In an age where health care has become a vital part of policy discussion and providing one of the defining differences among candidates contesting the 2008 American presidential elections, it is painful to read about (and experience) Uganda's deteriorating health care (The East African, June 4).

This negative report contrasts sharply with Mr Moses Byaruhanga's positive appraisals of improvements in Uganda's health care when he wrote: "On health, Uganda under Museveni has been able to achieve 89% immunisation from 30% in 1986. This coupled with improvement in water provision which is about 60% in rural areas from below 15% 20 years ago." (Daily Monitor, June 4).

Watching a recent debate between the eight candidates vying for nomination by the Democratic Party in next year's US presidential elections, a bone of contention among the leading three- former Senator John Edwards, Senator Hilary Clinton, and Senator Barack Obama - was what would they as president do about America's health care system.

The two issues that seem to dominate this debate are how to bring the 44.8 million Americans who are not covered by health insurance into the system of coverage, and how to lower general costs of health care.

The result of this focused attention on health care has been the production of detailed proposals by these candidates. For Edwards, a major component of his plan would be to legislate mandatory health care coverage for all and fund it to the tune of $120 billion annually. Part of this money would come from raising taxes.

For Clinton, health care would revolve around "lowering costs, reducing premiums, eliminating inefficiencies and preventing disease." In order to achieve this Senator Clinton would implement a seven step plan that would include: "Prevention initiative - reduce preventable diseases such as diabetes; modernising health care records through computerisation; overhauling care for chronically ill; ending insurance discrimination by providing care to people with preexisting conditions; creating a best practices institute with both government and private participants to determine standards of care; legalising prescription drug importation and requiring Medicare to negotiate lower drug prices and implementing common sense changes to the medical malpractice system."

And finally for Obama the focus would be on "health coverage for all and initiatives for lowering costs and expanding insurance coverage." As these candidates develop their plans both differences and similarities emerge and clearly allowing the media and the public to participate in this debate raises the hope that the end product of a cheaper, better and more inclusive health care system will become a reality.

Unfortunately for Uganda, health care is out of reach for most, extremely antiquated and almost irrelevant. It is one thing to say the number of clinics around the country have increased, and quite another to say that those clinics offer quality health care. When the vast majority lack basic diagnostic capability, it is difficult to imagine how improved health care really has become.

When all 27, 632 health facilities are "plagued by some form of corruption and/or mismanagement," and virtually all of them stock expired drugs, it is hard to feel a sense of confidence .

The Uganda National Minimum Health Care Package (UNMHCP) details the aspirations of the Ugandan health community. Unfortunately, even this minimum package has proved difficult to meet. The only real accomplishment has been the programme of Integrated Management of Childhood Diseases that has raised the level of immunisations The health dangers to women remain serious. The list is endless on "the rot in Uganda's health care system" and can only be improved by at least:

A total restructuring of the whole system. Ways to encourage greater local participation in the setting up and running of health centres needs to be investigated, so that they become not just a source of service to those in need, but a source of pride for the local communities.

Some thought should be given to the training and work environment of nurses. They are the backbone of any health care. Hours of work, availability of supplies and number of persons on duty at any given time should be improved. The number of qualified Ugandan medical professionals working abroad needs to be reduced through incentives that would encourage people to return.

Modern diagnostic health facilities need to be invested. These facilities need to be spread more evenly throughout the country. More needs to be done with prevention. Uganda has a long way to go before it can claim progress in providing health care.