7 th Makerere University College of Health Sciences (MakCHS) & 19 th Uganda National Association of Community and Occupational Health (UNACOH), Annual Scientific Conference KEY NOTE ADDRESS Dr. Jane Ruth Aceng Director General of Health Services Ministry of Health 20 September 2011

Why invest in Health To have a healthy population Healthy population is economically productive Economic productivity boosts economic growth Economic growth boosts household income Increased household income boosts health Quality of life improves, and proportion of household income spent on health drops

International Perspective Alma Ata Declaration 1978 and HFA 2000 Millennium Development Goals ( ) WHO Building Blocks of Health System strengthening Many other international and African protocols, declarations on specific health issues

National Perspective National Development Plan (2010/11 – 2014/15) Second National Health Policy ( ) Health Sector Strategic and Implementation Plan (HSSIP) (2010/ /15)

Uganda’s Health Investment General GOU allocation for health as a % of total GOU budget: 9.6 (Abuja target is 15%) % of approved posts filled by trained health workers (Public sector): 54% (Required investment to achieve the health MDGs is 40 US dollars per capita per year)

Where are we? Current status of health Poor health Indices Recent statistics show: Life Expectancy at Birth: M-48 years F- 54 years ( for some nations, this is over 80 years for males and 85 years for females) MMR: 435/100,000 (2006) IMR: 76/1000 (2006) U5MR: 137/1000 (2006) Contraceptive PR: 24 (2006)

Current status of the health sector SERVICE UTILIZATION % of women who attend ANC 4 times during pregnancy: 47% Deliveries in public and PNFP Health facilities: 38% Third dose pentavalent vaccine coverage in children: 74% % U5s with fever receiving malaria treatment within 24 hours: 70% % eligible persons receiving ART: 53%

Current status of the health sector Uganda Health Sector Staffing Situation HRH data for both public and PNFPs together indicates the country has 37,368 health workers Of this 8,978 (24%) are Nurses, 4,535 (12%) are Midwives, 1,118 (3%) are Doctors. Data also indicates that Nursing Assistants still form a big number of the H/W - 6,371 (17%). This implies that more effort is needed to recruit and retain qualified staff.

Current status of the health sector Why the low numbers of HRH? Poor remuneration and motivation Poor attraction and retention (more severe in rural districts), more so for critical cadres Limited funding for recruitment. Inequity in distribution (numbers, skills mix, rural-urban, facility level) Inadequate tools and equipment Ethical erosion

Current status of the health sector Health Financing Government funding for health is still inadequate estimated at 11.1 USD per capita (FY 2009/2010). Donor support for health is a major component of the budget though largely targeted to three diseases (malaria, HIV/AIDS, TB. The bulk of donor support to the health sector (41%) is off budget. A significant proportion (21%) of GOU expenditure on health is mainly on payment of salaries. There is high fragmentation within and between health financing mechanisms mainly due to reliance on out of pocket payments (52%), limited prepayment mechanisms

Current status of the health sector Fragmentation of services Poor coordination among health system players has led to fragmentation of services. Lack of a harmonized support to one sector plan leading to significant off-budget expenditure not known to Government. Too much verticalization of health interventions by different health actors, leading to duplication and resource wastage. Actors have immense interest in M & E (data), at the expense of investment in service delivery. Many actors are measuring the same indices

Status of Uganda (MDGs) The Millennium Development Goals are mainly about the quality of life of humanity by They were promulgated in 2000 after we failed to achieve HFA by Most of MDGs are related to health, and how health can be achieved.

Uganda’s progress on MDGs The Uganda MDG Report 2010 shows that we have only achieved debt relief (MDG 8D); On track – eradication of extreme poverty and hunger (MDG 1), – promoting gender equality and empowerment of women (MDG 3), – universal access to treatment for HIV/AIDS (MDG 6B), – proportion of people without safe drinking water and basic sanitation (MDG 7C), – cooperation with the private sector on benefits of technologies (MDG 8F).

Uganda’s progress on MDGs Slow – boys and girls alike completing primary school (MDG 2A), – reducing under-five child mortality (MDG 4), – reducing maternal mortality (MDG 5A), – universal access to reproductive health services (MDG 5B), – reducing incidence of malaria and other major diseases (MDG 6C), – reducing loss of environmental resources and biodiversity (MDG 7aA,B). Stagnant on access to affordable essential drugs (MDG 8E), and have had reversal in stemming HIV/AIDS spread (MDG 6A)

Uganda’s progress on MDGs It is apparent that slow, stagnant and reversal are more and therefore negatively counter-balance the achieved and on track targets. This means the health sector, and indeed all the actors in health are under serious challenge to find urgent solutions if MDGs are to be achieved by 2015, or even after. MDGs are not just figures, they represent real actions and situations of real people in Uganda - our own people. That is why we all must act ). Hence the relevance of the theme of this Conference: All for Health-One Health.

Where do we want to go? Vision: A healthy and productive population that contributes to socio-economic growth and national development. Mission: To provide the highest possible level of health services to all people in Uganda through delivery of promotive, preventive, curative, palliative and rehabilitative health services at all levels. Goal: To attain a good standard of health for all people in Uganda in order to promote healthy and productive lives

How do we get there? MOH should take its stewardship role seriously – Evidence based policy formulation, policy guidance, Governance and accountability, resource mobilization and alignment, coordination, monitoring, supervision, etc

How do we get there? Intersectoral collaboration: Other departments and institutions whose mandate has a significant contribution to the determinants of health should play their role eg, agriculture, water, environment, housing, education, etc

How do we get there? Development Partners Support a Single Country Plan. There should be collective/joint planning, implementation, monitoring and evaluation and documentation. (one impact and one data)

How do we get there? Training and Research Institutions Continue training the relevant HR for the sector. Address the issue of quality and complete pre- service training to avoid wastage on poor quality in-service training. Continue to produce and disseminate evidence to inform policy Support service delivery

How do we get there? Private Sector and Civil Society Organizations Collaborate as partners with Government in planning, financing, resourcing, delivery and monitoring of health services

How do we get there? Communities and their Leaders Active participation in health programmes Lead lifestyles conducive to health

WHO Building Blocks for Health System strengthening WHO has proposed 6 blocks, on how to improve health services all over the world. Leadership and Governance (Stewardship) A well performing health workforce A well functioning health information system Equitable access to essential medical products, vaccines and technologies A good health financing system Good health services which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources. (To these, however, we must add research and community empowerment and mobilization for health)

Conclusion Having a good health system involves many building blocks, which must work in a coordinated and integrated way, if they are to deliver a common product of health. All for Health – One Health.

Recommendation All efforts geared towards health must be in a coordinated manner through Ministry of Health, if Uganda’s health system is to work efficiently and effectively

Thank you for listening.