The Uganda Health Sector Development Plan was published in 2015. This page has verbatim excerpts relevant to FRESH AIR's aims and objectives.
It shows the important role health plays in the Uganda Vision 2040: " “A Transformed Ugandan Society from a Peasant to a Modern and Prosperous Country
within 30 years” as approved by Cabinet in 2007. It aims at transforming Uganda from a predominantly peasant and Low Income Country to a competitive Upper Middle Income Country."
Health related targets in Vision 2040:
|Children aged 0-59 months (under five years)||6.6||18.9|
|Women of reproductive age (15-49 years)||7.3||20.9|
|Population that is 15 years of age||17.0||48.7|
|Population of adolescents (10-19 years of age)||8.6||24.5|
Source: National Population and Housing Census 2014
Current baseline: improvement in life expectancy since 2001
The Plan builds on the achievements registered under the Health Sector Strategic and Investment Plan (HSSIP) 2010/11 - 2014/15 and takes into consideration the challenges encountered and lessons learnt during its implementation. The achievements realized under HSSIP include among others: reduction in maternal mortality ratio from 438/100,000 (UDHS) live births in 2011 to 360/100,000 (WHS estimates) live births in 2014; reduction in under five mortality from 128/1000 live births in 2006 to 90/1000 live births in 2011 to 69/1000 (WHS estimates) live births in 2014 and reduction in infant mortality rate from 71/1000 live births in 2006 to 54/1000 live births in 2011 and 45/1000 (WHS estimates) in 2014. The impact of all this has been an improvement in the life expectancy at birth in Uganda, from a low of 47 and 45 years in 2000/01 for females and males respectively, to 57 and 54 years by 2011, and estimated to have improved further since then.
Main causes of death
We see from the latest Burden of Disease estimates as produced in the Global Burden of Disease report, 2010 series that HIV, malaria, lower respiratory infections, meningitis and tuberculosis still are estimated to cause the highest numbers of years of life lost in Uganda. These five killers on their own are responsible for just under half (48%) of all mortality in Uganda. Apart from malaria, the mortality due to all these top 5 killers is on a reducing trend, with lower respiratory infections having reduced the most (53%) from the 1990 levels. In addition to these major causes, the sector has faced challenges with new / re-emerging conditions that cause minimal burden but are significant public health risks e.g. polio, Hepatitis E & B, Ebola Virus Disease, Marburg, and the idiopathic ̳Nodding disease‘.
Growing problem of NCDs
On the other hand, NCDs are increasingly becoming a major burden due to life style changes, increased life expectancy in addition to genetic factors. Although Protein Energy Malnutrition has also reduced, it still remains the underlying cause in nearly 60% of infant deaths (Uganda Nutrition Action Plan (UNAP) 2011 – 2016). The latest burden of risk factors show alcohol use, tobacco use, household air pollution, childhood underweight, iron deficiency and high blood pressure as the most significant risk factors, responsible for over 16% of all disease conditions.
Risk factors - acknowledges importance of tobacco smoking and household air pollution - the FRESH AIR targets
According to the GATS 2013 7.9% of the population above 15 years were using tobacco while 17.3% of the youth were using tobacco (GYTS 2011).A study at Mulago hospital indicated that 1/4 and 1/5 patients at Uganda Cancer Institute diagnosed with cancer of the oesophagus and lung respectively had a history of tobacco use
Household air pollution is a silent killer in the country, contributing significantly to LRIs, cancers and other morbidity and mortality causes. Meanwhile, a baseline survey by the Ministry of Health in 2014 estimated tobacco use at 11% and further revealed that over 80% of the population with NCDs are not aware of these risk factors and hence will present with difficult to manage complications like stroke, kidney failure, blindness and impotence. Note: CRDs are not mentioned here specifically, and so there is work FRESH AIR needs to do to highlight the impact of these risk factors on lung health beyond cancer of the lung: FRESH AIR will be able to complete this table with the prevalence of CRD:
Improvement in lower respiratory infection, particularly pneumonia, and success of vaccination programmes
The LRIs, particularly pneumonia, are registering a significant reduction in mortality. This could be attributed to the introduction of vaccines targeting these conditions, particularly the pentavalent (Haemophilus Influenzae type B disease) and lately the pneumococcal vaccine. This reducing trend is testament to the success of these efforts and universal coverage with these vaccines should further reduce the burden of these lower respiratory infections till they are not of public health concern. Note: our FRESH AIR programme on childhood respiratory infection and chronic lung disease can build on this, and also ensure accurate differentiation.
Information technology and e-health
The country was able to transition to District Health Information System (DHIS)-2, which is an electronic web based reporting mechanism to ensure timely reporting for decision making. E-health has become a stronger area of focus, with the national e-health technology framework completed and draft e-Health strategy developed. Although a number of surveys and research studies were conducted the sector still faces challenges in health research including; inadequate human resources in all research institutions, low government financial allocation to health research, weak collaboration mechanisms between planners, research institutions, industry and academia and partners.
The health workforce is still a key bottleneck for the appropriate provision of health services, with challenges in adequacy of numbers and skills, plus retention, motivation, and performance challenges. Efforts by the GoU and Partners have facilitated recruitment of much-needed staff increasing the proportion of approved posts from 56% in 2010 to 69% in 2013/14. Note: one of the flagship projects for government investment is the Community Health Worker (CHW) Extension Programme. CHWs are essential to FRESH AIR's success, and it will be important that their role in NCDs is established and sustained.
Over half of health facilities do not have facilities for CRD.
Four key objectives and aim for universal health coverage
The HSDP goal is to accelerate movement towards Universal Health Coverage with essential health and related services needed for promotion of a healthy and productive life. Thus, the Plan sets key objectives to be attained during the 5 year period. These include: (i) contributing to the production of a healthy human capital for wealth creation through provision of equitable, safe and sustainable health services.; (ii) increasing financial risk protection of households against impoverishment due to health expenditures.; (iii) addressing the key determinants of health through strengthening intersectoral collaboration and partnerships.; and (iv) enhancing health sector competitiveness in the region and globally. In order to achieve these objectives, the health sector will work towards strengthening the national health system including governance; disease prevention, mitigation and control; health education and promotion, curative services; rehabilitation services; palliative services; and health infrastructure development.
Over this Plan period the sector will focus on attaining the following results: reducing the Infant Mortality Rate per 1,000 live births from 54 to 44 and the Maternal Mortality Ratio per 100,000 live births from 438 to 320/100,000; reducing fertility to 5.1 children per woman; reducing child stunting as a percent of under-5s from 33% to 29%; increasing measles vaccination coverage under one year from 87% to 95%; increasing TB case detection rate from 80% to 95%; increasing ART coverage from 42% to 80%; increasing deliveries in health facilities from 44% to 64; and increasing HC IVs offering CEmOC services from 37% to 50%.
Objective 1: Program areas and key interventions for NCDs control across the life course
Note: FRESH AIR is contributing to communication straties, implementation of article 14 of Framework Convention on Tobacco Control, capacity building, developing NCD guidelines. It is not supplying rehabilitative appliances, but instead capacity building to teach rehabilitation using very little equipment. It would benefit from availability of essential medicines for tobacco dependence, COPD and asthma. COPD is known to be an independent risk factor for osteoporosis, and muscle weaknesses. From existing FRESH AIR studies, we know women and children are more exposed to household air pollution and smoke, causing long term lung damage.
Includes Awareness creation on indoor air pollution prevention, proper liquid, solid and gaseous waste management.
17% budget is allocated to NCDs.
Abridged and annotated by Siân Williams, 17 March 2017