Uganda’s Jubilee: Time for Health Audit

Jubilee Project

A brief overview of the history of the medical profession in the last 50 years gives us a sneak view of our health journey as a nation. According to a historical account by John Iliffe, in 1955, Uganda had 216 doctors (124 government employed and the rest private – 79 Asian, 9 African and 4 European). In the late 1950s there was an influx of Asian doctors and by independence, Uganda had about 450 practicing doctors of whom only 90 were Ugandans. Uganda’s African doctors though few in number outnumbered those in all other East African countries and took control of the fledgling health system maintaining it throughout the sixties. With a population of 6.5 million at independence, the doctor ratio to the population was 1:14,444.  In real terms, the ratio was much higher as most of the doctors practiced in the urban centres while the population, which was almost exclusively rural, depended on traditional medicine.

Makerere Medical School was already world renown for research and teaching; this grew through the sixties and very early seventies. Makerere expanded output of doctors became available to the nation in the late 1960s. By 1969 there were 647 doctors of whom 194 were Ugandans, the rest being Asians and Europeans. Even with these dismal numbers, the quality of medical care offered in Uganda at the time was among the best in Africa.

Attendance at government medical institutions doubled between 1958 and 1963, and again by 1969. At that time there was such a national demand for hospitals that the government ignored medical opinion and built more facilities causing a skyrocketing of medical expenditure.

The tyranny of the Idi Amin years in the 1970s created a terrible dilemma for the health profession ushering in a period of darkness and regression, a far cry from its early blossoming and promising years. Of the 55 doctors who died between 1964 and 1986, at least 15 (27%) died from violence. Medical income for health professionals declined and controls lapsed opening up the profession to quacks, a setback not yet resolved today.  By the mid 1970s almost all expatriate researchers and several leading Ugandan doctors had left, research funding had ceased, publications had fallen by 90%, the WHO had transferred its cardiovascular center from Mulago to Accra and leadership in East African Medical Research had moved to Nairobi. Mission hospitals though weaken by expatriate departure, acquired new importance because their quality of care was often superior to that offered by government institutions. The decades of the 1970s and 80s witnessed a mass exodus of health professionals out of the country. In 1991, the Ministry of Health estimated that 660 Ugandan doctors were working outside the country.

The advent of the NRM government in 1986 brought a new profile to the medical profession. Six of the first cabinet ministers were medical doctors and in the ensuing years two rose to the rank of Vice President. The new administration set about redressing the plight of modern medicine in the nation by focusing on rehabilitation and primary health care. A 13-member Health Policy Review Commission dominated by senior doctors from Makerere University was appointed in 1987. The Commission was appalled at the state of disrepair it found in the hospitals visited across the country. Corruption was rife and medical workers demoralized.

In the late 1980s and early 1990s, the health system was further burdened and almost crushed by the AIDS pandemic. Prevalence rates spiraled up to 29% in the urban areas and some doomsday prophets began speaking of a nation being wiped out. Strong political leadership has been widely credited with the reversal in the prevalence rates.

Despite continuing problems, the NRM rule has seen improvements in aspects of the health system. A kiganda proverb states that one who has never travelled is always praising his mother’s cooking. So while we celebrate achievements in health, it is helpful to look at how we compare with the rest of the world how the rest of the world has cooked and served health to their populations.

Imagine the world’s nations as students in one large classroom sitting an exam entitled Health Status, what does Uganda’s report card look like?

  1. In the subject entitled Life Expectancy ( in 2010): 203rd out of 221 countries (53.24 years compared to Monaco (1st) which scored 89.73 years)
  2. Infant Mortality Rate (the number of deaths of infants under one year old in a given year per 1,000 live births in the same year): 198th out of 220 countries with 62.47 deaths/1,000 live births compared to Monaco (1st) which had 1.79 deaths/1000 live births (2011).
  3. Health Expenditure as a Percentage of GDP (2009): 51st (8.2%) in the world compare with Malta (1st) with 16.5 %.
  4. Physician Density (2005): 161st out of 192 countries – 1 doctor for every 10,000 people compared to Norway (10th), with 1 for 250.
  5. Hospital Beds per Population (2009): 177th out of 183 countries  – 4 beds for every 10,000 people to Japan (1st), with 140 beds for 10,000.
  6. People Living With AIDS, (2011): 8th largest number of people living with AIDS (6.5%) in the world for any nation (1.2 million) compared with Turkey (0.10%).

Uganda has the third highest number of deaths from malaria in Africa and the notoriety of hosting the place with the highest rate of malaria transmission in the entire world. Apac district is referred to as the “malaria capital of the world; a 2010 report indicated 5000 cases of malaria every week.

These sober statistics should stir us to aspire for more. The specter of corruption in the health sector, which is said to be responsible for the deaths of about 300 people each day or about 110,000 people a year must be eradicated. When health funds or medicines do not reach their destination, the deaths that result are on the hands of the misappropriating officials.  Corruption is a silent remote mass murderer in which the perpetuators are not present to witness the death of their victims. We will only attain our national health dreams if this monster is firmly dealt with. Healthy Jubilee Celebrations!

Dr. James Magara
Chairman, Steering Committee

 

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