H.E Julius Peter Moto, Uganda High Commissioner UK & Ireland was the first ever to host the Uganda Independence Celebrations in the UK Parliament/ House of Lords. Below is his full speech at the function.
“Historical aspects and paradoxical mutual benefits between Uganda and United Kingdom”
Presented by: Amb Julius Peter Moto, High Commissioner of Uganda in London.
8th Oct 2018
House of Lords, UK
In pursuit of Uganda Vision 2040, the health sector aims at producing a healthy and productive population that effectively contributes to socio-economic growth.
The Vision is “A Transformed Ugandan Society from a Peasant to a Modern and Prosperous Country within 30 years”.
Within the health sector, this vision will be achieved by provision of accessible and quality health care to all people in Uganda through delivery of promotive, preventive, curative, palliative and rehabilitative health care. Therefore, the roles and contributions of all health care players; the government, non-governmental and private players including Ugandans in diaspora, indigenous traditional and complimentary health practitioners remain pertinent in the implementation of the health Sector development plan in the Second National Development Plan (NDP II). 2015/16 – 2019/20
Uganda got independence from the British on 9th October 1962. She went on to establish a robust health system in 1960s that witnessed the construction of 22 new Hospitals, staff development and equipment. Hospitals that were built by the Colonial government were all expanded, equipped, and staffed. Hundreds of health clinics were built, staffed, equipped and stocked.
In the 1970s up to mid-1980s, no new hospitals and health centres were built. The health sector suffered a major blow as many trained man power left the country for fear of their lives. The largest exodus of personnel in the health sector was in 1972 when Ugandan Asians medical workers were forced to leave the country. The cause of brain drain was occasioned by insecurity and poor pay and inadequate resources in the sector.
All sectors of Uganda economy was hit by economic decline and despoliations of the 1970s and 1980s.
Riddled with unsustainable debt, Uganda’s total debt stock at end June 1993 was estimated at US$2.64 billion. The debt outstanding and disbursed was estimated at 105% of GDP, with a debt service ratio of nearly 80% which constituted a major bottleneck to Uganda’s economic recovery process and future developments hence the health sector and all other sector had no hope for progress.
In early 2000s, under the HIPC initiatives, the debt of Uganda was forgiven and the country started to get back its bearing, amidst civil wars and insurgencies.
During all these periods, all Hospitals ran out of stock. Buildings were weathered to states of disrepairs. Equipment was outmoded. Human resources establishment were not filled to capacity in all units and departments. With a population of about 15 million people at the backdrop of less than $3 million tax revenue collection per year, it was a hard hill task to allocate resources for national building.
New shifts in approach to health
As Uganda faces shifting dynamics of health threats due to population growth of 3% per annum, economic development, climate change, and human migration and displacement, the multi-sectoral nature of these threats necessitates a departure from traditional, vertical public health responses. To address this need, the Government of Uganda will adopt a One Health approach to addressing three priority public health threats: zoonotic diseases, AMR, and biosecurity, drawing on experience and lessons from Uganda’s rich history of multi-sectoral disease response.
Since the 1980s, Uganda has had several successful multi-sectoral disease response initiatives. While many of these efforts predate the One Health concept, they demonstrate its effectiveness in action. Some key initiatives include:
In the early 1980s, Uganda recognised the importance of linkages between human and animal health, and established a Veterinary Public Health division within the MOH.
The Uganda Trypanosomiasis Control Council, established in 1992, with the Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU) as its secretariat was one of the earliest high-level multi-sectoral coordinating bodies for disease response.
Despite the severity of the HIV/AIDS epidemic in Uganda, strong political leadership and civil society participation were hallmarks of its successful multi-sectoral approach to disease response.
Following effective multi-sectoral responses to the avian Influenza outbreaks in 2009, Uganda worked with the World Bank on the Avian and Human Influenza Prepared-ness and Response Project, further fostering collaboration.
In 2013, the Ugandan veterinary and medical associations hosted a One Health Conference, which resulted in the signing of a One Health MOU. This was followed in 2016 by a One Health Framework and the establishment of the NOHP, the foundation for this plan.
The Ministry of Health and its affiliated semi-autonomous Agencies such as National Drug Authority (NDA), National Medical Stores (NMS), and National and Regional Referral hospitals provide policy setting, regulation, stewardship and governance oversight, strategic planning, monitoring, supervision, resource mobilization and direct provision of health services. The local governments are charged with operational planning, management and delivery of health services.
