New Vision (Kampala)

2 January 2013

Uganda: The Bittersweet Memories of 2012

Photo: Aphaluck Bhatiasevi/WHO
The health sector played a key role despite numerous challenges in the year 2012.

The health sector continued to play a major role this year, albeit with numerous challenges. The challenges include:

Nodding disease:

The alarm bells sounded early in the year with an outbreak of a strange disease that hit northern Uganda. Nodding disease, as it came to be known, greatly affected children. It is characterised by constant nodding of the head, body weakening and gradual loss of cognitive abilities.

This outbreak was one of the biggest challenges to the health sector this year, as little was known about the cause of this disease. It took a while before the health ministry came up with workable interventions to control the disease.

By the end of January, the disease had killed 200 children in northern Uganda.

In February, Dr. Scott Dowell, US-based health expert arrived in Uganda to help find clues to the cause of the nodding disease. The Government also contributed sh2.7b for treatment of the disease. Recently, the health ministry carried out aerial spraying in the affected districts to kill black flies, which are believed to transmit the disease.

Ebola and marburg outbreaks:

While we thought that the ebola ghosts had long been exorcised, the viral disease returned to haunt the country this year, claiming several lives. The latest ebola outbreak appeared in western Uganda. By November, over 20 people were reported to have died from the disease.

As strategies were being devised to eradicate ebola, marburg disease emerged in Kabale district and quickly spread to Rukungiri, Mbarara and Ibanda districts in Western Uganda, claiming seven lives. Towards the end of the year, another ebola scare was reported in Luwero district.

It was also this year that the Ngora siamese twins who had been admitted in Mulago in October 2011 died after developing flu and cough. According to reports, the twins, Apio and Adong, succumbed to pneumonia a few months after their admission to Mulago Hospital from Kumi Hospital.

According to the Ministry of Health, the marburg epidemic was brought under control by November. This was evidenced by the fact that no new cases of marburg fever have been reported in the country in the last couple of months.

Shortage of TB drugs:

It also emerged in March that hospitals had run out of drugs to treat Tuberculosis.

According to Prima Kazoora, a monitoring and evaluation officer with Coalition for Health Promotion and Social Development (HEPS Uganda), the shortage has been on since December 2011. This shortage sent alarm bells and raised concern about the ability of the Government to provide lifesaving drugs to its citizens.

According to the Ministry of Health, there are 500,000 people in the country affected with the chronic disease.

HIV infections rise:

As we grappled with the worrying news about TB, the Ministry of Health announced that the HIV incidence in the country had risen to 6.7%.

This meant that approximately two million people out of the 33 million total population in Uganda are infected with HIV. The revelations further reveal that 7% of women and 5.6% of men are HIV-positive.

Considering that the number of HIV-positive people nearly 10 years ago was just 1.1 million, this trend is worrying. The only silver lining of this grim news perhaps was that people were abandoning multiple partners and that HIV was low among circumcised men.

The month of July also came with the disturbing news that HIV infections in Uganda had shot up from 6.4% in 2005 to 7.3%, according to a Ministry of Health report.

Talking about the findings, Christine Ondoa, the health minister, said HIV prevalence is highest among widowed women at 32.4% and men at 31.4%.

HIV infections were lowest among people who have never been married, standing at 3.9% in women and 2.0% in men. This news sent shock waves, seeing as Uganda had previously been doing well in managing HIV. These rising figures are attributed to multiple sexual partnerships and failure for couples to use condoms.

Health officials dropped:

The health ministry came under fire this year when six top officials were dropped under unclear circumstances.

These included Dr. Francis Adatu, the programme's manager of the National Tuberculosis and Leprosy Programme; Dr. Zainab Akol, the head of the AIDS Control Programme; Dr. James Sekajugo, the programme manager of non-communicable diseases and Dr. Sarafin Idibaku, the in-charge of the Malaria Control Programme.

Others are Dr. Rachael Senyange of Uganda National Expanded Programme on Immunisation and Dr. Robert Basaza, a senior planner. This came at a time of massive drug shortages and various inconsistencies in the health sector. There was worry when later in March, measles struck 18 districts and more worry when 30 diabetes patients were amputated at Soroti Hospital.

