Health promotion is the way forward for Uganda’s fragile system
Health is an essential part of our being because when we do things right, all other activities follow. And in this article, I am specifically addressing physiological health. And with the current fear of the Covid-19 pandemic, a discussion on health has never been so timely!
There is no doubt that the Ugandan health sector, like others, continues to struggle to stay united, the Ugandan health sector has a total of 6,937 health facilities spread across the country. These facilities are responsible for providing health services to an entire population estimated at approximately 43 million Ugandans.
I am by no means political, but visiting most government facilities, the tension is visible. The country is definitely facing increasing challenges in the health sector due to the rapid population explosion and other unforeseen pressures such as refugee influxes etc. — especially doctors, in certain establishments which have few full-time on-call doctors. With private hospitals paying slightly better than public facilities, this has only alleviated the situation as most private hospitals are located in urban areas, resulting in an additional shortage of qualified medical personnel in rural areas.
If there is one lesson we should learn, as one country learned from recent waves of the indiscriminate Covid-19 pandemic, it should be the urgent need to improve our healthcare system! Rich and poor, we have all struggled to access health facilities whose capacity to absorb the overwhelming number of patients was less than satisfactory. One of the feasible ways to reduce the burden of overcrowding in healthcare facilities is to advance health promotion approaches in this country.
This calls for the Ministry of Health to pay more attention to strategies that improve citizens’ health knowledge, attitudes, skills and behavior (KAPB) within given communities; to treat and prevent the root causes of ill health, because prevention is better than cure! SOPs like wearing masks, washing hands with soap, disinfection and physical distancing currently used to fight Covid-19 are visible components of health promotion, but communities, especially rural ones, need more awareness.
The efforts of the Ministry of Health in preventing disease and reducing hospital admissions are, however, duly appreciated. Health promotion must be deliberately and strategically treated as a complementary driver to joint efforts. Fragile health systems like ours benefit more from these disease control and prevention strategies that try to manage the situation at the individual level before contracting the disease, which reduces the pressure on health facilities and health workers. .
However, public health expenditure is heavily committed to primary health care and does not prioritize health in public spending. For example, the health sector accounted for 5.1% of the national budget in the 2020/21 financial year, compared to 7.9% in the 2019/2020 financial year (Unicef-Uganda-2020-2021-Health brief budget). Yet, although primary health care receives the lion’s share of Uganda’s health sector budget, distinguishing and focusing more on health promotion as a social mobilization strategy for the health of individuals will greatly save our health system.
The government needs to put more emphasis on health promotion strategies, more targeted financing of the sector and capacity building of technocrats at the national level. The district health education team should be given more reasonable resources to strengthen their support for outreach programs which then trickle down to village health teams (VHTs).
At the community level, VHTs whose mandate is to mobilize communities for health programs and strengthen health service delivery at the household level should be well compensated and trained to adequately relay information to communities. Essentially, they play a dual role: service; and promotional functions. In this way, we will have literally improved the performance of our health sector lest we forget who we are – an extremely fragile health care system and economy, of course, at the risk of our own progress and our very existence. .
The author, Douglas Kaziro, is a Masters student in Public Health at Uganda Martyrs University-Nkozi,