INVESTING IN HEALTH CARE IN UGANDA

Map of Uganda

TABLE OF CONTENTS
TABLE OF CONTENTS
General Overview of the Health Care Industry

The status of Health in Uganda is at the forefront of the overall development Programme of Government. It is one of the key areas identified in the Poverty Eradication Action Plan (PEAP) which is the guiding document in poverty eradication in Uganda.

The current government policy on decentralisation and liberalisation has changed the roles of both central and local governments in health care delivery. Furthermore, the Private sector and its interaction with the public sector have become more prominent. In this respect, government has produced a National Health Policy document and a National Health Sector Strategic Plan for Uganda.

(A) THE NATIONAL HEALTH POLICY

The National Health Policy sets out guidelines intended to achieve the overall goal of attainment of a good standard of health by all the people in Uganda in order to promote a healthy and productive life. The overall policy objective is to reduce morbidity, mortality, fertility and ensure a National Minimum Health Care Package (NMHCP) strategy for Uganda.

The overall strategy aims to:

¨ Continue to promote Primary Health Care as a basic philosophy through the NMHCP,

¨ Ensure equitable distribution of health services throughout the country. Priority is being given to further decentralisation of the health care delivery system to increase access,

¨ Provide good quality health care through cost-effective interventions targeted at the most important health problems of the population,

¨ Maintain a high level of efficiency and accountability in the development and management of the national health system,

¨ provide greater attention and support to health promotion, disease prevention and empowerment of individuals and communities for a more active role in health management,

¨ Cater for the emerging health problems including the care for the elderly,

¨ Strengthen the existing collaboration and partnership between the public and the private sectors in health, including NGOs, private and traditional practitioners while safe guarding the identity of each,

¨ Promote and consolidate inter-sectoral co-operation and co-ordination between the different health related ministries, and development agencies engaged in health development and,

¨ Intensify efforts to promote sustainable additional health financing mechanisms.

(A) THE HEALTH SECTOR STRATEGIC PLAN 2000/01 - 2004/05

The Health Sector Strategic Plan (HSSP) has been developed as a collaborative undertaking of the Ministry of Health, Development Partners and other stakeholders. It acts as the Implementation Strategy for the National Health Policy and prioritizes areas of action, set targets and, defines Organisational and Management approaches for the health sector.

The principal aims of HSSP are to:

§ Improve access of the population to the National Minimum Health Care Package (NMHCP) with emphasis on increasing effective access for the poor, the difficult to reach and the disadvantaged,

§ Improve the quality of delivery of the Package,

§ Reduce inequalities between various segments of the Population in accessing quality services.

Special attention will be paid to:

(a) Training, recruitment, rational deployment, motivation and retention of qualified staff across the country,

(b) Rehabilitation and improvement in performance of existing facilities while providing new facilities to identified under-served populations,

(c) Social mobilisation for community empowerment and participation in the management and monitoring of health services and,

(d) Better coordination and management of resources through ensuring that all stakeholders adhere to the Sector-Wide Approaches (SWAps)code of conduct.

The Uganda National Minimum Health Care Package has nine technical health care programmes namely:

· Control of communicable diseases

· Integrated management of Childhood illnesses

· Sexual and Reproductive Health and Rights

· Immunization

· Environmental Health

· Health Education and promotion

· School Health

· Epidemic and Disaster Prevention, Preparedness and Reponses

· Improving Nutrition

These programmes are considered as cost-effective interventions with high impact on reducing morbidity and mortality identified under the existing resources. Clearly, there are other emerging illnesses not catered for under the minimum health care package which are potential areas for investment. These include the cardiovascular conditions and Trauma/accidents among others.

The implementation of the National Health Policy will therefore involve Government and other stakeholders including the Private Sector and will inevitably contribute towards good health.

Performance and Achievements made

within the Health Sector

Uganda had a well distributed health care system in the 1960s concentrating mainly on curative care. The Health sector, like all other sectors of the economy experienced significant decline from the early 1970s to mid 1980s. The health infrastructure was grossly affected and the only providers of health care services that remained were the Non Governmental Organizations (NGOs) and the Missionaries.

Although the health status remains poor, there has been significant improvement as manifested by the following statistics collected through the population census, the 1995 Uganda Demographic and Health Survey and the Uganda National Household Survey 1999/2000:

¨ IMR decreased from 122 to 97 between 1991 and 1995,

¨ Under 5 Mortality also decreased from 203 to 147 between 19991 and 1995,

¨ The percentage of households with access to safe water increased from 48 percent in 1995 to 57 percent in 2000,

¨ The percentage of households with safe disposal of sanitary facilities increased from 77 percent in 1992 to 85 percent in 2000,

¨ Reported Guinea worm cases have decreased from 1,455 cases in 1995 to 322 cases in 1999.

¨ According to Uganda National Household Survey 1999/2000, there has been an improvement in the welfare of Ugandans between 1992 and 2000. Recent poverty indicators show that the proportion of Ugandans living below the poverty line has declined from 44 percent in 1997 to 35 percent in 1999/2000.

These improvements can be attributed to sound macroeconomic policies that have resulted in an annual average growth of GDP of over 5 percent as well as increases in people’s incomes. In addition, improvements in government allocation to the health sector, introduction of Safe Motherhood Initiatives, intensification of the Immunisation Program and people’s involvement in the management of health services all contributed to this performance.

The above improvements notwithstanding, the resource constraints of government limits it to focussing on only those key areas as identified in the National Minimum Health Care Package. This further leaves many of the curative services as potential areas of investment in the health sector.

