Uganda's health system is composed of health services delivered to the public sector, by private providers, and by traditional and complementary health practitioners. It also includes community-based health care and health promotion activities.
Uganda's health system is divided into national and district-based levels. At the national level are the national referral hospitals, regional referral hospitals, and semi-autonomous institutions including the Uganda Blood Transfusion Services, the Uganda National Medical Stores, the Uganda Public Health Laboratories and the Uganda National Health Research Organization (UNHRO).[3] The aim of Uganda's health system is to deliver the national minimum health care package. Uganda runs a decentralized health system with national and district levels.[3]
The lowest rung of the district-based health system consists of Village Health Teams (VHTs). These are volunteer community health workers who deliver predominantly health education, preventive services, and simple curative services in communities. They constitute level 1 health services. The next level is Health Center II, which is an out patient service run by a nurse. It is intended to serve 5000 people. Next in level is Health Center III (HCIII) which serves 10,000 people and provides in addition to HC II services, in patient, simple diagnostic, and maternal health services. It is managed by a clinical officer. Above HC III is the Health Center IV, run by a medical doctor and providing surgical services in addition to all the services provided at HC III. HC IV is also intended to provide blood transfusion services and comprehensive emergency obstetric care.[4]
In terms of governance, the MOH is currently implementing the Health Sector Strategic and Investment Plan (HSSIP), which is the third iteration of health sector strategies. The MOH coordinates stakeholders and is responsible for planning, budgeting, policy formulation, and regulation.[5]
According to a 2006 published report, the health sector at the district and sub-district level is governed by the district health management team (DHMT). The DHMT is led by the district health officer (DHO) and consists of managers of various health departments in the district. The heads of health sub-districts (HC IV managers) are included on the DHMT. The DHMT oversees implementation of health services in the district, ensuring coherence with national policies. A Health Unit Management Committee (HUMC) composed of health staff, civil society, and community leaders is charged with linking health facility governance with community needs.[5]
In addition, the Uganda Medical Association (UMA) seeks to "provide programs that support the social welfare and professional interests of medical doctors in Uganda and to promote universal access to quality health and health care."[6] However, the government's failure to improve the compensation of doctors , as well as failing to conduct a review of the supply of medicines and other equipment in health centres across the country, led to a UMA strike in November 2017, effectively paralysing Uganda's health system.[7]
Health system reforms
At the beginning of the 21st century, the government of Uganda began implementing a series of health sector reforms that were aimed at improving the poor health indicators prevailing at the time. A Sector-Wide Approach (SWAp) was introduced in 2001 to consolidate health financing.[8] Another demand side reform introduced in the same year was the abolition of user fees at public health facilities, which triggered a surge in outpatient attendances across the country.[9][10]
Decentralization of health services began in the mid-1990s alongside wider devolution of all public administration, and was sealed in 1998 with the definition of the health sub-district. Implementation of the health sub district concept extended into the early 2000s.[5]
To improve medicines management and availability, the government of Uganda made medicines available to private-not-for-profit (PNFP) providers. With decentralization of health services, a "pull" system was instituted in which district and health facility managers were granted autonomy to procure medicines they needed in the required quantities from the national medical stores, within pre-set financial earmarks. The result was better availability of medicines.[11]
A comprehensive review of Uganda's Health System conducted in 2011 by USAID uncovered strengths and weaknesses of the health system, organized around the six technical building blocks of health system that were defined by the WHO. In summary, the assessment found that whereas significant efforts are being implemented to qualitatively and quantitatively improve health in Uganda, more needs to be done to focus on the poor, improve engagement of the private-for-profit sector, enhance efficiency, strengthen stakeholder coordination, improve service quality, and stimulate consumer-based advocacy for better health.[12]
The Ministry of Health (MOH) also conducts annual health sector performance appraisals that assess health system performance and monitor progress in delivery of the UNMHCP.[11] The 2011 USAID report assessing Uganda's health care system pointed to the fact that the UNMHCP often sets health sector targets and activities without an adequate analysis of the costs involved or the implementation of measures to allocate required resources appropriately.[12]
A number of factors affect the quality of services in Uganda, including the shortage of healthcare workers and lack of trust in them, a lack of needed treatments, high costs, and long distances to facilities.[13] In 2009, a survey conducted of Ugandan patients indicated a decline in the performance of the public sector health services. These were indicated through comments about poor sanitation, a lack of professionals and drugs and equipment, long wait times, inadequate preventative care, a poor referral system, rude health workers, and lack of services for vulnerable populations like the poor and elderly.[13] The quality of services affects utilization in different ways, including preventing patients from seeking out delivery services or leading them to see traditional providers, self-medicate, and decide not to seek formal care or seeing private providers.[13]
Health workforce
There is a significant shortage of health workers in Uganda.A Human Resources for Health Policy is in place to guide recruitment, deployment, and retention of health staff. In spite of this, shortages of health workers persist. According to a 2009 published report, there is one doctor for every 7,272 Ugandans. The related statistic is 1:36,810 for nurse/midwifery professionals. The shortages are worse in rural areas where 80 percent of the population resides, as 70 percent of all doctors are practicing in urban areas.[14] There are 61 institutions that train health workers, with five medical colleges, twenty-seven allied health training schools, and twenty nine nursing schools.
