Uganda on the move, yet some are being left behind..

I was in Uganda recently and having not been there for a few years, was pleasantly surprised at the signs of development everywhere — new roads, bridges and buildings being built, more bodas, cars and lorries on the streets, more vendors and roadside stalls selling fresh produce. There’s even talk of the SGR railway being extended from Nairobi to Kampala, which will considerably improve Uganda’s connectivity with global trade routes. The country’s economy seems to be on the move and the World Bank forecasts growth of over 5% in the last fiscal year which is great news.

The economic growth however does not seem to have benefitted all people equally, and there are many gaps on the human development front, which was evident as we travelled across the country. There are visibly more people seeking alms in the cities and the poorest in rural communities seem to lag farthest behind with little access to basic amenities or social services such as primary healthcare.

Health centres in some rural areas seem dilapidated, lacking trained and motivated staff and essential equipment and supplies to deliver basic healthcare services. Women from the poorest households are half as likely to give birth at a health centre as the richest, and over a quarter of young children in the country do not meet their full growth potential.[i]

All parts of Uganda have high rates of malaria transmission, and while the mosquito net ownership has steadily increased over the past decade, according to recent reports improving their use has been quite challenging. Young children and pregnant women are the most vulnerable to malaria and more progress is needed to ensure their use of mosquito nets.

Malaria Consortium has worked in Uganda for over 15 years, providing technical leadership on holistic malaria, child health and disease control. We work closely with the national Ministry of Health, local authorities and partners across all regions and districts of the country.

We also have our East and Southern Africa Regional Office in Kampala, which meant that there are additional technical, operational and management experts around, and this being my first trip since joining the organization, I was expecting a week of meetings in boardrooms and offices across town, and perhaps a field trip to a nearby project site.

What I had not come prepared for, literally in terms of choice of clothing that I brought, was a road trip around the country (mostly off-road though) — in fact we ended up travelling over 1100kms across 3 regions and 8 districts in 6 days, visiting numerous health centres, DHO offices, field offices and village health teams.

But this was perhaps the best orientation I could have asked for — it was truly impressive to see the scale and breadth of our programming across the country, and meeting inspirational staff and health workers on the frontline, delivering services under challenging circumstances.

Key highlights that stood out for me were;

Our leadership on the USAID’s flagship Malaria Action Program for Districts and support to quality case management of malaria and childhood illnesses across the country

Our stewardship of the second universal coverage campaign, supporting the national malaria control program to deliver nets across the country and promoting a culture of net use

Our policy engagement with the Ministry of Health and leadership of the national malaria technical working group, coordinating partners’ efforts and informing policies and practices.

Most importantly, we’re helping strengthen district health systems and service delivery at the last mile — improving government capacity, equipping health centres and empowering frontline health workers to deliver quality of services for mothers and children.

A key benchmark for success to me is the government ownership and community engagement — and in almost at all places visited and people met, I could feel the energy and conviction of the Ugandan people, striving to do a better job under sometimes difficult circumstance.

The communities seem resilient and the spirit of entrepreneurship is driving people forward, however the government needs to step-up efforts if Uganda is to expedite its progress towards sustainable development goals and the African Aspirations for 2063.

The 1st East African Community (EAC) Summit on Health Financing in Kampala this week presents an opportunity not just for Uganda but other countries in the region, to reaffirm their commitment to universal health coverage and child survival.

Uganda, with over 7% of GDP allocation to health, is already the leader on health financing in the region, however, will need much more investment to strengthen and scale up quality primary healthcare services and ensure universal health coverage for all people across the country, in particular providing mechanisms for financial protection of the poorest and vulnerable groups.

The EAC Heads of State Summit also presents an opportunity to plan for reducing reliance on foreign aid and progressively mobilise domestic resources for health, as this will enable countries to sustain gains made through donor-funded projects.

Uganda is on the move, on the fast track to economic development, but must ensure that human development does not get deprioritised and that some people do not get left behind.

Zaeem Haq is Malaria Consortium’s Head of Technical for East and Southern Africa. He visited Uganda between 22–27th January 2018.

[i] Tracking Progress towards Universal Coverage for Reproductive, Newborn and Child Health: The 2017 Report. Washington, DC: United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), 2017.