Poverty Made in Uganda: Healthcare bottlenecks hinder poverty reduction

A new report examining the poverty trends in Uganda over the past eight years has detailed a disturbing picture of how Ugandans are failing to meet their daily basic needs.

The National Poverty Status Report 2021, which was published by the Finance ministry in February, arrives when the economy is grappling with the aftereffects of the Covid-19 pandemic, rising costs of living, income inequality, a bulge in the youth population, and climate change, among others.

The ministry analysed data from Uganda National Household Survey 2016/17 and 2019/20. It found that in 2016/17, more than 21 percent of the population was deprived of formal education, marginally dropping to 20.5 percent in 2019/20.

To validate claims that education influences the incidence of poverty, the report points out that those who lived in households headed by a person without formal education were the poorest in both years, with a multidimensional poverty rate of 68.1 percent and 69.4 percent, respectively.

On the other hand, in 2019/20, those who lived in households headed by a person with post-secondary education had the lowest rate of 7.5 percent.

“The influence of educational attainment on multidimensional poverty is compounded by the fact that if a household member (aged 14 years and above) lacks six years of education, it will contribute to deprivation. Furthermore, a lack of formal education increases the likelihood of subsistence livelihood and financial exclusion.”

The analysis showed that in 2016/17, 25.8 percent of the school age population did not attend school, decreasing to 23.2 percent a year later.

“Deprivation in school attendance reduces the future productive capacity of households and hence can drive up poverty in all its dimensions,” the report said.

Four poverty dimensions—education, health, living standard and empowerment—were looked at, coinciding with the new government commitment to improve welfare through the National Development Plan III (NDP III) and the Parish Development Model (PDM).

Up to 44.3 percent of Ugandans were multi-dimensionally deprived in 2016/17, slightly decreasing to 42.1 percent in 2019/20.

Noticeably, the multidimensional headcount ratio was more than twice the monetary poverty rate. This indicates that many more Ugandans are deprived of basic needs than the monetary measure of poverty indicates.

While deprivation of formal education negatively affects the ability of household members to participate fully in the labour market, the individuals also face exclusion from community activities.

Regional picture
Northern Uganda had the highest multidimensional poverty headcount ratio. In 2016/17 the north returned 65.7 percent and 62.9 percent in 2019/21 while eastern Uganda stood at 54.8 percent and 45.7 percent, respectively.

“Multidimensional deprivation is highest in the Karamoja Sub-region, followed by Acholi, West Nile and Bukedi sub-regions… Kampala and Buganda had the lowest deprivation level, as with monetary poverty,” the report says.

It was also realised that multidimensional poverty remains higher in male-headed households due to the patrilineal nature of Ugandan society, in which males head most households. And that households with seven or more members had the highest incidence of deprivation.

Many households frequently face shocks that make them vulnerable to poverty. If the probability of becoming poor is higher than 50 percent, then a household is classified as highly vulnerable.

According to the UNHS 2016/17 survey, the non-vulnerable population are those whose likelihood of being poor is less than 21.4 percent, but if the probability lies between 21.4 percent and 50 percent, the population was classified as relatively vulnerable.

In 2020, 54.66 percent of the population was vulnerable to poverty, representing about 22.7 million people.

However, residents of the central region were generally less likely to become poor in 2020 compared to other regions, explained by the relatively vibrant economic activities in the region and favourable rainfall patterns that support both commercial and subsistence farming.

The northern and eastern regions rely more on rain-fed agriculture, which made them vulnerable when there were unfavourable weather conditions. 

“The top 10 districts in their ranking of vulnerability to poverty in 2020 were Nabilatuk, Napak, Kotido, Kaabong, Moroto, Nwoya, Nakapiripirit, Rubanda, Busia and Pakwach, among others,” the survey reported.

Other granular details
According to the multidimensional poverty index, use of healthcare facilities remains an enormous challenge. 

Although the number of those without access to healthcare facilities within a five-kilometre radius fell from 18.6 percent in 2016/17 to 14.2 percent in 2019/20, the data is still worrying.

Similarly, to clean water is also a challenge for many households. Almost 32 percent of Ugandans do not use clean water, although it is a slight improvement from 33.9 percent recorded in 2016/17.

“Limited access to clean water can have high opportunity costs since households spend valuable time searching for clean water, or they may contract waterborne diseases from contaminated water sources. This, in turn, reduces their productive capacities, thus rendering them poor,” it said.