Community health workertraining has increased since the 2000s. TheUgandan Ministry of Healthimplemented the Village Health Teams (VHT) Training Program to develop community health workers who connect rural communities to health facilities and aid in the spread of preventative knowledge aboutmalaria,pneumonia, worm infestations,diarrhea, andneglected tropical disease.[17]VHTs have also aided in health campaigns and disease surveillance. Nongovernmental organizations, such as Health Child Uganda and Omni Med, have also been working with the Ministry of Health to train and maintain VHTs.[18]
An assessment of VHT abilities led to the creation of a Community Health Extension Worker (CHEW) Program, which involves the training of health workers for a year in all districts of the nation.[17]Unlike VHTs, CHEWs will possess elevated skills in addressing the health needs of their communities, will be based at the Health Center II level.[17]The CHEW program is planned for implementation in 2017 and 2018.[17]
In 2006, there were 3,237 health facilities in Uganda.[citation needed] Seventy-one percent were public entities, 21 percent were not-for-profit organizations, and 9 percent were for-profit.[citation needed] The doubling in public and not-for-profit facilities was primarily driven by the government’s initiative to improve access to services.[citation needed] However, 68 percent of these services are located in the capital Kampala and the surrounding central region, while rural areas face a gross shortage of such facilities.[citation needed]
According to the Uganda National Household Survey 2012/2013, the majority of those who sought health care first visited a private hospital orclinic (37 percent) or a government health centre (35 percent). Twenty-two percent of the urban population used government health centers, while that proportion rose to 39 percent in the rural areas. Thirty-five percent of government health centers visited by persons who fell sick were within a radius of 5 kilometres (3mi) from the population.[18]
Fertility rate and family planning
Uganda has the second-highest fertility rate in the East African Community, behind only Burundi. According to 2014 data, a Ugandan woman, on average, gives birth to 5.8 children during her lifetime compared to 7.1 in 1969 and 6.8 in 2001.[19] The age-specific fertility rates indicate that fertility peaks when women are aged between 20 and 24 years and then declines slowly until age 34. According to 2011 data, the fertility rate in urban areas (3.8 per woman) was significantly lower than in rural areas (6.7 per woman).[20]
Based on 2012 data, 30 percent of married Ugandan women are using some method of contraception, with 26 percent using modern contraceptive methods (MCM), such as female and male sterilization, pill, intrauterine device, injectables, implants, male condom, diaphragm, and the lactational amenorrhea method. MCM were used by only 8 percent of married Ugandan women in 1995.[20] There is a gap between the demand for contraception and the amount of contraception being made available. Several organisations are providing health education and contraceptive services.[21]
Antenatal care, facility deliveries, and postnatal care
Antenatal care (ANC) coverage in Uganda in 2011 was almost universal with more than 95 percent of women attending at least one visit. Only 48 percent of women, however, attended the recommended four visits. Deliveries in health facilities accounted for about 57 percent of all deliveries, far below the number of women who attend at least one ANC visit. That percentage had risen from 41 percent between 2006 and 2011.[20]
Only one-third of women received postnatal care (PCN) in the first two days after delivery. In 2011, only two percent of mothers received a PNC check up in the first hour for all births in two years before the 2011 Uganda Demographic Household Survey.[20]
Table: Uganda Trends in Selected SRH indicators[20]
Indicator
1980
1995
2000
2006
2011
Births attended by skilled health staff (% of total)