Delay in workers' salary:

It was bad news however, when in April, health minister announced delay in health workers' salaries. Appearing before the social service committee in Parliament, Minister Christine Ondoa said health workers might have to wait to have their salaries increased because the Ministry of Finance had not provided the money needed.

This did not go down well with the many health providers in this country who work under very constrained conditions and whose pay has been wanting for a very long time.

Shortly after the bad news, four people were appointed as temporary replacements for some of the officers in the health ministry. Dr. Joshua Musinguzi, Dr. Jascinta Musinguzi, Dr. Albert Okwir and Dr. Gerald Mutungi replaced Zainab Akol, Dr. Rachel Seruyange, Dr. Sarafin Adibaku and Dr. James Sekajugo .

Achievements

It has been a difficult year for the health sector, marred by dangerous, albeit familiar epidemics that claimed lives, resurgence of HIV and poor healthcare facilities. But it also came with its successes. These include;

Innovations:

Makerere University College of Health Science in collaboration with the University of San Francisco (New

York) came up with a Tuberculosis-testing machine. The machine called GeneXpert will be able to detect about 70% of cases missed by microscopes.

Maternal health:

Towards the end of March, the International Parliamentary Union meeting began, in which members of Parliament from different parts of the world discussed maternal health.

Health experts expressed concern at the high numbers of women dying in pregnancy and childbirth, or as a result. They called for change in strategy to tackle the issue from all fronts including Parliament and at societal level. They resolved to reaffirm national and regional commitments to Millennium Development Goal Five, reducing maternal mortality and ensuring universal access to reproductive health services.

They called on policy-makers, government and international bodies to show political will and dedicate resources required to achieve the goals set and deliver on the promises made. They also promised to involve parliaments in the maternal health fight seeing as there has been little, or no involvement of legislative arms of government.

Despite the gross misuse of the Global Fund money, Uganda received sh650b from the body, perhaps indicating that all is not lost in supporting the fight against HIV, malaria and Tuberculosis.

Mulago gets 10 dialysis machines:

The month of April started well with a donation of 10 dialysis machines to Mulago Hospital. The donation came from the Japanese government to help in the treatment of patients with kidney problems. Mulago has gone many years without a dialysis machine; any attempts to avert this situation therefore came with much relief.

Uganda makes cheaper ARVs:

In a major breakthrough early this year, it was announced that Quality Chemicals, a Ugandan-based pharmaceutical company, would start producing a new anti-retroviral (ARV) drug called tenofovir. The drug would to cost about sh44,000, far less than nearly sh1.4m that it would cost in Europe. Seeing that there have been drug shortages and sometimes fake drugs, this discovery would go a long way in providing affordable ARVs to many people who would otherwise not afford them. Government health units will receive tenofovir next year.

HIV prevention:

Circumcision was a hot issue this year. In April, the acting programme manager of the STD/AIDS Control Project, Dr. Joshua Musinguzi, said the Government was planning to circumcise 4.2 million men aged between 15 and 49 by 2015 to reduce new HIV infections.

This issue has been one of the most debated health topics this year. Throughout the year, men and boys have been encouraged to go for circumcision.

The programme was touted by doctors as critical in controlling HIV. Safe male circumcision, according to research findings, reduces the risk of HIV infection by 60% and does not lead to increased risk-taking behaviour. It is an integral part of "combination prevention".

Ondoa confirmed this to the press. This, however, sparked a controversy, with some people saying that circumcision is not a silver bullet and that while it might help, the public should not be complacent.

This controversy has raged throughout the year until December 2, when officiating at the annual World AIDS Day celebrations at Kasensero village in Kyeebe sub-county, Rakai district, President Yoweri Museveni added his voice: Circumcision does not eradicate HIV, so people should not be fooled into engaging in reckless behaviour.

Prevention of mother-to-child transmission of HIV:

The coordinator of the elimination of mother-to-child transmission programme at the Health Ministry, Dr. Godfrey Esiru, announced in May that the transmission rate of HIV/AIDS from mothers to babies reduced from 30% to 6.3% in Uganda. For a country where PMTCT strategies were introduced, only a few years ago, this revelation was an important health milestone.

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