Understanding Uganda’s MDG Progress

2015 may be just another calendar year, or maybe not, as it marks the final year for the implementation of Millennium Development Goals (MDGs) 2015. The implementation years for the MDGs were 1990 to 2015. It is also a year away from 2016 – when Uganda holds its next general elections. I would like to evaluate Uganda’s MDG achievements in promoting health as a major tenet of the MDGs, of which goals number 4, 5 and 6 are directly health related.

Team of Global Health Corps Fellows (L-R: James, Sam, Rebecca C, Orrin, Kimberley and Rebecca R) who participated in advocating for health on Kaaza Island, Lake Victoria one of the least served areas in the country. Photo Credit: Chris Brooks

Goal 4: Reduce child mortality
Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

This goal shows a lot of mixed progress. According to UNDP, there have been some positive results, though much more needs to be done. Between 1995 and 2009, the Infant Mortality Rate (IMR) under 5 fell from 156 to 137/1000 live births. This coincides with a World Bank report, which notes that up to 95% of Ugandan women now receive antenatal care from a skilled provider at least once, and 57% deliver babies under the supervision of a skilled health provider. Furthermore, 33% of mothers received a postnatal check-up within two days of birth. On the other hand, according to the World Health Organization (WHO), Uganda is among 24 countries responsible for more than 80% of deaths of children under five years last year. The country has a maternal mortality ratio of 310 deaths per 100,000 live births and an under-five mortality rate of 56 deaths per 1,000 live births.

According to Dr. Anthony Mbonye,

Uganda can clearly not meet MDGs four and five—to reduce by three quarters the maternal mortality rate and to reduce by two thirds the child mortality rate between 1990 and 2015 target of 131 per 100,000. It is yet to meet the 15% budget allocation required by the Abuja Declaration to which Uganda is signatory”.

This goal requires an average reduction in rate of under-five deaths by 5% per year. To that end, between 2006 and 2011, rates dropped from 137 to 90 deaths per 1,000 live births; representing a reduction of 8.1%; by 2012. The major causes of under-five mortality were malaria (28%), pneumonia (15%), anemia (10%) and other respiratory infections (9%).

Goal 5: Improve maternal health

Target 5.A: Reduce maternal mortality ratio by three quarters – between 1990 and 2015.

Between 1995 and 2001, Uganda experienced stagnation in maternal mortality at 506/1000 births. However by 2006, according to UDHS the rate had declined to 435/1000 births. Between 1995 contraceptive prevalence rate increased from 15% to 24%, and up to 30% by 2011. Adolescent birth rate dropped from 198 to 159/1000 women between ages 15-19. Unmet family planning needs plummeted from 41% to 29%. Unfortunately, only 9% more births were attended to by skilled health workers in years after 1995 thus a shift from 35% to 44%. This mostly affected the ever increasing poor population  among which only 29% in 2006 delivered attended to by a health worker, compared to the wealthy where 77% received professional birth attention. Between 2006 and 2011, births assisted by trained health workers increased from 42% to 58%. In 2011, 33% of women in rural areas were receiving post-natal care already. This status has however stagnated.

Proper attention by health workers towards expectant mothers is one means of improving maternal health: Photo Credit: Charles Akena

Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6.B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

As noted by several reviewers, Uganda made tremendous progress on HIV in the 1990s. However in the 2000s, the number of HIV positive expectant mothers attending antenatal care dropped from 18% to 6%. By 2012, the rate of condom usage had increased to an average of 72% from 49% in 2001. Level of HIV literacy increased to 42% in 2006 as opposed to 39% in 2001. By 2008, 44% of advanced HIV cases had access to medication, and 2009 saw an increase to 54%. There was a slump to 50% in 2010, but 2012 access increased to 62% against a 2015 target of 80% access.

However, HIV indicators showed vulnerability among girls aged 15-24 averaged 6.3% and 2.4% for boys of same age group. The total number of people living with HIV in 2010 was around 1.2 million, higher than at the epidemic’s height in the 1990s. With about 200,000 new infections yearly, HIV provokes not only concern but shows complacency over recent past years. In 2014, I wrote an opinion piece trying to understand the upturn in new HIV infections in Uganda.

The year 2008 saw over 110,000 malaria cases reported, representative of 37/1000 of the population. This was much higher than figures in 1990, which hovered around 15,000 – 30,000 per year. Recent years saw an increased distribution of Insecticide Treated Nets from an 8% usage in 2000 to 33% in 2009. One major concern is that less than 30% of children who needed malarial treatment in 2005 were able to receive the appropriate medicine.

Tuberculosis, another disease of concern in Uganda, was reduced from 652/100,000 to 350/100,000 persons between 2003 and 2008. This was because between 1998 to 2014 we saw a marked decrease in the number of HIV patients suffering from TB with 69% case detection rate and a 71% recovery rate in 2011.

In summary;
4. A: Reduction of under-five mortality rate by  two-thirds is on track
5. A: Reducing the maternal mortality rate by three quarters has stagnated
5. B: Universal access to reproductive health is progressing too slowly to be achieved
6. A: Halting and beginning to reverse the spread of HIV has suffered setbacks
6. B: Achieving universal access to treatment for HIV for all who need it is on track
6. C: Halting and beginning to reverse the incidence of malaria and other major diseases is on track

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