38
39
42
58
Maternal Mortality Ratio
435
561
505
435
438
Contraceptive Prevalence rate
19
24
30
Unmet Need for FP
35
41
34
Total fertility rate
7.1
7.1
6.9
6.7
6.2
HIV Prevalence (% of Adult Population)
10.2
7.3
6.7
7.3
Percentage of men (15–59) circumcised
25
27
Sexual health
Sexual health in Uganda is affected by the prevalence of HIV, sexually transmitted infections (STI), poor health-seeking behaviours regarding STIs, violence, and female genital mutilation that affect female sexuality in isolated communities in the north-eastern part of the country. As of 2015, Uganda's national HIV prevalence rate was 7.2 percent among adults aged 15–59 years, representing an increase from 6.7 percent in 2005. Prevention now includes voluntary male circumcision, although sexual behaviors among circumcised men need more understanding.[22] As of April 2018, there was an estimated 1,350,000 people living with HIV/AIDS in Uganda.[23]
Uganda is one of the three countries where randomized controlled trials were conducted to determine whether voluntary male circumcision reduces transmission of HIV from women to men.[24]
Issues affecting men including violence, sexually transmitted diseases, prostate cancers, infertility, HIV, and non-communicable diseases that affect sexual performance. The latest intervention that could improve men's sexual health is male circumcision.[25]
The 2015 maternal mortality rate per 100,000 births was 343, compared to 420 in 2010 and 687 in 1990.[26] The under-five mortality rate, per 1000 births is 130, and the neonatal mortality as a percentage of under-fives' mortality is 24.[citation needed] In Uganda, the number of midwives per 1000 live births is 7, and 1 in 35 is the lifetime risk of death for pregnant women.[citation needed]
A nurse in Uganda monitoring a patient's heart rate with a Pinard horn stethoscope.
Related Research Articles
According to the recently conducted national survey in 2024, Uganda's population stands at 45.9 million. Health status is measured by some of the key indicators such as life expectancy at birth, child mortality rate, neonatal mortality rate and infant mortality rate, maternal mortality ratio, nutrition status and the global burden of disease. The life expectancy of Uganda has increased from 39.3 in 1950 to 62.7years in 2021. This is lower below the world average which is at 71.0 years. The fertility rate of Ugandan women slightly increased from an average of 6.89 babies per woman in the 1950s to about 7.12 in the 1970s before declining to an estimate 4.3 babies in 2019. This figure is higher than the world average of 2 and most world regions including South East Asia, Middle East and North Africa, Europe and Central Asia and America. The under-5-mortality-rate for Uganda has decreased from 191 deaths per 1000 live births in 1970 to 41 deaths per 1000 live births in 2022.
The very high rate of human immunodeficiency virus infection experienced in Uganda during the 1980s and early 1990s created an urgent need for people to know their HIV status. The only option available to them was offered by the National Blood Transfusion Service, which carries out routine HIV tests on all the blood that is donated for transfusion purposes. The great need for testing and counseling resulted in a group of local non-governmental organizations such as The AIDS Support Organisation, Uganda Red Cross, Nsambya Home Care, the National Blood Bank, the Uganda Virus Research Institute together with the Ministry of Health establishing the AIDS Information Centre in 1990. This organization worked to provide HIV testing and counseling services with the knowledge and consent of the client involved.
Pakistan is the fifth most populous country in the world with population approaching 225 million. It is a developing country struggling in many domains due to which the health system has suffered a lot. As a result of that, Pakistan is ranked 122nd out of 190 countries in the World Health Organization performance report.
