Two lawsuits have been filed against the Ugandan government for alleged negligence in the handling of nodding disease. The disease has killed at least 200 children since 2009 and currently affects 3,500 others, according to the Ministry of Health. A local charity, Health Watch Uganda, has filed one lawsuit, and two members of parliament have filed a separate case. Health Watch Uganda has accused the government of violating the rights of affected children by not providing them with adequate health care. In February, the government rolled out a plan to fight the disease, opening three specialised clinics and training 99 health workers, but critics say it is overdue and inadequate. The Health Ministry says lack of funding has made it difficult to implement the plan. The government has vowed to fight the lawsuits, arguing that it has been conducting research into the disease in cooperation with the World Health Organisation.
Governance and participation in health
The Ugandan Government wants non-government organisations (NGOs) to align their projects to government’s development priorities. At the national civil society fair held in Kampala early in July 2013, James Baba, the state minister for internal affairs, said NGOs should strive to understand government priorities and work on them both in the local and central governments. The Cabinet has charged the Ministry of Internal Affairs in consultation with the Minister of Finance to closely work with NGOs to ensure that all projects are aligned with government priorities. The National Development Plan outlines various strategies for the socio-economic transformation of Uganda from a peasant economy to a modern and prosperous country within 30 years. Baba promised to enhance the co-ordination of NGO stakeholders to ensure improved communication flow aimed at promoting smooth relations between the Government and the NGOs.
Uganda has released the result of Demographic Health Survey (UDHS 2016) highlighting the success in family planning and reproductive health. Uganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). As of January 2017, the population of Uganda was estimated to be 40 million, the age structure defines 49.9% in the below 15 years, 48.1% in 15-64 year of age group and the rest 2.1% are 64+ n the past 10 years, showing increasing growth rate (3.24 in 2016 est.), the country has added more than 10 million, from 24 to 35 million. DHS 2016 showed noteworthy success in maternal health care. Nearly three-quarters (74%) of live births were delivered by a skilled provider and almost the same proportion (73%) were delivered in a health facility which was almost half in 15 years back. Throughout the course of their lifetimes, Ugandan women have a 1-in-35 chance of dying due to pregnancy-related causes; every day, 16 women die in childbirth. However, the overall trend indicates a decline of pregnancy-related mortality over the time. Infant and child mortality rates are basic indicators of a country’s socioeconomic situation and quality of life. The country’s infant mortality rate was one of the highest in the world, but 2016 DHS showed steep declining trend. The Contraceptive Prevalence Rate (CPR) has risen steadily from a low starting point and moved upward sharply in most years in Uganda, on the other hand the unmet need of contraceptive is showing gradual decreasing trend. As the country’s population continues to grow, the majority of that growth is taking place in rural areas, where access to health services is extremely limited. PPD argues that with the call for universal access to reproductive health and family planning, the country is moving rapidly towards this goal. Such progress will help the country move closer to the targeted demographic that are linked with the larger development goals. Significant effort is argued to still be required to mitigate rural-urban disparity. Political commitment beyond the health sector, partner collaboration, community provision to increase community engagement is reported to lie behind the trends in the DHS key indicators report.
At the final meeting of the United Nations Thematic Consultation on Governance and the Post-2015 Framework, held in Johannesburg at the end of February 2013, participants argued that human rights and accountability must be placed at the heart of governance at the national and global levels. A high point of the meeting was the address by High Level Panel member Graça Machel, who spoke of the panel´s commitment to ensuring that issues of governance, human rights and inequality were central to the new post-2015 framework. There was wide consensus at the meeting that weak and unaccountable governance, including at the global level, is one of the key issues that must be addressed in a future framework, and that democratic governance must be predicated on respect for the full range of human rights. Ultimately, it will be up to the international community to decide the parameters of the successor framework when it gathers for the Millennium Development Goal Review Summit in New York in September 2013. In this article, the author calls on global civil society to promote rights-based governance in the run up to this important event, which is likely to prove pivotal for the future of international development.
