The Uganda Health System and CUAMM projects in Uganda. Dr. Peter Lochoro Country Representative Doctors with Africa CUAMM

Transcription

1 The Uganda Health System and CUAMM projects in Uganda Dr. Peter Lochoro Country Representative Doctors with Africa CUAMM

2 General Information 1 Democratic government, stable country and more peaceful Population estimated to be 30.1 million (87% rural) in 2008/09 doubling every 20 years owing to a very high population growth rate of 3.2% TFR 6.9 GDP/Capita of US$ 453 growing at an average of 6.5% per annum since 1990 Human Development Index (2007) cf. Italy Poverty level down from 56% in 1992 to 31% in Poverty in north 70% Karamoja 82%

3 General Information 2 Health Financing Total Health Exp (THE) as % GDP in 2008: 6.3% External resources as % of THE 32.2% Public Budget 2009/10: Ush Bn (210 million Euro). 36% Donor projects - Health Budget as % of GoU Budget 9.6% Private Exp as % of THE 77.4% (Out of pocket being 51% of this) Total per capita Health Exp USD 33 (7 by Gov) No User fees in public health units, negligible insurance as % of T.H.E, 11 struggling Community Insurance schemes

4 Consequences of Funding Severely underfunded with only about a third of the US$ 28 needed to provide the minimum health package Shown in perennial shortages of drugs and supplies, poor health infrastructure and shortage and de-motivation of human resources. Constraints magnified for the northern region.

5 General Health Problems Over 75% of life years lost in Uganda are due to ten preventable diseases/conditions including: maternal and perinatal conditions (20.4%), malaria (15.4%), acute lower respiratory tract infections (10.5%), AIDS (9.1%) and diarrhoea (8.4%). Others include tuberculosis, malnutrition and trauma. HR. Only 51% of staffing positions filled The pop. to HW ratios: 1:8,373 x Drs, 1:6,458 x allied HW ;1:1,212 x Ns + MW. Some indicators Life Expectancy: 50.4 Years (48.8 Male; 52 Female) IMR: 76/1000 live births U5MR:137/1000 live births MMR: 435/100,000 live births Supervised Deliveries: 41% Fully Immunized (12-23 months) 46.2% Stunting (under 5) 38.1%

6 Uganda Trend for Health MDGs % % % % % 15.0% U5MR MMR HIV/AIDS % 6.4% % % 5.0% 0.0%

7 Development Strategy PEAP development framework and MDG Uganda development framework emphasises poverty eradication and economic development for social transformation. Now government developing a National Action Plan to replace PEAP Off-track in achieving MDG goals with exception of HIV/AIDS reduction. Poor health indicators contribute to the low life expectancy of 50.4 years

8 Populatio n Uganda Health System HOUSEHOLDS / COMMUNITIES / VILLAGES 5,000 HC II HC II HC II HC II HC II 20,000 HC III HC III HC III HS D 100,000 Referral Facility (Public or NGO) (HC IV or HOSPITAL) 500,000 District Health Services HQ 2,000,000+ Regional Referral HOSPITALS National Referral HOSP MOH Headquarters

9 Health Facilities by Ownership Level of Facility Ownership Governmen t status NGO Private Total Hospital HC IV HC III ,118 HC II 1, ,030 Total 2, ,460

10 Where CUAMM Works Where internal political, economic, social and cultural borders have caused severe deprivation and suffering Main focus a region referred to as Karamoja Where indicators look to be from another country altogether very poor compared to the average for the country Emphasis is in improving the last mile to effective services and enhancing capacity of duty bearers to perform

11 CUAMM Work in Uganda Our Mission 1. To improve the health status of African people. 2. To promote a positive attitude and solidarity towards Africa.

12 CUAMM Work in Uganda 1. Contribute to improving health among poorer sections of the population by supporting the local district health service (hospitals, health units, and community), in particular working to reduce maternal and infant mortality. 2. Support activities and interventions that aim to increase access to primary care and improve nutrition among women and children in rural areas. 3. Promote and encourage, within the community, the capacities required to recognise problems regarding health and to identify suitable solutions. 4. Support national programmes that focus on reducing endemic diseases (HIV, TB, Malaria) without omitting the neglected diseases.