Health in Ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. A central feature of the sector is the priority given to the Health Extension Programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. The development and delivery of the Health Extension Program, and its lasting success, is an example of how a low-income country can still improve access to health services with creativity and dedication.
As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.
Rwanda faces a generalized epidemic, with an HIV prevalence rate of 3.1 percent among adults ages 15 to 49. The prevalence rate has remained relatively stable, with an overall decline since the late 1990s, partly due to improved HIV surveillance methodology. In general, HIV prevalence is higher in urban areas than in rural areas, and women are at higher risk of HIV infection than men. Young women ages 15 to 24 are twice as likely to be infected with HIV as young men in the same age group. Populations at higher risk of HIV infection include people in prostitution and men attending clinics for sexually transmitted infections.
Healthcare in Senegal is a center topic of discourse in understanding the well-being and vitality of the Senegalese people. As of 2008, there was a need to improve Senegal's infrastructure to promote a healthy, decent living environment for the Senegalese.
In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.
The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.
Bwindi Community Hospital was founded in 2003 by Scott and Carol Kellermann. It began as an outreach clinic under a tree, and has grown into a 155-bed hospital providing health care and health education services to a population of over 100,000 people in Uganda. The hospital began with a special mission to help the Batwa pygmies who were displaced from the Bwindi Impenetrable Forest after it was made a National Park in 1991. Since leaving the forest many Batwa have lived in extreme poverty and are affected by the health issues that poverty brings.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
AIDS Information Centre-Uganda (AIC) is a Non-Governmental Organization in Uganda established in 1990 to provide Voluntary Counseling and Testing (VCT) for Human Immune Deficiency Virus (HIV). The Organization was founded as a result of growing demand from people who wanted to know their HIV status. At this time the HIV/AIDS in Uganda was high.
Examples of health care systems of the world, sorted by continent, are as follows.
Uganda, like many developing countries, has high maternal mortality ratio at 153 per 100,000 live births. According to the World Health Organization (WHO), a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. In situations where attribution of the cause of death is inadequate, another definition, pregnancy-related death was coined by the US Centers for Disease Control (CDC), defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.
Founded in 1999, Alliance India is a non-governmental organisation operating in partnership with civil society, government and communities to support sustained responses to HIV in India that protect rights and improve health. Complementing the Indian national programme, we build capacity, provide technical support and advocate to strengthen the delivery of effective, innovative, community-based HIV programmes to vulnerable populations: sex workers, men who have sex with men (MSM), transgender people, hijras, people who inject drugs (PWID), and people living with HIV.
The AIDS Support Organization (TASO) is an indigenous HIV and AIDS service initiative, registered in Uganda as a non-governmental organisation. It is a pioneer non-public actor in the HIV and AIDS response in Uganda. TASO is a membership organisation with over 4,000 subscriber members.
Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.
Healthcare in Somalia is largely in the private sector. It is regulated by the Ministry of Health of the Federal Government of Somalia. In March 2013, the central authorities launched the Health Sector Strategic Plans (HSSPs), a new national health system that aims to provide universal basic healthcare to all citizens by 2016. Somalia has the highest prevalence of mental illness in the world, according to the World Health organization. Some polls have ranked Somalis as the happiest people in Sub-Saharan Africa.
Jane Ruth Aceng is a Ugandan pediatrician and politician. She is the Minister of Health in the Cabinet of Uganda. She was appointed to that position on 6 June 2016. Before that, from June 2011 until June 2016, she served as the Director General of Medical Services in the Ugandan Ministry of Health.
Rhoda Wanyenze is a physician, public health consultant, academic and medical administrator, who serves as the Dean of Makerere University School of Public Health, a component school of Makerere University College of Health Sciences, which is part of Makerere University, Uganda's oldest and largest public university.
References
1 2 3 The World Bank (2010). "Fiscal Space for Health in Uganda". Africa Human Development Series. 186.
1 2 USAID (2012). "Uganda Health System Assessment 2011". Health Systems.
↑ Jeppsson A (December 2002). "SWAp dynamics in a decentralized context: experiences from Uganda". Social Science and Medicine. 55 (11): 2053–2060. doi:10.1016/s0277-9536(01)00345-8. PMID12406470.
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