Moreover, 76.5 percent of the population do not have improved toilet facilities, exposing them to infections, loss of working hours, higher spending on healthcare thus monetary poverty, it said.

Almost half of Ugandans in 2016/17, lived in overcrowded tenements, with poor housing conditions. Sixty five percent of the population lived in houses with either earth floors, wood/mud walls, or thatched/tin roofs.” 

In terms of living conditions necessary for a middle-class society, 46.1 percent of the population is deprived of access to fridges, cookers, television sets, bicycles, radios and phones.

It was also noted that areas with high income poverty also experience high multidimensional poverty, although multidimensional poverty is almost twice the income poverty rate.

“Some of these deprivations are beyond households’ choice. In the case of public utilities such as clean water and electricity supply, a household is deprived if the utilities are not provided in their location,” it said.

The provision of these services is fully reliant on the government, this calls for improvement in the provision of public goods and social services to reduce both income and multidimensional poverty.

Govt views
On April 4, Ms Kasule Lumumba, minister for General Duties in the Office of the Prime Minister, told Parliament that the Covid-19 outbreak caused a huge setback to Uganda’s economy.

She was briefing the House on how far Uganda has gone towards achieving the sustainable development goals (SDGs) as set out in a worldwide development agenda championed by the United Nations.

“Although Uganda has registered significant progress in the attainment of SDGs, there are concerns about the likely negative impact of Covid-19 on the progress. The effects of Covid-19 will live with us and we have to devise measures on how to live with the effects of Covid-19,” she said.

There are also challenges related to the limited financing of SDGs, low levels of awareness among local leaders to integrate SDGs within local development initiatives and low levels of digitisation, she noted.

Ms Lumumba also said the Finance ministry was asked to fast-track the Integrated National Financing Framework as a means of mobilising resources to support sustainable development.

Meanwhile, Ms Grace Kwiyucwiny, the state minister of Northern Uganda, believes that introduction of the 4th Northern Uganda Social Action Fund (Nusaf 4) will address the poverty dilemma that has condemned the north and east to regression.

Nusaf 4 is supposed to target 39 percent of poor households in the subsistence economy and will cover West Nile, Acholi, Lango, Teso, Karamoja, Bukedi, Elgon, Bunyoro and Busoga sub-regions. It is estimated to cost the government $220 million in loans, with $50 million coming as a grant.

The project’s components are sustainable livelihood support and strengthening the safety net for enhanced resilience and human development, among others.

“It is envisaged that these are going to complement PDM, especially in the areas of production, storage, processing and marketing, enhancing financial inclusion, mindset change and management information system,” she said.

Ms Kwiyucwiny explained that despite massive government intervention, the poverty indicators in the north and east are still high.

“The causes of high poverty are attributed to over-reliance on subsistence farming, lack of cash crops, dependency syndrome, limited skills, lack of value addition, low productivity, land fragmentation, limited employment opportunities, environmental degradation, low access to financial credit, and a poor mindset,” she said.

However, President Museveni accuses educated Ugandans of spreading propaganda that has confused the majority of illiterate Ugandans into ignoring the government’s interventions to eliminate poverty.
In February, while presiding over the Janani Luwum Day celebrations in Kitgum District, President Museveni took a swipe at the elite across the country who he said are frustrating the government’s fight against poverty.

“You the elites in this region, you the learned, and you are the ones confusing our people … I appeal to you to listen carefully to the NRM message on wealth creation for everyone and every homestead. Help us spread the right message of wealth creation,” he said.

He added that it is disappointing that the majority of Ugandans continue to wallow in poverty despite infrastructural development and improved service delivery.

“Now we have tarmac [roads] everywhere, health facilities, and schools but have they solved the poverty challenge? Poverty is in the homes, the tarmac road is there but if you don’t use the tarmac road to create wealth, you will still be poor,” he added. 

“Kalangala District doesn’t have tarmac as we have here, but they have taken to growing palm oil and now they are much richer than many parts of the country. Bundibugyo has palm oil, coffee, cocoa…”

Middle class

In terms of living conditions necessary for a middle-class society, 46.1 percent of the population is deprived of access to fridges, cookers, television sets, bicycles, radios and phones.

It was also noted that areas with high income poverty also experience high multidimensional poverty, although multidimensional poverty is almost twice the income poverty rate.