We need to work towards attaining health equity

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Rudi Veestraeten

In Uganda, we are joining the rest of the world in celebrating World Health Day on 7 April. We jointly want to formulate a few thoughts on this occasion, on behalf of all Heads of Mission of the European Union resident in Kampala.

First of all, we want today to acknowledge the long path Uganda has travelled in achieving better health for its population.

Over the last decades, life expectancy has increased, infant and under-five mortality rates have decreased, and fewer women are dying during childbirth.

Those are remarkable achievements, and as partners of Uganda in the health sector, we take particular pride in them and we share that pride with all the doctors, nurses and health workers in the country.

At the same time, much remains to be done. In many fields there is ample room for improvement.

Let’s take a fictive but realistic example of Lorna, a 15-year-old girl, oldest of six siblings, living in the outskirts of Moroto town. Her mother recently passed away while giving birth to her youngest brother, a baby boy.

As the oldest girl she drops out of school and runs the household. Her dad is a casual labourer who does not earn enough income to sustain the family.

On one of her firewood quests, Lorna meets an older boy. This is not long before she becomes pregnant. Lorna feels very confused as she is still too young to be a mother and already has 5 siblings to take care of. In addition, she discovers the boy she met has HIV.

The fictive example of Lorna illustrates many of the health challenges young girls face. One in four teenage girls is already a mother or pregnant.

Most of these pregnancies are unwanted and sometimes end in an unsafe abortion. Mothers too often die during childbirth. Maternal mortality rates, although reducing, are still very high and far from the sustainable development goal target.

Another challenge is the alarming number of new HIV infections among young people. The corona pandemic has worsened the situation since schools closed, mobility reduced and more expensive, and income diminished for many.

The theme of this year’s World Health Day is health equity. This theme is about fair distribution of health services among all members of society.

In Uganda, huge disparities exist across regions, ages, gender and education levels. Lorna might have had a different experience if she hadn’t dropped out of school and was educated about sexuality and how to avoid pregnancies. Inequity in health is also a direct result of huge differences in the quality of services.

The latest Report of the Auditor General (February 2021) for instance finds a lack of medical equipment for maternal health in health facilities across the country.

Health is not an isolated issue. Health is linked to the context: economic and social conditions, such as income- and education levels; housing conditions; cultural beliefs and traditional values and norms.

Good health care needs to be accessible to all, regardless of these conditions. All citizens need to have the same access to information and to quality services.

People should be empowered to make their own, individual informed decisions regarding their sexual health. People should be empowered to act on their own decisions.

Reality shows we are still quite far from such empowerment. Makerere School of Public Health found that access to information on family planning is low among the poor, the disabled and those who are least educated and the youngest (between 15-17 years).

Young citizens have less access to family planning care. There are significant differences between the rural and the urban populations.

If we want to change this situation, working with young citizens is paramount. Adolescents between 15 and 17 years old are at a disadvantage for quality service and for information.

This leads directly to high rates of teenage pregnancies. Half the population in Uganda is below 16 years old. Changing the situation, improving health services demands that we give priority to the young citizens.

Sexuality education, both in the schools and outside are not an option, but a necessity. Girls and boys need more information and better services. In Uganda, young men need to be taken on board. Young men need to support change.

The Government of Uganda and the Ministry of Health are well aware of the need for change. The Government has drafted a new Adolescent Health Policy.

We hope to see this policy approved and put into practice any time now. This is an urgent matter, in particular for the more vulnerable part of the population.

Finally, let us talk about health financing. Uganda’s health sector remains significantly under-funded, and this is at the cost of the poorest. Health care in Uganda mainly relies on out-of-pocket spending by patients.

For a poor family, even a small contribution is a big deal. Poor households spend proportionally more of their total income on health. Getting sick pushes poor families deeper into poverty.

More public investment in the health sector is urgently needed. The adoption of a national and inclusive health insurance that provides financial protection to citizens will significantly improve health equity.

The Makerere School of Public Health, Belgium and the other EU member states remain strongly committed to the advancement of health care in Uganda.

To ensure this progress is geared in the right direction for all people regardless of age, sex, education level, economic background or any other difference, we need to look at the progress through an equity lens.

It is important to leave no-one behind while continuing the journey to better health for all. Wishing you all a happy and especially healthy World Health Day 2021.

The author is the ambassador of Belgium to Uganda. It was co-authored by Prof Rhoda Wanyenze, the dean, Makerere School of Public Health



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