Focus on: UGANDA’s HEALTH ISSUES

A space open to contribution articles from everywhere, this column aims to serve as an observatory of challenging health issues in Uganda from a comprehensive view encompassing the policies, strategies and practices of all involved actors 

image credit: WHO

Rapid Assessment on the Impact of COVID-19 among Female Sex Workers, Adolescent Girls and Young Women, and Women Living with HIV & AIDS in Uganda by AWAC-Alliance of Women Advocating for Change

Find here a to-the-point study by the Alliance of Women Advocating for Change (AWAC) partner organization. AWAC is an umbrella network of grass root female sex worker led organizations in cutting across the 6 regions of Uganda. It was established in 2015 by female sex workers (FSWs) to advance health rights, human rights, socio-economic rights and social protection for FSWs and other marginalized women and girls including their children in Uganda. Geographical focus areas encompass: slum areas, islands, landing sites, transit routes, mining, quarrying, plantations, road construction sites and border areas in Uganda

The Effects of the COVID-19 Pandemic on the Health Service Delivery Systems in Uganda by Zziwa Joshua and Bukenya Denis Joseph

Health services in Uganda are at risk in the COVID-19 outbreak through various mechanisms. Clinicians and direct care givers of COVID-19 patients have a disproportionately higher mortality than the general age-adjusted population. Closure of logistics-related workplaces and transport services interrupts supply lines. Travel bans and reduction in public transportation limit access, and public perceptions of increased risk of SARS-CoV-2 infection near health facilities dissuade attendance, whereas clinic activities considered “non-urgent,” such as antenatal care, may be postponed. Uganda has a relatively fragile health system with limited capacity to expand critical care services

Politics and the Myths Around COVID-19 Pandemic Affecting the Right to Health by Bukenya Denis Joseph and Zziwa Joshua

A big number of people in Uganda are disregarding the Ministry of Health’s guidelines and Standard Operating Procedures simply because these people don’t feel that there is a real threat hence regarding COVID-19 pandemic as a scum and this is supported by most of their political leaders who have decided to preach drinking of water while themselves opting for wine. This is evident through the dishonesty of the government officials and who have visibly used the pandemic to steal and embezzle funds from the government coffers depicted through the continuous inflation of price of essential equipment like; face masks and the distribution of radios and TVs plus food that has either not reached the people or never been given at all

Interview to Ms. Gloria Nirere, Menstrual Health Management Trainer in Uganda by Daniele Dionisio 

Menstruation matters in resource-limited countries where poverty substantially impacts menstruation health management. In this connection, PEAH had the pleasure to interview Ugandan stakeholder Ms. Gloria Nirere currently involved as menstrual health management trainer at Kampala based WoMena NGO. Previously, Ms. Nirere long served in poorly equipped Ugandan contexts where she performed tasks concerning clinical research, community health, humanitarian assistance, and project management at local and national level

Interventions to Curb Covid-19 Spread in a Low-Income Country: Feasibility Challenges by Gertrude Masembe

A report here by a field engaged stakeholder about the challenges Uganda currently faces regarding the feasibility of interventions to curb nationwide Covid-19 spread

Increasing Uptake of Vasectomy as a Family Planning Method in Uganda by Amon Mulyowa

Men plus is a one-year project that started in February 2019 by Reach a Hand Uganda – RAHU in collaboration with Reproductive Health Uganda (RHU) which is aimed at increasing men’s involvement in Family Planning in Uganda through promoting access to and uptake of long-term and permanent Family Planning methods and services, through community outreaches, clinic-based interventions, group education sessions, online campaigns, and interpersonal communication between men in the different focus districts

Public Health or Poverty Alleviation? What are Mosquito Nets for? by Gertrude Masembe

A total of 21.5 and 27 million nets were distributed in Uganda in 2013/14 and 2017/18 respectively, and this yielded reduced malaria cases in the country. However, despite good government intentions, a number of Insecticide-Treated nets have not been used for their intended purpose and many are using them as fishing nets, wedding veils, ropes and for ant collection. It’s therefore important that government incorporates and ensures implementation of a proper malaria communication strategy

Development Cooperation: Concerns and Emerging Challenges by Michael Ssemakula

Challenging the ideological deficiency in the existing Aid narrative is essentially dependent on how we accord attention to the existing shifts in the interests of global economic power centers, and power imbalances rooted in imperialism- that is perpetuating the misdiagnosed fundamental dynamics of capitalism in the multilateral trading system that has quite often acted as a tandem to direct the route of trade

Two Goals with One Action: HIV/AIDS and Hunger (Health and Community Development) by Kiyini Jimedine

Zidan Benevolence International is a local community based organization that works to fight against pediatric HIV and AIDS, and operates in Buikwe district-Uganda Africa to provide HIV prevention, care and treatment services for women, children, and families. Zidan is trying to achieve two goals with one Action that is HIV/AIDS Virus and Hunger by connecting the link between Nutrition and HIV/Aids through Health and Community Development as our focus area.

