Comparative Analysis of Uganda’s 1999 and 2009 Health Policies

University of osnabrueck
Social Sciences  Faculty
MA. Democratic Governance and Civil society

Comparative Analysis of Uganda’s 1999 and 2009 Health Policies

By

Julius Byaruhanga

jbyaruhanga@uni-osnabrueck.de

17^th June 2013

Objective

Evaluation of the progress and challenges with in Uganda‘s Health sector from 1999 to date & forge a way forward 

Summary

Policy(s) Background

1. Uganda’s Health Staus 1999 and 2009

Policy(s) Aims and Objectives 

1. The National Health Policy 1999 and 2009 Political issue/aims
2. Policy sector; 1999 and 2009Matters and objectives

Implementation

1. Actors (implementers and supporters of the Policy)
2. Strategies, beneficiaries
3. Health Situation analysis; Critics and possible solutions/measures
4. Other current health challenges and possible solutions

Conclusions

1999 Uganda‘s health Status

1. Projected population of 20.4 million (Statistical Abstract 1997), that is 50.9% females and 49.1% males,
2. Annual population growth rate of 2.5% (1991 Census) & annual GNP per capita of US$300 and
3. Approximately 46% of the people living in absolute poverty

75% of the life years lost due to premature death were due to ten preventable diseases i.e.

1. Perinatal and maternal conditions (20.4%),
2. Malaria (15.4%),
3. Acute lower respiratory tract infections (10.5%),
4. AIDS (9.1%) and
5. Diarrhoea (8.4%)
6. Others included; tuberculosis, malnutrition (with 38% of under-5s stunted, 25% underweight for age and 5% wasted), trauma/accidents and measles.

2009 Uganda‘s health Status

1. Population of 30.7 million with an annual growth rate of 3.2% & population density of about 120 persons per km2
2. Life expectancy increased from 45 years in 2003 to 52 years in 2008; HIV prevalence has stabilised; polio and guinea worm had nearly been eradicated
3. Between 1995 and 2005, U5MR declined from 156 in 1995 to 137 deaths per 1,000 live births; and MMR reduced from 527 to 435 per 100,000 live births.

4.      Under‐weight prevalence reduced from 23% to 16%

These health indicators are still poor.

1. Malaria, HIV and AIDS and tuberculosis remain the leading causes of morbidity and mortality.
2. 70% of overall child mortality is due to malaria, Acute Respiratory Infections, diarrhoea and malnutrition.

Overall Objective and mission

Health Sector Objective

The overall objective of health sector policy is to reduce mortality, morbidity and fertility, and the disparities therein. Ensuring access to the Minimum Health Care Package

1999 Mission

Attainment of a good standard of health by all people in Uganda, in order to promote a healthy and productive life

2009 Mission

A healthy and productive population that contributes to economic growth and national development

The National Health Policy 1999 and 2009 Political issue/aims (specific objectives)

1. Organisation and management of the national health system
2. The minimum health care package (1999 & 2009)
3. Monitoring and evaluation
4. Legalislation and regulation
5. Health resources
1. Human Resource Management and Development
2. Medicines and health supplies
3. Health Infrastructure
4. Health financing
6. Partnerships in health
1. Public Private Partnership in Health (PPPH)
2. Inter‐sectoral and inter‐ministerial partnership
3. Health development partners
4. Partnership with the community

Components of the minimum health care package

“Policy overlap”

1. Control of Communicable Disease

1. Malaria 
2. STI/HIV/AIDS
3. Tuberculosis

2. Integrated Management of Childhood Illness

3. Sexual and Reproductive Health and Rights

1. Essential Ante-natal and Obstetric Care
2. Family Planning
3. Adolescent reproductive health
4. Violence against Women

4. Other Public Health Interventions

1. Immunisation:
2. Environmental Health
3. Health Education and Promotion:
4. School Health:
5. Epidemics and Disaster Prevention, Preparedness and Response:
6. Improving Nutrition:
7. Interventions against diseases targeted for eradication

Actors (implementers and supporters of the Policies)

„Well structured?“

1. Health related central line ministries,

Minister of Health

ü  State Minister for Health (General Duties)

ü  State Minister for Health (Primary Care)

