Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Uganda to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 60 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 66 deaths per 1,000 live births, a notable decrease from 69 in 2012, and measles immunisation at 82 per cent, up from 75 per cent in 2011. The United Nations Development Project (UNDP) has noted that Uganda has reduced child mortality markedly since the publication of the 2010 MDG Report, and suggests that if the recent accelerated rate of progress is maintained, Uganda has a good chance of fulfilling the requisites of the goal by 2015. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Uganda, maternal mortality should fall to 150 cases per 100,000 live births. In 2013 Uganda had an adjusted maternal mortality ratio of 360 deaths per 100,000 live births (this figure was estimated at 310 deaths per 100,000 by UN agencies/World Bank in 2010). It is therefore very unlikely that Uganda will meet this target when the 2015 data is analysed, as it would need to more than halve its maternal mortality ratio in just two years. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2011 this figure stood at 58 per cent and so this target is also unlikely to be met. The UNDP notes that health care in Uganda has shown progress across the majority of indicators for maternal health since the publication of the 2010 MDG report, but states that it is unlikely to meet the targeted reduction in overall maternal mortality by 2015. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. While HIV prevalence in Uganda has shown an overall reduction since the early 1990s, it has increased since 2006 and the percentage of the population infected with the disease is high at 7.4 per cent (in the 15–49 age group). In addition, confirmed cases of and mortality from malaria in the country are high. Estimated levels of TB incidence and mortality are high, but levels of both have reduced significantly since 1990. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Less than a quarter of health care in Uganda (24 per cent) was government funded in 2012. The remaining 76 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted eight per cent of GDP in 2012. Expenditure by government amounts to US$10 per capita. The UNDP has noted that progress has been registered in reducing the burden of malaria and tuberculosis. Equally, improved access to medical treatment has reduced the mortality rate associated with HIV/AIDS. However, it has been found that the prevalence rate among 15–24-year-olds has increased, which could be attributed to Ug a n d a improved treatment indirectly contributing to a rise in the number of new infections by prolonging the lives of those living with HIV. A World Health Organization (WHO) report in 2009 found that the resources available for health are less than required to deliver the Uganda National Minimum Health Care Package. Public health care is free, in theory, but there are often unofficial fees and patients can be asked to buy drugs and surgical items privately. In rural areas, health care coverage can be patchy and the costs of travelling to the nearest clinic are prohibitive for some. The WHO Country Co-operation Strategy (2009–14) prioritises planning to ensure equitable resource allocation and harmonisation of donor projects, as well as generally strengthening the country’s health systems. The National Health Policy II (2010–20) includes a Health Sector Strategic and Investment Plan, the aim of which is ‘the attainment of a good standard of health by all people in Uganda, in order to promote a healthy and productive life’. Uganda was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1987 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 910,000 people in Uganda are over the age of 65 – two per cent of the total population (2013). At the age of 60 a person living in Uganda can be expected to live for an additional 17 years, on average (2013). Uganda’s Senior Citizens Grant, which has been piloted in 14 districts, dates back to 2011. Today, monthly pension credits are paid by the state at a rate of US$9 per person (2007–12) on a universal basis in the districts where the pensions have been introduced. Overall, public pension spending is equivalent to 0.4 per cent of the country’s total economic output (2011). Population over 65 2% There are several old people’s homes in Uganda. Traditionally, the elderly are cared for by younger generations of extended family. However, AIDS has killed the children of some older people, leaving them vulnerable. The UK-based Quicken Trust runs a Sponsor an Elderly Person scheme that provides food and pays for health care for elderly people in rural Uganda. Further information Ministry of Health: www.health.go.ug Commonwealth Health Online: www.commonwealthhealth.org/health/africa/uganda Commonwealth Health Partnerships 2015 287
Commonwealth Health Partnerships 2015
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