ORGANISATION OF THE HEALTH CARE DELIVERY SERVICES

The Health Care Delivery System has undergone re-organization and restructuring in order to improve performance at all levels. This is intended to increase efficiency in the health care delivery systems. As a result, the roles of the health providers have been streamlined at the central, district and sub-district levels.

The Ministry of Health has retained the following roles:

· Policy making/formulation, standards setting and quality assurance,

· Resource Mobilisation,

· Technical Support and Capacity Development,

· Coordination of Health Services,

· Provision of Nationally Coordinated services e.g. Epidemic Control,

· Monitoring and Evaluation of the overall performance of the sector and;

· Training.

At District level, the roles includes:

· Implementation of the National Health Policies,

· Planning and management of the distribution of health services,

· Provision of preventive and promotive as well as curative and rehabilitation services,

· Vector control,

· Health Education,

· Ensuring provision of Safe Water and Environmental sanitation and,

· Health data collection, management, interpretation, dissemination and utilisation.

The District Health System is also being restructured in order to streamline the collaboration of the districts with NGOs and the private sector. The National Health Policy recognises the private sector as a major partner in the health care and service delivery. The Private Sector includes among others Traditional Practitioners (TBA), NGOs and the Private Health Care Providers. The NGOs Health Care providers are already collaborating closely with Government to avoid duplication of services, to increase coverage, equity and financial access of the poor to health care. Traditional Practitioners have already been recognised and mobilised countrywide and a law is in the offing to coordinate and regulate their practice.

At Sub- district level, The Health Care Delivery System has been boosted by the introduction of the Health Sub-District (HSD). Each health sub-district services a population of approximately 100,000 people and will comprise of lower Health Centres III, II and Village Health Committees. This concept of HSD has already taken root and is operational in some districts now.

Village Health Committees will be the first level of Health Centre. The services are to be managed by the community. The community health worker will play a key role in identifying community health needs, providing a link between community and health providers as well as mobilising and monitoring the utilisation of all resources for their health program.

Health Centre II will have no physical structures but services such as out-patients care, immunisation, ante-natal, family planning, health education, and basic first aid and data collection will be provided. This will be under the guidance of either government or an NGO.

At Health Centre III or Health Sub District (HSD), there will be physical structures and services of health centre II, in-patient care and environmental health will be provided. The health centre may be based at the government, NGO or Private health facility. This is the highest level of health services nearer to the population. Services to be provided include obstetric emergencies.

Health centre IV is the headquarters of the health sub-district. In addition to providing services of health centre III, surgery services are also provided. This facility has at least one medical officer, two clinical officers, one registered midwife, one enrolled nurse, one enrolled midwife among others. In every constituency will have either a health centre established or where a lower level health centre already exists, these will be upgraded to health centre IV status.

The Private Sector

The Private sector continues to participate in the health care delivery services, thanks to the favourable macro economic policies of government. To date, there are 5 private hospitals in Uganda and the private sector will be encouraged and facilitated through:

· Contracting out services in public health institutions,

· Facilitating increased investment in tertiary health care by providing incentives to investors to develop centres of excellence,

· Enacting a law for compulsory Health Insurance for the formally employed and,

· strengthening the supervision and regulation of the private health providers.

Availability of Health Facilities

There are 1,740 health facilities in Uganda of which 1,226 belong to government, 465 for NGOs and 49 for the private sector. This represents an increase in the total number of health service providers of about 15 percent (233 units) between 1996 and 2000.

Table 1: Number of Health Units by Ownership

Facility	Government	Non-Governmental Organization	Private	Total
Hospitals	57	44	5	106
Health Centre	179	68	3	250
Pilliative Care	1	1	-	2
Other^[i]	989	352	41	1382
Total	1226	465	49	1740

Source: Ministry of Health

Government hospitals are in three categories;

a) National referral hospitals which double as teaching hospitals,

b) Regional referral hospitals with specialists in limited fields and,

c) District/rural hospitals manned by general doctors. These comprise of all the government hospitals not mentioned above.

In total , there are 57 government hospitals, 44 NGO hospitals and 5 private hospitals. In addition, there are 3 private health centres and 41 other private units which include dispensaries, maternity units and sub-dispensaries. The rest are owned by either government or NGOs.

TRAINING OPPORTUNITIES IN THE HEALTH CARE INDUSTRY

Health care training institutes continue to provide about 80 percent of the manpower requirements of the health sector in Uganda. Below is the number of graduates from Makerere University and Mbarara University of Science and Technology. Furthermore, other training institutions are also listed along with their capacities to assist investors in identifying possible areas for interventions.

Table 2: Number of Doctors Graduating from Makerere and Mbarara Universities, 1995-2000

Courses offered	1995	1996	1997	1998	1999	2000
MB.CH.B. Medicine	107	150	133	179	139	137
BDS ( Dentistry)	11	6	6	15	12	9
B. Pharmacy	7	10	11	7	15	10

Statistical Abstract 2000 and Ministry of Education and Sports

The table below indicates the number of training institutions in the country. Although the number totals to 69, they are still inadequate to fully address the growing demand for specialised skills in the health care sector. There is therefore, a potential and opportunity to invest in this sector particularly in areas where specialised manpower shortages have been identified.

Table 3: Number of Training Institutions

COURSE	DURATION IN YEARS	No. OF SCHOOLS OFFERING COURSE	TOTAL CAPACITY OF SCHOOLS
Anaesthesia certificate	1	1	30
Anaesthesia Diploma	1.5	1	30
Bachelor of Dental Surgery