A child born in Uganda in 2000 would have expected to live up to the age of 48.9. One born today, on the other hand, can expect to live for 66 years, and rising. This is one of the success stories in Uganda’s health sector, and the country’s life expectancy has risen above the sub-Saharan African average to near global levels.
There are many underlying reasons, including mass immunisation that has rolled back many preventable diseases, antiretroviral therapies that have reduced mortality from HIV/Aids, the end of major armed conflicts, and a young population that is yet to face the inevitable turbulence of mid- and late-life ailments.
The expansion of primary health care has seen reductions in maternal and neonatal mortality rates, while expansion in private health care has driven investments in complex medical treatments and procedures.
A close look under the microscope, however, shows the many pathogens and problems that, left unattended, will undermine Uganda’s social and economic transformation, as well as the ability of many Ugandans to live long, healthy and productive lives.
First, for all the progress made over the past decades, the two leading causes of death in Uganda are treatable (malaria) and preventable (HIV/Aids).
In the case of malaria, the incidence rate has been worsening since 2021, according to the World Health Organisation. This speaks to a failure in case management and primary health care, especially at the grassroots.
Similarly, the third-leading cause of death — lower respiratory infections like pneumonia, among others — suggests a lack of awareness of hidden dangers such as air pollution, and a lack of public health messaging to address them.
Growing tobacco consumption among young people through vaping, smoking water pipes, and just second-hand cigarette smoke without any meaningful public health education and behavioural change campaigns will only make this worse.
The second, and related, problem is the growing risk of lifestyle or non-communicable diseases like diabetes, hypertensive disease, among others, which kill about four out of every 10 Ugandans. To this add injuries, including those from road traffic accidents, which claim about 10 percent of fatalities every year.
Some of the fixes in this category are obvious and straightforward. Just forcing boda boda riders and their passengers to wear helmets would reduce the fatality rate from these two-wheeled widow-makers. Enforcing driver learning and regular vehicle inspections would reduce overall road traffic accidents.
Others, however, are harder to see and, therefore, harder to formulate policies around. For instance, the urban low-income-earner diet has changed from organic local food to the refined high-calorie sugars of wheat and antibiotic-flavoured industrial eggs.
The disappearance of public spaces and sports facilities, combined with a growing culture of vertical living in apartment blocks, has taken away free or low-cost exercise options. This pressure on physical space will only increase as the population doubles over the next 25 years.
Crowded into ever denser conurbations, and without common spaces for physical exercise or mental decompression, obesity and its related diseases, combined with mental health disease, are likely to rise. As the population pyramid begins to bulge in the middle, non-communicable diseases could become the leading causes of death.
Public health policy makers, therefore, need to plan for malaria vaccines, as well as running tracks and public parks! This will require new thinking and smarter investments, including in making health care more affordable.
Spending on health as a percentage of GDP, currently at under five percent, will have to triple to meet the pledge in the Abuja Declaration.
The absolute increases, however, will have to rise in tandem with more intelligent decision-making such as buying more ambulances than luxury SUVs, and allocating more money to maintenance and staffing.
One obvious low-hanging fruit is the national health insurance scheme, which has been decades in the planning. It would expand coverage and reduce the cost of healthcare for the most vulnerable, providing a guardrail against that very real nightmare of losing it all with one major medical emergency.
Yet even small illnesses carry large costs. In a new paper, Dablin Mpuuga of the Economic Policy Research Centre and colleagues found that 28.7 percent of households spent more than 40 percent of their non-food expenditure on out-of-pocket healthcare costs during the Covid-19 pandemic.
Another 33 percent spent more than 25 percent — money that could have been spent on investment or other forms of consumption.
Fixing the health sector requires a combination of greater investment in prevention and treatment, focusing on outcomes to ensure value-for-money, and derisking inevitable health challenges through a national health insurance scheme.
Ugandans are living longer; we shouldn’t let the cost of healthcare make some wish they could die earlier.