Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
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New Vision (Kampala) - December 3, 2001
Barbara Bitangaro
In 1992, HIV infection prevalence rates in Nsambya sentinel site declined from 24.5% in 1989 to 16.8% in 1995, 15.4% in 1996, 14.6% in 1997, 13.4% in 1998. But between 1999 and 2000 the rates fell from 12.3% to 11.8%: A difference of only 0.5%.
At Jinja sentinel site rates fell from 24.9%in 1989 to 13.2% in 1995. But between 1999 and 2000 the rates fell from 10.8% to 8.3% respectively: A small difference of 2.5% over the last two years.
In Mbarara there was a fall from 21.8% in 1989 to 16.6% in 1995 and between 1999 and 2000, HIV infection rates fell from 11.3% to 10.0%.
"This means there are issues outside the government sector which have to be corrected like poverty," Dr Samuel Okware the Commissioner of Health Services, (Community Health), Ministry of Health, said in a recent interview in Kampala.
"As long as 44% of people in Uganda are below the poverty line, we will still have prostitutes, he said, adding that access to health care was at present 49% and therefore a contributing factor to the slow declining rates. "If every person could have a facility within 5 kilometres or one hour walking distance, this could drastically bring down the rates," he said. The World Bank World Development Indicators 2000, states that in 1993, 55% of Ugandans were below the poverty line at national level.
Okware explained that an ideal health centre would provide basic health services like immunisation, management of simple diseases, provision of obstetric emergency care, provision of sanitation, education on various diseases and problems. "Even if we worked 100%, with low access to health care we will still miss half the population," said Okware.
Turning to health expenditure, the doctor revealed that 83% of the population buy their own drugs and only 17% have access to drugs in government hospitals. Ministry of Health has only been using 10% of the national budget, which is less than 50% of what is needed to provide the minimum health care package for Uganda.
To implement the minimum health care package, the average amount needed for the African region is 12million dollars per capita per year.
The cost of health care is 1.2 dollars per person per year and yet the average cost of an HIV patient is 50 dollars per year, said Okware.
Other reasons why there has not been sharp decline in rates over the last two years include lack of knowledge, which had not yet become universal, a senior epidemiologist in the Ministry revealed.
"And even if knowledge was universal, there needs to be enabling factors like access to health services with a focus on condom availability, drugs treatment and voluntary counselling and testing," the epidemiologist said.
"The issue of culture and ignorance has to be tackled. Wife inheritance especially in the east where they marry off young men to widows, has to be discussed," Okware said.
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