In the 1980s and 1990s, Uganda had one of the worst healthcare systems in the world, but that story is different today. For example, HIV infection rates reached 30% of the population then and have fallen to 6.5% today. The maternal mortality rate has dropped by 40%, from 561 deaths per 100,000 live births to 343 today. The table below shows how Uganda compares to Africa, the World, and USA on key public health measures, according to World Health Organization data.
Uganda is now outperforming Africa on each metric, although still significantly worse than the global average or the United States. Progress in public health is inevitably slow, with always one more hill to climb—like the topography of Uganda.
1. Maternal mortality ratio per 100,000 live births
2. Neonatal mortality rate per 1000 live births
3. Skilled health professional per 10,000 population
4. Malaria incidence per 1000 at risk population
5. Suicides per 100,000 population
Uganda is now outperforming Africa on each metric, although still significantly worse than the global average or the U.S. Progress in public health is inevitably slow, with always one more hill to climb—like the topography of Uganda. This steady progress reflects the leadership that the government of Uganda has provided in setting ambitious goals and putting programs in place to achieve them. Uganda was ahead of most African countries in providing free universal access to state health facilities beginning in 2001. This resulted in an 80% increase in visits, with over half coming from the poorest 20% of the population, but serious access and delivery problems remain.
The biggest challenge for Uganda is inadequate resources. Uganda has five medical colleges and 29 nursing schools training people in Western medicine. Even so, there remains a shortage in healthcare workers, with only one doctor for every 8,300 Ugandans. With 70% of doctors practicing in urban areas, where only 20% of the population lives, the coverage in rural areas is much worse: one doctor for every 22,000 people. Programs are in place to train community health workers, forming Village Health Teams that operate at the local level, but coverage has been too limited to solve the problems. The Uganda Ministry of Health conducts annual surveys that assess health system performance, and these have shown significant shortcomings in availability and quality of service. Customers complain about poor sanitation, a lack drugs and equipment, long wait times, rude service, and inadequate referrals. This uneven service discourages patients from seeking out professional care, especially in rural areas with longer travel times.
These shortcomings in the current public healthcare delivery system explain why 8,000 rural Ugandans will travel as far as 50 miles to attend a Bulamu weeklong medical camp. They know they will see a doctor, get properly diagnosed, receive treatment if possible, get referred to a hospital if not, and pick up the meds they need before leaving. Bulamu is perceived as a Ugandan organization, with an outstanding reputation for efficient service, quality care, and patient satisfaction. The result is a very cost-effective model: our patients are coming to us.