Background to the Thematic Pillar: Health
Uganda’s health indicators are generally low for all social categories and worse for women. About 16 women in Uganda die every day from pregnancy and childbirth related complications many of which are preventable. The maternal mortality rate reduced from 527 to 435 per 100,000 live births between 1995 and 2006, but still remains very high. For every one maternal death, about 20 neonatal deaths occur. Only 47% of women attend the recommended 4 times of antenatal care visits to health facilities and only 23% of the women in Uganda get postpartum care during the first two days following child birth. Teenage pregnancy estimated at 25 percent in 2006, is amongst the highest in sub- Saharan Africa and significantly contributes to the overall maternal mortality rate .
The provision of basic health services is affected by corruption in the delivery of drugs the absenteeism of staff and service providers, as well as poor terms and conditions of service, which lead to low motivation amongst medical staff. The smooth and effective implementation of government programmes especially at sub-county level is impeded by inadequate capacity.
These challenges greatly affect women who are care givers and shoulder the burden of care for the sick. Women further bear the brunt of ensuring that water is available for household use which has increased their labour demands especially during the dry seasons. This, impacts on women’s health, increases disease burden and as such render women less productive.
4.2 Key Issues Within the Thematic Pillar: Health
Masculinities and Male Health Seeking Behaviour
Patriarchy plays a great role in the health status of women. Patriarchal social relations, structures and systems are embedded in other oppressive and exploitative structures, which promote men’s access to and control over resources and rewards, within the private and public sphere. Hence, men access more information and make many decisions for themselves and women yet, they have very low health seeking behaviour. Masculinities hinder men from seeking counselling, support and care. This affects and down plays the achievements so far registered in the area of women and health.
In the fight against HIV/AIDS, male health seeking behaviour has become a major point of concern, as men generally do not seek healthcare in good time, have multiple partners and do not seek VCT counselling. This is further exacerbated by the fact that adherence levels amongst men are lower compared to those of women.
Trauma and Mental Health
Due to the normalised and ever increasing rates of actual and perceived violence in the public and private spheres and in post conflict areas, women need special attention. Women experience violence in a different way from men and therefore require special focus from the health sector, with particular attention to trauma and mental health illnesses that impact, on their general well-being.
Women and Girls Living with HIV/AIDS
With support from the USAID/PEPFAR, the Government of Uganda has been able to enrol 76,000 persons living with HIV/AIDS (PLWHA) onto Anti Retroviral Therapy (ART) and to provide laboratory equipment and supplies. This represents an estimated 50% of all persons living with HIV/AIDS in Uganda. In addition, as at 2009, 465,000 individuals received free/voluntary counselling and testing in the Prevention of Mother to Child Transmission (PMTCT) programs. There are also clinical trials for technologies controlled by women such as, microbicides and HIV vaccines.
HIV/AIDS has been mainstreamed in sector plans and the Medium Term Expenditure Framework. The development of a National Priority Action Plan, HIV/AIDS Mainstreaming Policy and a law on HIV/AIDS are underway. Similarly a national policy for addressing HIV/AIDS at the workplace has also been formulated. Government has also set aside funds for procuring ARVs using its own resources, rather than depend on donors. Furthermore the Uganda AIDS Commission (UAC) is in the process of establishing a functional database for HIV/AIDs and a National HIV Policy. The Ministry of Local Government has equally integrated HIV/AIDs in the local government programmes. There are currently 80 Local Government HIV/AIDs Focal Points, appointed to oversee the integration of HIV/AIDs concerns at local government level.
Despite these interventions however, women and girls still bear the burden of HIV/AIDS due to the inherent power relations; their reproductive roles and existing negative cultural practices such as polygamy; early marriage, bride price, wife inheritance and property grabbing which make them even more vulnerable. The mean age of young women’s infection is lower compared to their male colleagues in all age cohorts, due to cross-generational sex and sexual violence. Women are prone to discrimination as they tend to test and often know their status earlier than their partners, due to their reproductive roles that require them to undergo VCT. In light of the global economic crisis; history of abuse and the embezzlement of funds meant to support HIV/AIDS; there are concerns about the sustainability of HIV/AIDS funding as it impacts on the provision of free ART to women.
The Change we Want to See
1. Allocation of sufficient resources for the implementation of Government commitments made under the Abuja Declaration on Health, the AU Commitment on the Campaign on the Accelerated Reduction of Maternal Mortality in Africa and the National Roadmap on Maternal health
2 Increased funding to ensure functional and accessible health services, as well as improved remuneration of medical personnel.
3 Support and operationalisation of the Public Private Partnerships (PPP) in health care service provision.
4 Expeditious adoption of the Uganda Disaster Risk Reduction and Management Policy (2009) and the operationalisation of the Central Coordination Institution/ Centre on Disaster Management, so as to strengthen the country’s preparedness for disasters and epidemics
5 Integration of components of advocacy against Sexual and Gender Based Violence, in HIV Counselling, Care and Support
6 Increased support and funding to HIV research and interventions aimed at technologies controlled by women, such as Microbicides studies and HIV Vaccines
7 Renewed commitment to providing HIV Treatment, Care, Support to address the challenge of HIV/AIDs country wide