Find out here an all-round, first-hand report of their much constructive, balanced and passionate field engagement

Patents in Pharmaceuticals: The Emerging Sharp Sword to the Fragile Health Systems in the 21st Century by Michael Ssemakula

Regional institutions mandated with the overall trusteeship of granting patents like African Region Intellectual Property Organization (ARIPO) responsible for the filing, administering, examining and granting of patents for 18 Contracting States of the Harare Protocol (ARIPO’s legal instrument on patents), and Organization Africaine de la Propriété Intellectuelle (OAPI) responsible for examining and granting of patents in the 16 Member States in West and Central Africa signatory to the Bangui Agreement, continue to apply insensitive practice of granting these patents which is parallel to WTO TRIPS flexibilities and pharmaceutical exemptions given to the Least Developed Countries (LDC) during this pharmaceutical transition period. Patents remain an emerging sharp sword to fragile and ever hemorrhaging health systems. This is looped in the weak implementation of TRIPS flexibilities in member state national patent laws, infamous practice of processing and granting pharmaceutical patents in LDCs by region institutions like ARIPO which has a direct implication on the member states’ access to affordable medicines, and development of a vigorous generic industry that can check the monopolies in the pharmaceutical sector to enhance availability of cheaper drugs

The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda: Disconnections and Disruptions in the Health Sector Expenditure Priorities by Michael Ssemakula and Denis Bukenya

Uganda needs only USD 9.6 million to put its Mulago national referral hospital to an internationally recommended standard, the proposed USD 379.7 million can construct five state-of-art cancer hospitals with 1000 bed capacity each. But why would the government instead opt for a USD 379.7 million deluxe hospital that has a bed capacity of only 264 which will benefit a handful?! Is this the best approach to set our line-of-preferences at the cost of other numerous districts without a single public hospital?

Turbulences in Uganda’s Global Aid Construct: Is the Contemporary Aid Effective Enough to Transform Uganda’s Health System to Achieve UHC? by Michael Ssemakula

At a time when to care about Uganda’s health system a model shift is required to be drawn for the coverage and effectiveness of aid to yield more productive results, this paper scrutinizes the changes, the form, and the applicability of external financing for health to Uganda and evaluates the level of influence of new alternatives available for health sector development

Galvanizing the Action to Protect and Promote the Rights of Mentally-Disabled Individuals in the Key Populations: a Pathway to Achieve Health for All by Denis Bukenya and Michael Ssemakula

Obsolete mental health legislation in Uganda has a number of deficiencies such as failure to differentiate voluntary and involuntary care, inadequate protection and promotion of the human rights of people with mental illness and the presence of slurring and stigmatizing language; and henceforth not in line with the draft mental health policy as well as current trends in mental health care

The Rhetoric In Achieving The Universal Health Coverage Under Public-Private Partnerships In Uganda by Denis Bukenya and Michael Ssemakula

UHC has remained in a shackled unachievable dream in Uganda due to the wave of liberalization and improper incorporation of the PPPs during the early 1990s into the health system with unclear regulations, objectives and conflicting interests. 
The woe with the PPPs in Uganda is that the lack of proper laws that can regulate their work framework adds to the absence of a well streamlined policy in place that directs how these partnerships should be designed and controlled …at a time when… most of the decisions undertaken by the government consider less the public engagement concerns and rely more on the interests and choices of the private sector

Private Players in the Growth Paradox of Health Service Provision and Advancement in Uganda by Michael Ssemakula

This paper focuses on the role of private actors in the direct provision of health care in Uganda, through provision of health related goods and services such as research, treatments, human resources, and healthcare financing. It maintains that, while the health sector system of Uganda is predominantly covered by the private health care in its current state, this has mostly benefited the rich and middle class citizenry with higher disposable incomes who can afford the high charges on treatment. The paper also stresses that much as the private profit motivated forces hike fees on health care, this can also be worsened and perpetuated by the public entities

The Global Implications of the Gag Rule and its Manifestations on Reproductive Health Rights in Uganda by Denis Bukenya and Michael Ssemakula

This paper examines the adversative effects of the Mexico City Policy (or Global Gag Rule) and the overflow-stream of fears towards health that it has drawn to the health rights advocates and NGOs in Uganda. The paper dissects into issues surrounding the policy especially in regards to other health related services that have been deprived of the susceptible key populaces in the pretext of putting a stoppage to abortion linked services

