We join the rest of the world in celebrating World Health Day today. We jointly want to formulate a few thoughts on this occasion, on behalf of all Heads of Mission of the European Union resident in Kampala.
First of all, we want today to acknowledge the long path Uganda has travelled in achieving better health for its population. Over the last decades, life expectancy has increased, infant and under-five mortality rates have decreased, and fewer women are dying during childbirth. Those are remarkable achievements, and as partners of Uganda in the health sector, we take particular pride in them.
At the same time, much remains to be done. One in four teenage girls is already a mother or pregnant. Most of these pregnancies are unwanted and sometimes end in an unsafe abortion. Maternal mortality rates, although reducing, are still very high and far from the sustainable development goal target. Another challenge is the alarming number of new HIV infections among young people. The coronavirus pandemic has worsened the situation since schools closed, mobility reduced and more expensive, and income diminished for many.
The theme of this year’s World Health Day is health equity. This theme is about fair distribution of health services among all members of society. In Uganda, huge disparities exist across regions, ages, gender and education levels. Inequity in health is also a direct result of huge differences in the quality of services.
The latest Report of the Auditor General (February 2021) finds a lack of medical equipment for maternal health across the country. Health is not an isolated issue. Health is linked to the context: economic and social conditions, such as income- and education levels; housing conditions; cultural beliefs and traditional values and norms. All citizens need to have the same access to information and to quality services. People should be empowered to make their own, individual informed decisions regarding their sexual health. Reality shows we are still quite far from such empowerment.
Makerere School of Public Health found that access to information on family planning is low among the poor, the disabled and those who are least educated and the youngest (between 15-17 years).
Adolescents between 15 and 17 years are at a disadvantage for quality service and for information. This leads directly to high rates of teenage pregnancies. Half the population in Uganda is below 16 years . Changing the situation, improving health services demands that we give priority to the young citizens.
Sexuality education, both in the schools and outside are not an option, but a necessity. In Uganda, young men need to be taken on board.
The government of Uganda and the Ministry of Health are well aware of the need for change. Government has drafted a new Adolescent Health Policy. We hope to see this policy approved and put into practice any time now. This is an urgent matter, in particular for the more vulnerable part of the population.
Finally, let us talk about health financing. Uganda’s health sector remains significantly under-funded, and this is at the cost of the poorest. Healthcare in Uganda mainly relies on out-of-pocket spending by patients. For a poor family, even a small contribution is a big deal. Poor households spend proportionally more of their total income on health. Getting sick pushes poor families deeper into poverty. More public investment in the health sector is urgently needed. The adoption of a national and inclusive health insurance that provides financial protection to citizens will significantly improve health equity.
The Makerere School of Public Health, Belgium and the other EU member states remain strongly committed to the advancement of healthcare . To ensure this progress is geared in the right direction for all people regardless of age, sex, education level, economic background or any other difference, we need to look at the progress through an equity lens. It is important to leave no-one behind while continuing the journey to better health for all.
This article was co-authored by Rudi Veestraeten, Ambassador of Belgium and Prof. Dr. Rhoda Wanyenze, Dean, Makerere School of Public Health.