13 CUAMM work in Uganda 5. Promote quality performances in the health services, especially hospital services, and reinforce teaching, research and academic partnership with institutions of higher learning 6. Support the coordination activities of the Catholic Medical Bureau particularly to promote Public Private Partnership in health 7. Reinforce the local information systems for monitoring and evaluating health services.

14 CUAMM Uganda Staff December 2009 Project/Duty station Nationa Internatio Total Remarks l Staff nal staff Naggalama Coordination Office Arua West Nile 2 Diocese project Some staff positions supported in hospitals and dioceses but not as CUAMM staff Coordination office Kampala UMU Nkozi Oyam PIR West Nile Sudan Support Karamoja CUAMM- UNICEF Matany Nursing Sch project Total Some staff positions supported in the school but not as CUAMM staff

15 CUAMM DISTRICTS

16 Karamoja comparative humanitarian and development indicators Indicator Uganda Karamo ja Estimated population (UBOS) 28.9 Million Life Expectancy (UNDP 2007) 50.4 years 1.1 Million 47.7 years Population below the poverty line (World 31% 82% Bank 2006; OCHA/OPM 2008) Access to safe Water (UDHS 2006) 67% 43% Remarks years in Moroto district in Italy Literacy Rate (UNDP HDR 2006; UDHS 2006) 67% 11% Human Development Index (HDR 2007) to Italy 0.945

17 Health and Nutrition Indicators Indicator Uganda Karam oja Remarks Crude Mortality Rate/10,000 people/day (MoH 2004/05) Maternal Mortality ratio/100,000 live births (UDHS 2006, WHO 2008) Infant Mortality rate/1,000 live births (UNICEF/WHO 2008) Under 5 years Mortality rate/1,000 live births (UNICEF/WHO 2008) Global Acute Malnutrition (UNCEF/WHO 2008) HIV/AIDS prevalence (HIV Sero-survey 2004/05) Average % of district health posts filled (MoH 2008; UNOCHA 2008) Italy Italy Italy 5.0 6% 11% Even rising in Karamoja % In Karamoja was less than 1% 10 years ago 79% 49% Severe disparities within Karamoja

18 Health and Nutrition Indicators 2 Indicator Uganda Karam oja Children months fully immunized 46% 46% (UDHS 2006) DPT3 coverage (MoH 2007/08; CUAMM 82% 81.2% Data centre 2007/08) Deliveries in health units (MoH 2008/07; 33% 10.3% CUAMM Data centre) Pregnant Women Tested for HIV 79% 35.3% (CUAMM Data centre) Remarks

19 Karamoja Region Projects Project Start End Budget Responding to Chronic Emerg July 2012 June 1,113,040 Some Results Primary Eye Care (also West Nile) Matany Nursing School Project , Million Provide TA to districts to improve plans, mgt, info, S.S and Monit. Improve staff infrastructure Increase attention for hard to reach Specialist positions for Moroto Provide medical staff for hard to reach In puts for improving primary eye care Training school support for Matany hosp: scholarships, infrastructure, tutors, training materials, MS.

20 Oyam Lango Region Project Start End Budget Reproduct ive Health Oyam Octob er 2007 Sept Extended to March 2011 Support inputs for RH Support staff positions and capacity building Strengthen district mgt supervision Referral service establishment Improve community education and awareness of services Increase services for PMTCT Infrastructure improvement 2.24 M Results ANC Yr1, 13,363; Yr 2. 14,430 Deliveries in HU from 1,998 in 05/06 to 4,087 in 2008/09 to 5,489 in 2009/10 Postnatal care from 1,333 in 05/06 to 2,081 in 08/09 Pregnant women tested for HIV from 2,217 in 05/06 to 12,165 in 08/09 Maternal Death in Health units 262 in 2007/08 and 153 in 2007/08 per 100,000 LB

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22 Project Start End Budget West Nile Disability ,000 Primary Eye Care ,000 Some results (Half year 2009) 285 PWD accessing services Epilepsy cases seen 4, Appliances supplied 4,753 Physiotherapy cases seen Support to disability: Epilepsy, Motor, Eye. Providing necessary inputs Support community based rehab Support Ortho and physio clinics in hosp Support schools of the blind

23 Nkozi UMU Project Start End Budget Training of Health Managers Extended to August M Support to teaching staff Training, Salaries Support learning resources: Books, Computers Support Research Publication of journal Classroom extension Student sponsorship