Development and Environment (ACODE), a policy research Think Tank, it was revealed that deficiencies in staffing levels has worsened the problem of absenteeism in the health sector. Of the 49,850 positions approved by local government structures in 2006/07, only 28,450 are filled which is only 57 per cent. This means the number is less than the 64 per cent which the government is said to be funding.

The study also shows that the creation of more districts has created internal pressure on the available resources and yet they could have been deployed under “public expenditure targeting”. In Nebbi for instance, when Zombo District was carved out, the health budget was split between the two districts, and yet the activities of the district health office were not reduced, further affecting health service delivery.

Poor health is a major cause of poverty which, if not critically prioritised, will hamper the achievement of the 2011-2012 budget theme of promoting economic growth, job creation and improving service delivery. It is therefore important for the government to prioritise outreach activities, increase health staff remuneration and fund activities that meet health-related Millennium Development Goals targets. The donors will also need to use policy dialogue and joint assessment framework mechanisms in order to ensure a consistent move to achievement of results-based management of budget support- specifically with regard to MDG 5A (Improving maternal health), where progress has proven to be slow.

Ms Achola is a researcher with ACODE

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