Saturday, July 21, 2012


Future bright for mothers,children Publish Date: Jul 20, 2012 Before independence, Uganda’s health care system was enviable and was considered the best in SubSaharan Africa. It included a strong public health system where health visitors, in conjunction with sub-county and parish chiefs, ensured home hygiene, latrine coverage, malaria control, safe water, immunisation and nutrition, among other strategies. A Public Health Act provided for functional disease prevention programmes and health care was free and funded by the Government. Between 1940 and 1970, infant mortality had reduced from 250 deaths per 1,000 live births to 120. At around independence (1962), Uganda had about seven million people. Ten years after independence, however, the violence that swept Uganda in the wars of the late 1970s (ousting President Idi Amin) and early 1980s (NRA guerilla war) greatly affected the health care system. But when the NRM government took over power in 1986 Uganda started implementing the World Bank/International Monetary Fund programmes of decentralisation. User fees were introduced, personnel were retrenched and programmes that did not initially do well were scrapped. The Government and donors had to invest lots of money and human resource to teach Ugandans about reproductive health — the state of physical, mental and social wellbeing in all matters relating to the reproductive system at all stages of life. Awareness messages had to be incorporated in education syllabuses and on agendas of all social gatherings to register some success. Prominent women personalities also joined the bandwagon and their journey started with the formation of the Uganda Council of Women that existed in the 1960s. Rhoda Kalema, one of the prominent women who spearheaded the council’s formation says: “During the wars, women would fail to go to hospital and many would deliver at home under unsafe conditions. The subsequent years were characterised with shortage of facilities.” But in the late 1980s, President Yoweri Museveni’s NRA (now NRM) government pledged to improve health care. The journey started with empowering women by electing them in positions of authority. These played a great role in improving reproductive health. Museveni started by appointing Joan Kakwenzire to a six-member commission to document abuses by the military after the war. The Government also declared that each district would have a woman representative on the National Resistance Council (now district woman Members of Parliament), which has been maintained to date in the Parliament of Uganda. In 1987, Museveni appointed Joyce Mpanga as minister for women and development. By 1989, there were two women serving as ministers and three serving as deputy ministers in the NRM cabinet. Between 1994 and 2003, Museveni appointed Dr. Specioza Wandira Kazibwe as Uganda’s first female Vice President — the highest ranking position in the hierarchy of Uganda’s leadership. She was also holding the portfolio of the Minister of Agriculture, Animal Industry and Fisheries. During Kazibwe’s tenure, she rallied fellow women leaders to push for their rights ranging from political, human rights to health, especially eproductive/maternal health. Female civil servants and professionals also formed organisations like Action for Development, to assist women, especially in war-torn areas. Since the 2006 presidential campaigns, Museveni has been pledging construction of health centres in every part of the country so that people can access health services in a distance of 5km; although it is yet to be achieved in some areas. Today, these women have done a tremendous job in ensuring that reproductive health improves and maternal and infant deaths reduce. Current and former parliamentarians including; Ruth Kavuma (former woman MP Kalangala), Beatrice Rwakimari (former woman MP Ntungamo) and Sylvia Namabidde (Mityana) have rallied fellow parliamentarians including men to support the funding of reproductive/maternal health. To them, reproductive health is the same as maternal health. In 2008, the MPs rejected a local government budget that had not catered for reproductive health. Kavuma, then a member of the social services committee, said they had pushed for funding and the World Bank agreed to give Uganda a loan of $130m (sh322b), of which $30m (sh74b) is for specifically procuring reproductive health supplies. “One of the biggest challenges we face is that when you ask for money for reproductive health, politicians tend to argue that by funding infrastructural development like building health facilities and roads, they have funded reproductive health, which is not the case. We need funds to be directly channelled towards buying reproductive health supplies,” she explained then. Reduction in maternal mortality For their efforts, Uganda has had its maternal mortality rate reduce from 600 to 310 deaths per 100,000 live births (4,700 deaths) in the last 20 years, according to a report done by WHO, UNICEF, the United Nations Population Fund (UNFPA) and the World Bank that was released in May this year. Commenting on the estimates, the UNFPA Uganda country resident representative Janet Jackson, notes: “It is good news for Uganda that maternal health is now a priority. We need to continue investing in maternal and reproductive health so as to accelerate the reduction in maternal mortality.” Jackson observes that this could be done through provision of obstetric care, skilled birth attendance, antenatal care and family planning. But the MDG target is to reduce maternal deaths by three quarters by the year 2015 and for Uganda’s case this means reducing the maternal deaths to at least 120 per 100,000 births. According to Reproductive Health Uganda (RHU) programme coordinator Annet Kyarimpa, more needs to be done to achieve this feat. She says teenage pregnancies that stand at 25% countrywide (the highest in Sub-Saharan Africa), need to be addressed. “Historically, expenditure on reproductive health commodities is far below allocation at less than 10%. The Government only contributes 15% to contraceptive procurement, while 85% is deferred to donors despite the fact that Uganda’s budget is financed by donors to the tune of only about 70%,” she observes. The Maputo Declaration of 2003 requires that governments allocate 15% of their budgets to the health sector. But Uganda allocates about 9% of its budget to the sector, which should be increased. Uganda needs $244,476,913 (over sh606b) to ensure that the country has all the reproductive health supplies it needs over the next five years, Kyarimpa states. If all the required money is got and the contraceptive prevalence rate increases from 24 to 50% countrywide, budget allocation for reproductive health is raised, and the unmet need goes down from 41 to 5%, maternal mortality will automatically reduce. Besides, the Government would save $112m (sh278b) by investing in contraceptive commodities and services to fill the entire unmet need. Unmet need refers to the percentage of women who would like to be able to either space their children or stop having children but are not using contraception. Abortion and contraceptives Experts also say that if contraceptives are availed, the about 300,000 abortions that occur in Uganda and the about 6,000 women who die from pregnancy-related causes would reduce greatly. And the fulfilment of reproductive health becomes more challenging with the ever growing population, which currently stands at over 34 million people, and it is projected to reach 130 million people by 2050, according to UN estimates.

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