Equality before the law, corruption-free government, inclusiveness, gender equality, and respect for the environment are among the priorities for any future set of development goals, as identified during four civil society and government meetings on the Millennium Development Goals (MDGs) and the targets that should replace them when they expire in 2015. Four "ground-level panels" were held in four developing countries, including Uganda. Respondents on the panel in Uganda agreed that no one should be left behind, urging a grassroots approach to policy. They proposed that bottom-up processes, where the people decide what is to be done by their government, must be a priority. The panel also felt foreign investment should create opportunities for Ugandans, and external investors should respect local customs and culture.
The Nyeleni 2007 Forum for Food Sovereignty in Mali was not your usual global conference of diplomats and policy makers; the six-day programme initiated by and for the underprivileged worldwide was marked by a spirit of international solidarity. The shabby conditions, however, seemed a perfect fit for the theme of the Nyeleni 2007 Forum for Food Sovereignty. The six-day programme was initiated by and for the underprivileged worldwide, whose major concern may be their next meal. Among the five hundred-plus in attendance were small-scale farmers and fishermen, indigenous peoples, landless migrant workers, pastoralists, and NGOs who have been working with the rural and urban poor.
The provision of appropriate reproductive health care remains one of the main health care challenges in developing countries. The delivery of reproductive health services is continually confronted by challenges from the changing environment, as health sector reforms are implemented, and particularly by decentralisation.
Rising powers such as Brazil, India and China have been criticised for their inputs in the negotiations on the post-2015 development agenda. The start of the United Nations (UN) negotiations saw high expectations for the role of these countries in shaping the Sustainable Development Goals (SDGs) that have not materialised. However, what appears to be a confrontational style of diplomacy is in fact an assertive affirmation of long-standing principles. The G77 and China have consistently
called for the reform of the UN Security Council, and of the Bretton Woods institutions, which resulted in International Monetary Fund reform being nominally approved in 2010 before being blocked by the United States (US) Congress. The issues defended by the Brazilian negotiators centred on poverty eradication, its relationship with inequality; sustainable production and consumption; financing and keeping climate change strictly within the UNFCCC process. Brazil is keen to avoid what it sees as the securitisation of development through the SDGs. It supports governance as a general principle guiding the SDGs, but is adamant in its refusal to consider security as a stand-alone goal. The Brazilians are prioritising the ‘how’ of the SDGs, concentrating on the means of implementation for sustainable development through data disaggregation and exploring how to reutilise the structure of the MDGs as well as Brazil’s experience of participatory development in implementation. The authors argue that a more nuanced understanding of these countries’ positions in the post-2015 process is required.
This briefing paper elicits the perspective of the African non-governmental organisations (NGOs) on the concept of universal health coverage (UHC). It defines the basic concepts and also explores the role NGOs can play to improve the definition and implementation of UHC to improve health outcomes for all. It describes some of the common misunderstandings and misgivings expressed by NGOs, such as the belief that UHC is limited in scope and does not address the social determinants of health. Examples from African countries that have successfully implemented UHC are provided. UHC does not only mean protection from catastrophic expenditure – it means that all people are able to access health services when they need them. In this regard it specifically targets the poorest and most vulnerable. In most instances, civil society organisations have played a significant role in ensuring that national policies reflect in the reality on the ground.
In this article, the authors reflect on how efforts towards UHC could offer an opportunity to address those aspects within health systems that continue to hinder efforts to meaningfully engage with patients, their families and local communities. The backbone of these efforts should be a health workforce that is skilled in engagement, responsive to local context and to the needs and expectations of those using their services. Community engagement was introduced in the 2013–2016 Ebola virus disease outbreak in recognition of the important role of response staff and their ability to engage with communities, in contrast to social mobilization or behaviour-change interventions. Engagement and empowerment of health service users and community members also re-emerged as a core strategy in the WHO Framework on Integrated People-Centred Health Services, which was formally adopted by Member States in 2016. To move towards a more meaningful understanding of what community engagement is and how it works, the authors suggest that several changes need to take place. First, to recognize that health systems have a fundamental responsibility and obligation for engaging with patients, their families, local communities, as well as a range of stakeholders, partners and sectors, recognising the physiological, emotional, mental and social interconnection of people. Health systems and communities are observed to be in continuous and interdependent action. If community engagement becomes a focus for UHC efforts, it could promote approaches that recognize that health and well-being are co-produced, and that empowers both health-care providers and communities.