Uganda - Health and Welfare

Social Welfare

Social services were an important factor in government planning in the late 1980s, both to support efforts to improve health care and to upgrade living standards in general. Providing running water in rural areas was a high priority, although even small improvements in water supplies were costly. Projects in the late 1980s focused on drilling wells, protecting springs, replacing and repairing pumps, and training community workers to oversee water systems. The government also recognized that many people had to walk several kilometers to carry water to their homes and declared its intention to extend pipelines into rural areas. Sewage systems, too, were considered an important but expensive improvement. Even so, many urban pipelines and septic tanks were in disrepair, and most rural areas lacked pipelines or sewage treatment facilities. Government workers began installing sewage systems in several small towns, including Rakai, Nebbi, and Bushenyi, in 1988.

Housing was an important symbol of development in Uganda under the NRM government. Providing low-cost urban housing was a high government priority. Projects in Masaka, Mbarara, Arua, and Namuwongo exceeded government spending projections in 1988 and 1989. In 1990 at least three housing projects were underway in Kampola. Estimates were that some 8,000 housing units needed to be built each year throughout the 1990s in urban areas alone to keep pace with population growth. Given the shortage of investment funds and the high cost of imported construction materials, it was unlikely that such a goal would be met.

Rural housing development was also an important goal, but in the late 1980s, most rural residents built their own homes. Although these were often mud-and-wattle huts, they were, nonetheless, a source of pride. Having a well-kept home was important to many Ugandans, even the very poor. People considered deteriorating housing standards a symbol of social disintegration, one that characterized a few poverty-stricken areas and those hardest hit by AIDS. Village cooperative societies in the Luwero region organized brick-making factories in 1988 and 1989, and the government was attempting to organize similar projects in other areas. Other government programs aimed at increasing credit opportunities and improving materials and transportation facilities for rural homebuilders. In the late 1980s, housing assistance was received from Austria, Britain, Finland, and the Netherlands.

One social problem with tragic implications for Uganda's future was the children--more than 1.5 million of them, almost 10 percent of the population--who had been orphaned by the spread of warfare or by AIDS in the late 1970s and early 1980s. By 1990 the number of war orphans alone was estimated at more than half a million. No reliable figures were available for AIDS orphans, but one study predicted that their number would grow over the next twenty years to 4 to 5 million.

Several thousands of these orphans were young boys who had attached themselves to the army. By the late 1980s, the government had established a few schools to provide boarding facilities and primary education for these kadogos, or child-soldiers. Others sometimes lived on city streets or in small groups without any regular supervision. Many Ugandans accepted the responsibility for caring for others' children, but this responsibility was generally believed to apply only within the boundaries of the extended family. Many children had lost a large number of relatives, in addition to their parents, and some orphans chose to avoid living with relatives they did not know well. As a result, neither government nor private agencies were able to surmount the economic and social obstacles to programs for immediate care for orphans. One of several ominous implications of this failure was that orphans and kadogos could remain on the periphery of society for the rest of their lives.

Health and welfare

In 1989 Uganda's estimated life expectancy, crude death rate, and infant mortality represented significant improvements over those of the 1960s, but local officials also believed the 1980s estimates were optimistic, based on incomplete reports. Health services and record keeping deteriorated during the 1970s and early 1980s, when many deaths resulted from government neglect, violence, and civil war.

In 1989 officials estimated that measles, respiratory tract infections, and gastroenteritis caused one-half of all deaths attributed to illness. Other fatal illnesses included anemia, tetanus, and whooping cough, but some people also died of malnutrition. An estimated 20 percent of all deaths were caused by diseases that were not well known among international health officials. Ugandan health workers were especially concerned about infant mortality, most often caused by low birth weight, premature birth, or neonatal tetanus. Childhood diseases such as measles, gastroenteritis, malaria, and respiratory tract infections also claimed many lives. Malaria and tuberculosis caused an increasing number of deaths among adults during the 1980s.

Certain forms of cancer were common in Uganda before they were first systematically studied in any country. Burkitt's lymphoma, which caused a large number of cancer deaths in children across Africa, was first described in Uganda in 1958. This malignancy was thought to be related to the incidence of malaria and possibly to food storage practices that allowed the growth of carcinogenic strains of bacteria or molds in stored grain or peanuts. Other research, although inconclusive, suggested that the spread of certain cancers might be related to parasites or other insect-borne diseases.

Acquired Immune Deficiency Syndrome (AIDS)

During the 1980s, Uganda developed the highest known incidence of acquired immune deficiency syndrome (AIDS), with an infection rate of over 15 cases per 100,000 population. By mid1989 , the Ministry of Health had reported 7,573 AIDS cases to the World Health Organization (WHO). In mid-1990, local officials reported that at least 17,400 cases had been diagnosed and the number of actual AIDS cases was doubling every six months. In Kampala health officials also reported that more than 790,000 people had positive test results for human immunodeficiency virus (HIV), the infectious agent believed to cause AIDS, a figure estimated at 1.3 million by late 1990. Over 25,000 children under the age of fifteen were HIV-positive, along with 22 percent of all women seeking prenatal medical care at Mulago Hospital, the nation's largest hospital in Kampala. Belgium's Institute of Tropical Medicine reported that an estimated 20 percent of all infant deaths in Kampala were related to HIV infections, and many tuberculosis patients were also infected with HIV.

