Investing in women’s Health is not a mere humanitarian call, it is a human right and development issue

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation.

By Fatia Kiyange

Every year, on the 28th of May, the world marks International Day of Action for Women’s Health. The day symbolises the importance of giving attention to the health of women and girls. It reminds nations that women’s rights are human rights. Reflecting on the World Health Organization’s definition of health, women’s and girl’s health means that women and girls are in a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Women play an indispensable role in the health of their families and consequently their communities. Because of this, investing in their health is an investment in population health with positive implications for the country’s overall development.

Women’s health, especially in lower-income countries is influenced by many factors. These range from social, cultural and economic to gender, biological factors and place where they live. These come with a myriad of barriers which make it difficult for women and girls to access health care services at the time and in a place where they need them. This constitutes an injustice and a violation of the right to good health and well-being for women and girls, consequently affecting their physical, psychological, mental and spiritual state.

The sexual and reproductive health of women and girls represents a big part of their overall health. The country continues to perform poorly on indicators for reproductive health, especially among women and girls despite previous and current interventions by Government and partners. Uganda’s maternal mortality ratio is still high at 336 per 100,000 live deliveries, and this translates into 18 deaths per day. This is way above the target of reducing maternal mortality to less than 70/100,000 births under Sustainable Development Goals. Important to note is that 28% of maternal deaths are among young women aged between 15 to 24 years. Early and unwanted teenage pregnancies are still high with a prevalence of 25%, one of the highest in East and Central Africa and with a national target of reducing it to 15% in the National Development Plan III 2020/21-2024-25. Our child marriage rate also remains very high at 43%. Despite the high total fertility rate of 5.4 contributing to the high population growth rate of 3%, the country has a high unmet need for contraception and other family planning services of 23.8% with a national target of reducing this to 10%. The HIV prevalence among women (7.6%) is higher than the national rate of 6.2%. Sexual and gender-based violence has remained high with spousal violence reaching 56% and sexual violence at 26%. A total of 12,715 cases of defilement (among children 0 -17 years) were reported in 2022 according to the Police crime report for the same year with 653 of these happening among children aged 0 – 8 years.

There are also health conditions women and girls suffer because of their biological make up. These range from reproductive cancers like breast cancer, cervical cancer, to menopause, pregnancy and menstrual cycle challenges. Urinary track infections and sexually transmitted diseases present more in women with undesirable effects.

It is now common knowledge that the Covid-19 pandemic and some of the response measures exacerbated indicators for sexual reproductive health, especially among young people and heightened the need for specific health services, such as mental health. However, emphasis for post-Covid recovery have been placed more on stimulating economic recovery programs. Attention towards access to quality health care for the most vulnerable members of our society could be given more attention to realise full recovery from the multifaceted impact of Covid-19.

All nations are working to realize the 17 SDGs by 2030 and committed to prioritise progress for those who are furthest behind by pledging to “Leave No One Behind”. Uganda among the first countries to develop a national development plan in line with SDGs for which Universal Health Coverage (UHC) under SDG 3 on good health and well-being is central. UHC means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliation) without the risk of financial hardship when paying for them. Given their economic challenges, women and girls especially those in the remotest areas are more likely to experience catastrophic expenditures on health which push them further down into poverty. A common and practical example is the reality of women and girls having to bear the cost of sanitary pads or their equivalent every month for the larger part of their lifetime.

As a country, we must reflect deeply on the underlying causes of these persistent reproductive health challenges of women and girls and set out to address them in the most honest and transparent way. Only then will we be able to realise Uganda’s Vision 2040 which identifies human capital development as fundamental for development. Human capital development contributes to the National Development Plan (NDP) III’s goal of increased household incomes and quality of life through increased productivity, inclusiveness, and well-being of the population. The Goal of the Human Capital Development Programme (HCDP) is to improve the productivity of labour for increased competitiveness and better quality of life for all. The challenges women and girls face in accessing health care services have to be addressed in order to realise this goal. We also have to reverse the population growth rate and structure which is largely constituted by a dependant young population.

Uganda has several policy and legal frameworks, which if well implemented can lead to improvement of indicators for the reproductive health of women and girls and consequently the health of families and communities. Examples of these are: Uganda Family Planning – FP2030 Commitments; the National Family Planning Costed Implementation Plan II; the National Sexuality Education Framework; 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School settings in Uganda; 2018 Uganda National Parenting Guideline and the second National strategy to end child marriage and teenage pregnancy 2022/2023 – 2026/2027, among others. For full implementation of these frameworks to be realised, financial resources must be allocated.

Investment in women’s health is a public health, rights based, gender justice and economic imperative. Non-investment in women’s health has grave consequences with some spilling over to the next generation. The projected reduction in budget allocation to the health sub-programme in 2023/232 will work against the realisation of the country’s goal of the Human Capital Development Programme (HCDP) of improving the productivity of labour for increased competitiveness and better quality of life for all.

The Writer is the Executive Director at the Center for Health Human Rights and Development (CEHURD).

Terms of Reference for the Uganda National Conference on Health, Human Rights And Development (UCHD) 2023’s Coordinator

Center for Health, Human Rights and Development (CEHURD) is seeking for the services of a competent and experienced large events organiser to coordinated the upcoming Uganda National Conference on Health, Human Rights and Development for a duration of Five (5) months (June – October 2023).

Deadline for submission of applications is Friday 26th May 2023.