2. The Health Service Commission,
3. The Local Governments,
4. Donors,
5. Private Practitioners,
6. NGOs and
7. Traditional Practitioners within the decentralized system
8. Semi-autonomous bodies;
1. Uganda National Health Research Organization
2. Uganda Blood Transfusion Service
3. National Drug Authority and
4. National Medical Stores

Strategies & beneficiaries

Some of the Strategies

1. Provide additional resources  
2. Subsidise designated public health and essential clinical  services
3. Provide national guidelines  
4. Restructure the organisation and management of the National Health Care System
5. Implement the organisation and management reform of the Ministry of Health
6. Strengthen district health services management
7. Decentralise operational responsibilities for integrated health promotion, disease prevention
8. Clarify the relationship between the key stakeholders
9. Divest clearly defined central MoH functions, as appropriate, to the autonomous and semi-autonomous bodies
10. Review and strengthen the existing national drug policy;
11. Review and update the national food and nutrition policy

Beneficiaries  

General Population with much emphasis on;

1. Pregnant and non-pregnant mothers
2. Children
3. HIV/AIDS Patients
4. Rural population

Health Situation Analysis

Policy area	Situational Analysis	Critic(s)	Posible solution
Health service delivery	Provided by the public and private sector with each sector covering about 50% of the standard units of outputs	High burden on the Pupulation	Establishment of more Public Hospitals & equiping the existing
The public health delivery system	Autonomous Village health teams (VHTs), HCs II, III and IV and district general hospitals) and regional (RRH) and national referral hospitals (NRH),	Less Accountability Poorly equiped Limited personnel	Personnel recruitment Equiping RRH and NRH to maximum Acc. Checks and balances
The private sector	_not for profit organisations (PNFPs), private health practitioners (PHPs) and the traditional and complementary medicine practitioners (TCMPs).	_not properly integrated with the public sector  _PNFPs have not been properly harnessed to support health promotion at community level	_Encourange PPP _Government support to private hospitals _Encourage Private Hospitals establishment at community levels
The Private not‐for‐profit subsector (PNFP)	PHPs provide mainly primary level services and have a large urban presence.	_Receive no support from government _Standerd not checked	_Need to be standerdised _Need for Gov‘t support
Traditional and Complimentary Medicine Practitioners	Approximately 60% of Uganda’s population seek care from TCMPs	Many traditional healers remain unaffiliated to gov’t or private HCs	_Check Standerds and affliate them with support from Gov‘t
Supervision, monitoring and evaluation	Area Teams, technical programs, District Health Teams and HSDs supervise service delivery at government and PNFP facilities at different levels, except the national and regional referral hospitals	_Supervision and monitoring visits are irregular and poorly documented;  _lack of human resource newly created districts  _Lack of supervisory skills at district and HSD levels;   _Lack of transport and inadequate budgets	_More empasis on funding the activity _Trainning of more supervisors _on-job training

Other current health challenges and possible solutions

Challenges	Possible solutions
Maternal Motarity rate still high	_Adquet funding and trainning of more Midwives  for at least 3 midwives per Health centre mainly at local levels
Childhood mortality is generally higher among children of less educated mothers	_Mass training of rural mothers
Delay of woman seeking care cited in 112 maternal deaths	_Compulsory natinental care for pregnant mothers
Uganda has the world’s 2nd highest accident rate, with over 20,000 road accidents a year and 2,334 fatalities in 2008	_Strengthening of traffic laws and effective implementation
Human resource shortage in hospitals remains a major challenge to service delivery	_Increase remuneration of medical personnel and sponsorships to students interested in medical field
Many of the hospitals especially private health practitioner hospitals do not satisfy the criteria of a hospital but are nonetheless registered as hospitals	_Strict laws on registration of hospitals based  even on number of Doctors and other health workers a hospital has before it registered
Very few if not no ambulances in rural government health centres	-Provision of at least 10 Ambulances per Health centeres at a Hospital Level and at least 4 each sub-county for Local Health centres

Conclusion

1. Why is the policy important? “Clear reasons for their development”
2. What are the requirements? “Specific actions defined”
3. Who needs to know, execute and own the policy? “Clearly communicated?”
4. Where do the standards apply? “Multiple areas?”
5. How will the standards be applied to business? “Awareness (language)”

Meeting such standards will automatically mean less or no priority overlaps in 1999 and 2009 Uganda‘s health policies