Uganda's first officially recognized AIDS deaths occurred in 1982, when seventeen traders in the southern district of Rakai died of symptoms that came to be associated with the disease. Within a year, AIDS (then known as "Slim") was diagnosed in Masaka, Rakai, and Kampala, and by 1989, all districts of Uganda were affected. The disease appeared to spread by heterosexual contact, often along main transportation routes. Men and women were equally affected, although the death of a man was more likely to be reported to officials. The majority of AIDS cases occurred in people between sixteen and forty years of age, and by the late 1980s, an increasing number of babies were born HIVpositive . These cases, more than adult deaths, shocked people into changing behavior that risked AIDS infection. Fewer than ten AIDS cases were reported among school-age children, who constituted nearly one-half of the population, prompting intensive efforts to prevent its spread into this age group.

Government health officials initiated an aggressive nationwide school education program to prevent the spread of the disease among the young, and they implemented nationwide blood screening and public education programs, including television, radio, and local press warnings in English and local languages. By the late 1980s, however, it was clear that the nation's beleaguered health care system could not cope with the increased health needs, and the government intensified efforts to gain international assistance to slow the spread of this deadly disease. The need to combat AIDS was urgent: according to one estimate, Uganda's population in 2015 could total about 20 million, rather than the 32 million that demographers anticipated, because of AIDS, and the number of orphaned children would rise dramatically throughout the 1990s and after.

The transmission of AIDS was complicated by economic decline and problems of national security. In many areas, warfare had destroyed communication systems and health care facilities. At the same time, AIDS slowed the pace of economic development, because skilled workers and young, educated Ugandans had high infection rates. A few people were able to capitalize on the tragedy of AIDS--a small number of local medical practitioners claimed to have cured AIDS victims and became wealthy fairly quickly. A few street vendors in Kampala sold vials of a liquid they identified as Azidothymidine (AZT), a drug being tested for possible AIDS treatment, at prices ranging as high as US$1,000 per vial. They were able to reap fortunes from desperate AIDS victims and their families, despite government warnings that no AZT was available in Uganda.

Health Care

Uganda had a total of seventy-nine hospitals in 1989, providing approximately 20,000 hospital beds. The government operated forty-six of these institutions, while thirty-three were staffed and equipped by religious and other private organizations. In addition, more than 600 smaller health facilities, including community health centers, maternity clinics, dispensaries, subdispensaries, leprosy centers, and aid posts, operated nationwide. At least one hospital was located in each district except the southern district of Rakai; the bestserved districts were Mukono and Mpigi, each with five hospitals, and Kampala with seven. In the more sparsely populated northern districts, however, people sometimes traveled long distances to receive medical care, and facilities were generally inferior to those in the south. In 1990 Uganda's entire health care system was served by about 700 doctors.

Uganda's per capita spending on health amounted to less than US$2 per year for most of the 1980s. This rate of spending increased slightly in 1989, when the government allocated US$63 million, roughly 26 percent of its development budget, for social services, and US$24 million of this amount for health services in particular. This represented an increase of 50 percent over health spending for the previous year.

The highest priority in government programs was rehabilitating existing facilities and improving supplies. In 1989 funding from the United Nations Development Programme (UNDP) and the International Development Association (IDA) was earmarked for rehabilitating nineteen of the nation's hospitals, primarily through building repairs and upgrading water and electrical systems. Primary health-care projects, including immunization programs, prescription drugs, clean water supplies, and public hygiene, also received special priority. European Development Fund (EDF) assistance was also used to construct twenty new health centers and one district health office and to train health-care practitioners.

A number of governmental and nongovernmental organizations were involved in health research in the late 1980s, much of this sponsored by the Ministry of Health, the Institute of Public Health, and Makerere University. The nation's largest health-care facility, Mulago Hospital, conducted research on local nutrition and endemic diseases, and researchers there developed child nutrition programs to be implemented through the United Nations Children's Fund (UNICEF) and the Save the Children Fund.

Several government ministries sponsored research and implemented community programs designed to improve health and nutrition. The Ugandan Red Cross and the Ministry of Health, in cooperation with several international agencies, opened an orthopedic workshop in Kampala for handicapped children and adults, most of whom had suffered from poliomyelitis or severe wounds in outbreaks of violence. Catholic and Protestant missions, the Food and Agricultural Organization (FAO) of the UN, the International Committee of the Red Cross (ICRC), and OXFAM were also active in emergency relief projects involving food and nutrition. Many Ugandans criticized their own government for inadequate attention to popular health needs, but they also hoped that government efforts to eliminate violence and warfare would lay the foundation for improved health care.

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