4 February 2011

Uganda: Local Governments Key to Achievement of the MDGs


The Uganda Local Government Association (ULGA), a body that brings together district chairpersons, district speakers and Chief Administrative Officers, met in Arua Town on January 8 and 9 for their Annual General Meeting (AGM).

This was the 17th AGM but the first in the West Nile region, underlining the return to peace. It is not surprising therefore that the theme of the meeting was "The role of Local Government in promoting peace and service delivery".

This was also a chance to underline the significant role district leaders have in ensuring acceleration in achieving the country's development objectives, including the Millennium Development Goals (MDGs).

While addressing the AGM at Arua Regional Referral Hospital, ULGA president, Mr John Karazarwe, recalled that in 1964, districts had to seek permission from the central government to construct a pit latrine. However, with decentralisation, districts can decide for themselves what needs to be constructed.

It is the district leaders who control the district plans and budgets and they enjoy the confidence and trust of their electorates. With this power, they have the responsibility to plan and budget. It is in this context, that the district leaders have committed themselves to invest more in delivering on the MDGs, especially the targets set for maternal health- reducing by 75 percent, maternal mortality and ensuring universal access to reproductive health by 2015.

With the recent launch of the Millennium Development Goals report for Uganda 2010, which called for joint action, the onus is on district leaders to make sure maternal health is prioritised when allocating resources.In discussing this at the AGM, district leaders realised that maternal health initiatives are being undertaken across districts.

However, unless these are coordinated and address nationally agreed priorities, the net effect at the aggregate level could be blurred. The non-uniformity of prioritising maternal health across the 112 districts was identified as a bottleneck to the effectiveness of scientifically proven interventions.

Uganda's MDG report calls for maternal health to be prioritised across relevant sectors and departments at district level.

In practical terms, this means for example that as the water department conducts its planning, water supply in health units should be counted as priority.

Likewise, the works department should ensure it opens up community and feeder roads, especially to make it easy for mothers to access health units. This is true also for security agencies to make night travel possible and safe for accessing emergency obstetric care in a Health Centre IV or at the nearest district hospital.

Given the decentralisation of decision making in planning and resource allocation for service delivery, district leaders need to follow agreed frameworks, such as the Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and the Uganda Chapter of the African Union Campaign for Accelerating the Reduction of Maternal Mortality Reduction in Africa.These set well the path for Uganda's maternal health improvement. The Uganda Local Government Association has an important oversight role in championing this effort across all districts in Uganda.

District leaders, however, should not stop at prioritising maternal health.Other social services provision should also be on their conscience. For example, they should be concerned that Uganda will soon have a population that is mostly made up of people aged 15-64 years.Given Uganda's population size, this is a massive potential waiting to be harnessed.

In economic terms, this has the potential to contribute positively to transform society in the country's quest to become a modern and prosperous nation. Population experts call this the demographic window of opportunity.

From lessons around the world, this would also mean that as Uganda achieves its goals of universal primary and secondary education, and health for all, families will in turn choose to have fewer children.

This is already happening in the country's urban centres, most notably Kampala. As more girls complete schooling and join the labour force, they are more likely to delay their first pregnancy and space subsequent births so as to remain competitive in their jobs.

For this to happen, women and couples must have a choice on the timing and spacing of births. Unfortunately, about 41 percent of women who would like to delay or stop pregnancies in Uganda, are not able to access modern methods of contraception. And this is expected to increase unless concrete action is taken on maternal health at district level.

District leaders must take upon themselves this responsibility and lead their communities in this initiative.

With a mobilised district leadership and an empowered population at community level, Uganda can accelerate its progress towards achieving the MDGs.

Ms Jackson is the Representative of the United Nations Population Fund in Uganda. Mr Charles Zirarema, the Acting Executive Director, Population Secretariat of the Ministry of Finance, Planning and Economic Development, contributed to this article.

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