Time to unplug bottlenecks in our health service delivery

Besides, the glaring absence of a functional multi-sectoral collaboration framework on Health continue to plague the sector yet health outcomes arise from an interface between various interventions outside the health sector such as livelihoods, education, access to water and sanitation, and effective law enforcement.

A staggering increase in development assistance to health initiatives in developing countries from $5 billion in 1990 to $21.8 billion in 2007 as featured by a study released in Paris, France, contains implications to the health dogma in developing countries such as Uganda.

The report, prepared by a team of international health experts, shows that dramatic funding increase has been propelled by a growing belief that health is critical to human development and economic growth.

The commitment to achieving the Millennium Development Goals adopted in 2000 - which include reducing malnutrition, child and maternal mortality and the impact of communicable diseases - helped to translate this belief into strong political momentum for new development assistance channels.

While the new channels and forms of aid for health such as Global Fund to Fight HIV/Aids, Tuberculosis and Malaria (GFATM), the GAVI Alliance, including philanthropy. The Gates Foundation have entered the scene and have produced significant results, they have also generated more complexity.

For instance, the Report argues that “improvements in aid management, both generally and in relation to health, are slower than they should be, and are uneven”.

The key challenges remain; health aid not always being aligned with government health priorities, aid still not predictable, and support to health information systems being insufficient despite increased pressure to demonstrate results.

Uganda’s health sector-development assistance interface, however, tells a different story. The policy and legal framework remains wanting as key policies and bills meant to promote and regulate health services delivery are not in place: the Pharmacy Profession and Practice Bill; the Uganda National Health Research Bill; the National Health Insurance Bill; the Mental Health Bill and the Food Safety Bill are still stuck in the legislative track.

Besides, the glaring absence of a functional multi-sectoral collaboration framework on Health continue to plague the sector yet health outcomes arise from an interface between various interventions outside the health sector such as livelihoods, education, access to water and sanitation, and effective law enforcement.

This rigidity has resulted into the failure of many programmes including the Infant and Maternal Mortality initiative and the 1997 Kampala Declaration on Sanitation, among others.

In addition, inadequacies in the supply chain between Uganda’s National Medical Stores and the health facilities have caused disconnects and shortage of medicines, health supplies and equipment. Elsewhere, some countries have developed robust, results-oriented national strategies for better health outcomes.

Mali for instance, is a good example of a country where strong management systems have helped to make the most out of the expanding development assistance channels.

As a result Mali recently signed an agreement with International Health Partnership (IHP+), an initiative which was launched in 2007 to achieve better health results through a more harmonised donor support to a single country-led national health strategy.

It is important therefore to go beyond a sector approach to using the same principles for an entire development framework as a strategy to carry forward both the Paris Declaration and the Accra Action Agenda on aid effectiveness. Doing so will require a more focused Public-Private and Civil Society engagement for positive and lasting effects in, especially health, education, environment, agriculture, trade, and gender equality.

Consequently, there is an urgent need to effect new development assistance architecture, one featuring key intervention areas that most importantly serve to reinforce the primary importance of “country ownership”, the first principle of the Paris Declaration on Aid Effectiveness.

Dr Odoch is a member of the Daily Monitor Panel of Experts.