Public Policy and Fiscal commitment key to achieving HIV-free generation

HIV-FREE GENERATION

 

The debate about a prospective HIV-free generation given the advent of WHO Option B+ attracts attention on the surface. A further probing of the whole idea, however, may reveal a distant utopia. To have HIV-free generation, our communities must come to a convergence on reducing new infections.

There is need for deliberate public health policy and unwavering fiscal commitment to this end. Unfortunately, our national spending priorities deprive the masses of critical social services needed to attain acceptable levels of health.

HIV/AIDS is a disease left to wreck havoc among the destitute of the world. The wealthy and educated are surviving the scourge longer. Their children are able to avoid contracting the disease when compared to the children from impoverished communities. This explains why the global burden of HIV/AIDS is most prevalent in underdeveloped countries like Uganda.

To think about a prospect of HIV-free generation, we have to see the big picture of the structure of governance, the quality of public policies and the distribution of critical resources necessary to secure prerequisites of health.  These forbearing conditions also do shape how society places value on containing the HIV virus spread and caring for those living with the virus. The recently passed HIV and AIDS Prevention Bill (2008) is an example of required policy instruments, which must be accompanied with equal funding commitment

The Ugandan government has demonstrated inability to meet most of the MDG goals including reduction of HIV infections. Scientists now agree that at its current pace, Uganda may achieve some of the MDGs in critical areas such as reduction of new HIV infection, eliminating mother to child transmission of HIV, providing services to reduce child-maternal mortality by 2035.

Uganda is a signatory to the 2001 Abuja Declaration, which committed governments to allocate at least 15% of its annual budget on health services. Uganda has achieved barely 8% since 2007 while only Tanzania has achieved this objective. The ratio of healthcare workers to patients remains staggering and yet the WHO Option B+ remains the most promising opportunity to the achievement of this goal.

It is impossible to effectively implement this HIV treatment regiment when government's per capita heath expenditure is far below minimum international threshold. An audit report in 2013 found that Uganda was spending only UShs 2, 500 (US $1) a month on healthcare, which means it's annual per capita health expenditure is about US$12. This is ridiculously below the 2001 Commission of Macroecomics and Health recommendation of US $ 34 per capita.

The HIV treatment has three parts to it: the biomedical aspect, which includes treatment; the psychosocial aspect, which entails the social needs of persons living positively with HIV; and health promotion, which entails preventive strategies. Each of these aspects is complimentary to each other and yet requires specialized skills, commitments, resources, and funding.

The HIV-free generation, health promotion in the context of maternal child health and HIV infection prevention are crucial. This is where our healthcare system is failing. The 380 people who contract HIV on the daily basis in Uganda are among some of the poorest and yet they endure insurmountable challenges in accessing health information and in economic production chains.

Opportunities for health promotion would mobilize distinctive and progressive cultural resources to enhance the quality, relevance, and efficacy of health promotion and the management of health to prevent new infections. Without bringing in relevant cultural resources, communities will shun important services such as family planning. Social and societal discrimination remains amplified and more so where resources are scarce.

Lastly and most importantly, is the understanding that to create HIV-free generation, we have to realize a reduction in new HIV infections. The WHO Option B+ is effective; however, certain cultural practices and beliefs are still retrogressive, oppressive, and predatory. These undermine opportunities for girls and women making them vulnerable to HIV infection. These conditions will continue to block progress towards achieving HIV-free generation.

 

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Death at Birth is still a reality in Uganda

Maternal Child Death

Death at birth in Uganda is still a daily reality. In fact being pregnant, seeking qualified healthcare services, including Emergency Obstetrics Care (EMOC) are pathways to death.  The UNFPA reported that only 13% of Ugandans actually live in urban areas, implying that Uganda as a whole is majorly rural. And yet, majority of the functional healthcare facilities to support maternal-child health including safe pregnancy and delivery are concentrated in urban areas.

As a consequence of this disparity, only 42% of pregnant women were delivering in health facilities. The figure has improved recently, showing that 57% of women are being delivered by skilled labor in healthcare facilities (according to 2012 data). Uganda’s maternal mortality ratio is 310 per 1000 of live births; 5000 mothers still die at birth annually (from a 2010 source) which has also improved. UNICEF has recently upgraded data which shows some improvements in maternity services consumption. For instance, 93.3% of pregnant women are now attending to at least 1 antenatal visits; 47.6% are attending at least 3 antenatal visits. The WHO recommends at least 4 antenatal visits.

The maternal child health in Uganda could improve if the needed services are taken to rural communities where majority of the women live. This effort requires a political will to commit to the Abuja declaration that government should commit at least 15% of its national budget to health. Currently, Uganda has not fulfilled that commitment as health budget remains staggeringly low while health services expenditures are increasing (Mbonye and colleagues, 2012).

There is also need to increase the density for Midwives, Nurses and Doctors from the current 1.4/1,000 to at least 23 as recommended by WHO, for Uganda to be able to meet its Millennium Development Goals. At the current rate, Uganda will only be able to meet those goals by 2035 or even later.

In my home district of Pader, there has been one doctor for the population of 231,700. Dr Ochaya recently passed on, which means Pader has no Medical Doctor! Given its relatively new status, Pader District is disadvantaged in that it does not have a robust Missionary hospital like its neighboring districts of Kitgum and Agago.

 In Uganda, 42% of functional hospital facilities are in the private hard-to-reach for the poor, the Missionary hospitals and NGO operated health facilities. Most of the government facilities are on steady decline; understaffed with some unqualified personnel attending to medical emergencies.

There are many untapped opportunities in the Ugandan healthcare system. The Village Health Teams offer untapped potential for reach to households in rural communities. This team should comprise of Comprehensive Health Nurses with facilitation to provide instant services in rural hard to reach localities. Instead of employing one Doctor in a rural district like Pader, we should transform the health care system into Public Health Units such that the Doctor becomes the director of various health services with emphasis on preventive healthcare services.

The way sub-Sahara Africa is portrayed in literature is as if it is entirely a place of doom where the males wish their wives and children death. This is arbitrary to the fact on the ground. Every African man strives to have a healthy family and suffers grief when a child or wife dies. Therefore, it is incumbent for us to articulate accurately, those social determinants of health which affect the health of these people in rural communities and work on them collaboratively. We need to pay attention to poverty, rural livelihood and opportunities for earning income, the use of income, investment in communities through functional education to enhance health literacy, transportation, clean and safe water, sanitation, nutrition and security etc.

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