The private sector and CSOs complement Government in the production and delivery of health services as well as training and research. The growing focus on communities and households to take charge of their health makes them important health system players. The bilateral and multilateral Development Partners remain key players in supplementing government efforts in financing and provision of health care. Aware that the major determinants of health including income, education, housing conditions, sanitation, safe water access and hygiene, gender, cultural beliefs, social behaviours, nutrition and management of natural disasters are outside the mandate of the health sector, strong inter-sectoral collaboration to enhance disease prevention and health promotion will need to be enhanced.
The Sector targets to: increase deliveries in health facilities (Health Centres and Hospitals, Public and Private Not For Profit) from 41 percent (2012/13) to 64 per cent (2019/20); reduce maternal deaths in health facilities from 148/100,000 (2012/13) to 119/100,000 by 2020; reduce under five deaths in health facilities from 18/1000 (2012/13) to 16/1000 by 2020; reduce annual Out Patient Department attendance due to malaria cases from 12,224,100 to 2,600,000; reduce new HIV infections among adults from 140,908 (2012/13) to 42,272 (by 70 percent) in 2020; reduce HIV related deaths from 52,777 (2013) to 21,497 by 2020; increase TB treatment success rate from 80 per cent (2013) to 90 per cent (2020); and increase proportion of population accessing health insurance from 1 percent(2013) to 6 percent by 2020.
Human Resources for health remain low particularly midwives and doctors as well as medical specialists. While physical access to health facilities increased to about 72 percent (2013) with 5kilometres, health infrastructure remains out-dated in many general hospitals and some lower level health facilities. Functionality of some health facilities particularly Health Centre IVs remains inadequate.
The country’s high population growth rate, driven by the high fertility rate of 6.2 children per women (UDHS, 2011) poses challenges for health care delivery in terms of demand and supply. The women and children being the most vulnerable groups to diseases and yet the highest percentage of the population presents both challenges and opportunities that require re-positioning of the health sector. Inadequate behavioral change for disease prevention, emerging diseases and epidemics and porous borders are some of the challenges that the sector will need to tackle; while tapping opportunities such as the growing economy and technological advancements in health care and exploiting the large pool of private providers and good will of health development partners.
In order to address challenges and the outstanding capacity issues, the sector shall implement the post-2015 development agenda which prioritizes universal health coverage (including mass treatment of malaria); sexual and reproductive health; ending malnutrition in all its forms; reducing maternal mortality, ending preventable new born, infant and under-five deaths, ending HIV/AIDS, TB, malaria and neglected tropical diseases, and reducing premature deaths due to non-communicable diseases.
The sector will also work towards achieving Universal Health Coverage (UHC) through establishing a national health insurance scheme while harnessing synergies from public private partnerships and strengthening the referral system.
Uganda and UK and mutual benefits
Uganda enjoys a strong bilateral relationship with United Kingdom. Uganda’s influence and relative stability in the region makes it a priority country for UK objectives. Over the years, UK supported the budget processes for socio economic recovery of Uganda. UK hosts over 430 health care professionals in the NHS. Recall the reasons I alluded to as to why our experts left the country in the historical background.
UK has continued to support capital development budgets of Uganda. The Department for International Development (DFID) leads the UK’s global efforts to end extreme poverty, deliver the Global Goals for Sustainable Development (SDGs) and tackle a wide range of global development challenges. Top 3 planned spending programmes in 2018/19 (as at 9th May 2018
Building Resilience and an Effective Emergency Refugee Response £35m;
Strengthening Uganda’s Response to Malaria £10.3m; Northern Uganda:
Transforming the Economy through Climate Smart Agribusiness £8.8m.
While Government and development partners’ focus on communicable diseases, there is a need for innovations and private sector participation. This has created investment opportunities in health management, human resource training e-health solutions and logistics, tertiary care services, early detection, treatment, medical tourism and manufacturing of affordable equipment including drugs and other centres of excellence provide more investment opportunities. Ugandans in UK are encouraged to invest in the health sector.
The successes of the Uganda Health sector require your support in order to actualise the One Health Strategy adopted by Government of Uganda, as a main vehicle to contribute to the Vision 2040.
Uganda health sector Overall, sector efforts will be geared towards: strengthening of the national health system including governance; disease prevention, mitigation and control; health education, promotion and control; contributing to early childhood development;
curative services; rehabilitation services; palliative services; and health infrastructure development.
Inputs by Ugandans in diaspora are appreciated. Ugandans in diaspora should pay it forward and contribute to the health improvement of Uganda.
I wish you a happy 56 Independence Celebration.
Uganda Vision 2040,
Second National Development Plan (NDP II)
Research Paper 66 African Economic Research Consortium, Nairobi November, 1997
UK Government website: https://www.gov.uk/government/publications/dfid-uganda-profile-july-2018.
For God and My Country