Download attachment below for details;

Call for Expression of Interest to Conduct a Midterm Evaluation for the Joint Advocacy for Sexual and Reproductive Health and Rights (JAS) Programme in Uganda

The Center for Health, Human Rights and Development (CEHURD) with nineteen (19) partners are implementing a four-year programme titled: The Joint Advocacy for Sexual and Reproductive Health and Rights in Uganda (JAS) Programme in Uganda. The JAS programme is due for midterm evaluation to assess the progress so far made in the implementation. CEHURD therefore, seeks to engage a consultant / firm to support in the external evaluation of the programme that will inform decision making for the remaining period of implementation.

Deadline for application is Friday May 26th 2023.

The Unsung Heroes: Celebrating the Resilience and Dedication of Nurses in Uganda

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

By Christopher Ogwang

International Nurses Day is celebrated annually on May 12th to commemorate the birth anniversary of Florence Nightingale, the founder of modern nursing. This day is an opportunity to acknowledge the contributions of nurses to society, raise awareness about the challenges they face and find possible solutions to them.

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

Uganda, like many other low-income countries, is struggling with a severe shortage of healthcare equipment and supplies. According to a report by the World Health Organization (WHO), Uganda has only 1.2 hospital beds per 1,000 people and a severe shortage of medical equipment, including diagnostic tools, surgical instruments, and anesthesia equipment. This shortage of equipment has a direct impact on the quality of care that nurses can provide, as they often have to work with outdated or insufficient tools.

The shortage of equipment is particularly evident in lower-level healthcare facilities, such as health centers, which are often located in rural areas. These facilities often lack basic equipment like stethoscopes, blood pressure cuffs, and thermometers, making it challenging to diagnose and treat patients. 

On this Nurse International Day, let us take a moment to recognize the challenges that nurses in low-income countries like Uganda face every day. We must work together to address the shortage of equipment and supplies and ensure that nurses have the tools they need to provide quality care to their patients. By investing in healthcare infrastructure and supporting initiatives that provide equipment and supplies, we can help nurses in Uganda provide the care their patients deserve.

The writer is a Senior programme officer at CEHURD in the Campaigns, Partnerships and Networks Programme.

Parliament should save our ailing health system

The Ministry of Health has made significant strides in improving access to health services with 91 percent of  Ugandans now leaving with 5km of the health facility. Reduction of budget allocation to health will roll back the achievement made this far. Investment must now be directed at functionalising these health facilities. 

By Peter Eceru

Parliament is currently scrutinising Ministerial Policy Statements for the 2023/2024 Financial Year. The statements are the equivalent to the draft Budgets for the subsequent financial year. For most people, discussions on the budget does not make sense because it is perceived not to add value to their lives. Unfortunately, for millions of Uganda, whose lives depend on access to health care, is dependent on the public health delivery system these conversations are a question of life and death.

Adequate allocation to the health sector is critical to promoting equity in health service delivery. In the next financial year, the health budget allocation is projected to drop to about 6.5 percent of total budget from 7.7 percent as provided in the current budget. The drop is worrying development and must be arrested by Parliament during the current budget scrutiny. To put this into perspective, it is important to look at some macro-economic factors that have a direct impact on the health budget. 
In Uganda, the annual population growth rate is about 3 percent per year. The increasing population calls for increased investment in public health. Also, the Uganda shilling is projected to lose value against the dollar. This implies the cost of importing a unit of drugs and other health equipment will become more expensive in the coming year than it is this year. Prudent budget allocation will, therefore, demand that the allocation of resources to health should take into consideration these macro-economic considerations.

The Ministry of Health has made significant strides in improving access to health services with 91 percent of  Ugandans now leaving with 5km of the health facility. Reduction of budget allocation to health will roll back the achievement made this far. Investment must now be directed at functionalising these health facilities. 
In Uganda, 71.6 percent of the Out-patient Department attendance is at health centres II and III. Similarly, 56 percent of deliveries take place there. To foster health equity, public health financing must ensure that the quality of service at these lower health facilities is improved because they help decongest the higher health facilities.  
Improving the quality of health service delivery means investing in essential medicines and health supplies, strengthening human resources for health, investing resources in primary health care, ensuring that there are medical equipment and that they are functional, among others.

The draft budget does not respond to the above needs and in some cases, financing has been reduced.  National Medical Stores is projected to receive about Shs537.6 billion in the next financial year with a funding shortfall at Shs245 billion. The biggest funding gap for essential medicines is in health centre IIs accounting for about Shs17 billion. At the height of the drug stockouts earlier this year, we argued that funding was one of the driving factors for drug stockouts in the public health facilities. This budget making process gives Parliament an opportunity to conclusively address stock out challenges. 

Last year, Parliament allocated Shs23 billion for Uganda Blood Transfusion Service and made a proposal for progressive increase in the budget for blood collection, processing and distribution. Unfortunately, government has instead proposed a reduction in the budget for blood from Shs23 billion to Shs21 billion.  The reduction will mean that Uganda Blood Transfusion Service will be incapable of closing the gap of 150,000 units of blood needed by patients in Uganda with the possible result being that more Ugandans will die. 
Financing for service delivery, including health is usually dependent on availability of resources and we have consistently argued that we need to tap into all available opportunities including health insurance. 
We also need to aggressively ensure that every one pays their fair share of the tax that is due to them. Uganda currently loses more than Shs7 trillion annually to tax exemptions that would be channelled to service delivery. These have a direct impact on the country’s ability to provide quality health service delivery for its citizens. Government needs to urgently review its policy on tax exemptions.

The writer is the Program Coordinator- Advocacy at Center for Health Human Rights and Development (CEHURD)

A version of this article was published in the Daily Monitor on April 24th 2023.