Uganda: the Big Challenge of Maternal and Child Health by Pietro Dionisio

Uganda has made progress towards improving the health of children, newborns, adolescent boys and girls, women and men in the country. However, Uganda  still ranks among the top 10 countries in the world with high maternal, newborn and child mortality rates. Many policies have been implemented over the last 20 years trying to improve maternal and child health. The related health indicators are progressing but there is still much to do

Falsified and Substandard Medicines: Threat to the SDGs – but Who’s Watching, Caring or Acting? by David Patterson

Falsified and Substandard (FS) medicines remain a largely hidden problem in many lower-and-middle income countries. Adding to law reform, a comprehensive response should include strengthening of capacity, accountability, collaboration and coordination of all concerned parties

The Untold Story about Counterfeit Medicines and Its Effects on the Right to Health in Uganda by Denis Bukenya and Michael Ssemakula

Uganda's National Drug Authority (NDA), a national body that presides over the oversight and authorization of sale and distribution of drugs, does not have a National Formulary (NF) to outlaw and disallow importation of counterfeit drugs. This paper raises many questions relevant to drug authorization in Uganda and calls for response to the unresolved answers: What does NDA use to guide and control the marketization and selling of imported drugs in Uganda in the nonexistence of a National Formulary? What does NDA use to make a taxonomy between unauthorized and authorized drugs for general public use?

Accessibility to Medicines in Uganda by Denis Bukenya and Michael Ssemakula

This paper examines the vast gap in access to essential drugs in Uganda and highlights the many circumstances of the drug stock-outs culminating into the high premiums on medicines hence frustrating access to medicines and many a time sprouting drug resistance illnesses

Understanding the Systems that Influence Distribution Channels for Drugs in Uganda for Better Inventory Procedures by Denis Bukenya

In his own words, the director of National Medical Stores (NMS) Mr. Moses Kamabare said “the stores are full of drugs to the point that I am asking my suppliers to hold future deliveries as I try to work out stocks from the system”. Reading the NMS Director’s statement and considering the regular drug stock-outs in the country makes one wonder who is fooling the other. This is an indicator that someone in the system is incompetent in managing their job of furnishing the correct data to the relevant authorities. This article intends to examine the pros and cons of the nature of the system that NMS uses in procuring the drugs for Ugandans to avoid stock outs

The Injurious TRIPS Relationship between Human Rights and Access to Medicine in Uganda by Denis Bukenya

The issue to ponder about is who is this TRIPS meant to protect? Is it protecting the LDCs or the Developed Countries? The views I am trapping out there imply that the Agreement intends to protect creativity and the manufacturers so that they can expand their potential and motivate them in research. 
The least developed countries, Uganda inclusive need time to overcome the constraints preventing them from creating viable technological bases and Intellectual Property (IP) Laws.The IP Laws in Uganda are so muddled that they curtail the availability of affordable generic drugs in the country.
Uganda as a nation would use a good training to the officers of the law in the IP section and also there is a need for increased materials on IP to be circulated amongst the health rights activists and advocates

The Uganda’s “Narcotic Drugs and Psychotropic Substances (Control) Act” and how it impacts on Public Health and Human Rights by Muhwezi Edward

The essence of the Uganda's Narcotic Drugs and Psychotropic Substances (Control) Act (NDPSA) is to treat people who use and inject drugs (PWUIDs) as criminals who need to be locked up instead of viewing them as human being in need of assistance. The criminalisation of drug use has had the effect of limiting the range of medical  intervention available and accessible to PWUIDs in both private and public facilities. There is no comprehensive facility for the provision of public health services to PWUIDs. There is also no treatment available within Uganda for people who are on drugs and need critical and urgent medical attention like opioid substitution therapy. And there is a direct link between the criminalisation of drug use and HIV/AIDS as well as mental health challenges

The Effects of Current Trade Agreements and IP Standards on Access to Health Services and Appropriate, High-Quality Medicines in Resource-Limited Countries like Uganda by Denis Bukenya

As a matter of life and death, governments in the LDC sector need to strive to ensure that they develop effective health policies including development of essential medicines lists in a bid to improve access to health care.  Also they need to live up their individual and collective commitments and adopt a human rights based approach to access to all medicines, not only essential medicines

Synergizing Roles: Experiences of Civil Society Working Towards Promoting Local Generic Pharmaceutical Manufacturing in the EAC Region by Moses Mulumba 

Due to a number of bottlenecks, the generic pharmaceutical manufacturers in the East African Community region produce at a cost disadvantage compared to their large-scale Asian counterparts. This article highlights some of the key areas where civil society has engaged and can still engage with local pharmaceutical industries to address these challenges