SERVICE TO MY COUNTRY

SERVICE TO MY COUNTRY Back in the day, I was embedded with the then most feared Uganda People’s Defence Force (UPDF) fighting unit –the battle hardened , crack mobile, 3rd battalion, commanded by the late (RIP) Major Sula Ssemakula “Suicide” . I covered the Allied Democratic Forces (ADF) rebellion in western Uganda for four years (1996-2000) and there were battles fought in kyaka , Fort Portal ,Bunyangabu, Buryaha, in the then vast Kabarole district;to Kamwenge to Mbarara to Kanungu and then the mountainous areas of Kasese and Bundibugyo; to Hoima , Masindi, Mubende and Kibale. We ended up in Eastern DRC Congo where we encountered the bloody battles of Kisangani mojja and Kisangani mbirri. The rebels attacked katojo prisons in Fort Portal ,killed and released prisoners, attacked and killed close to 100 students at Kichwamba Technical Institute in Kabarole, cut off Bundibugyo , Bwera and Mponde border areas . They maimed , rapped ,defiled women and girls and killed hundreds of innocent civilians- raiding villages and displacing hundreds of thousands of people. But they (rebels)were still defeated. The war on the Ugandan side ended around 2000 and I headed back to my employer- The New Vision’s headquarters in the Capital Kampala and was appointed Editor in charge of rural news. I later went on to serve in the same capacity at the Daily Monitor . I also edited the Saturday and Sunday Monitor (2004-2010) after the ‘big walk out at NV’ in May 2004 (which changed the media landscape in Uganda forever) led by Conrad Nkutu and JB Wasswa, who became the Managing Director and Managing Editor at the Monitor (that equally important institution for free , independent private media), respectively. We were the first ‘outsiders’ to serve at Daily Monitor after the founders ,Wafula Ogutu, David Balikowa, Kevin Aliro, Richard Tebere,Charles Onyango Obbo and Jimmy Serugo were bought out by the Nation group,(that is another rich long story to be told another day.) I would like to recognize the following Afandes among others , ( named not necessarily in order of seniority ) who participated in the fight to end the ADF rebellion and allowed me the freedom to tell the story the way I saw it at the battle field. Afande Yoweri Kaguta Museveni, Afande Maj.Sula Ssemakula Suicide (RIP), I directly worked under his command, Afande Jet Mwebaze (RIP) was the first senior UPDF commander to take me to the war frontline, Afande Katumba Wamala, afande Salim Saleh, Afande Charles Angina, afande James Kazini (RIP), Afande Nobel Mayombo (RIP), Afande Kahinda Otafiire, afande Nathan Mugisha, afande Muhanga, Afande David Kaboyo, afande Richard Edyegu (he suffered severe injuries and his leg was amputated after he was hit by a landmine at the Kasese officers mess), afande Stephen Masiga (RIP), Afande Charles Owor ( oba where he?), afande Walter Ochola (RIP), afande Balikudembe Kileju (headed the then PPU now in private practice), afande Abbas Byakagaba (now commanding the Oil Police protection unit he was then regional police special branch commander western Uganda ), afande shaban Bantaliza, afande Abbey Kisubi, afende Andew Muzira, afande Maj. Kibowa, afande , maj.Kawesi, afande Muhesi, afande Tumukunde. I also salute comrades in the journalism profession who joined me to carry the story forward but first to my editors at the time, again NOT in order of seniority : William Pike, Sam Serwanga, Hellen Mukiibi, Ben Ochan, JB Wasswa, John Kakande, Ikebesi Ocole Omoding ,Barbra Kaija, Paul Nsereko (RIP), Robinnah Basalirwa, Adyeri Kanyeihe, Ben Opolt, Wange M,Joacim Buwembo, Ben Bella , Epaja Ejelu, Rosemary Kemigisha and Rev Sam Adido . And the war reporters and editors ; Grace Matsiko NV, Emmy Aliro NV , DM ‘s Kevin Aliro, (RIP) ,Richard Tebere (RIP) of the Maama and Baba Pajero fame, Photo journalists, Arthur Kintu ( you remember when the mambas were first deployed to Bundibugyo and we took and survived an RPG enemy fire), Cranmer Mugerwa (RIP), James Akena ,Peter Busomoke, Jimmy Adriko, Linda Nabusayi (you remember moving in the ‘bufallo’ in the chilly Bundibugyo mountains), John B Nzijah, John Twaite, Michael Karugaba (RIP), Kagyenda Apuuli ,BBC’s Anna Bozello, and Hassan Ali of the then BBC swahilli service (RIP). Just like Afandes, Masiga, Edyegu and many others, I too, carry scars from injuries I suffered on my left hand while on duty. We were ambushed by the rebels at a place called Sempaya just before the hot springs in Bundibugyo a few weeks into the war. We lost a couple of gallant fighters and a number were injured . But all the same, I wish every youth in this country can have the rare privilege to serve in our armed forces and show positive results for their service. That will be Patriotism at its Best. In the days to come ,I will share some of the pictures and stories which were published from the war frontline in The New Vision ,nearly 20 years ago. I also want to be inspired by comrades, Joachim Buwembo (Punishing the Messenger), Charles Onyango Obbo (Economic Gangsters: Corruption, Violence, And The Poverty,) Julius Mucunguzi ( the Story of Keeping Hope Alive) and write a book about my four years experience as a war reporter or better still, serving my country as a journalist for the last 20 years. MOSES PAUL SSERWANGA Esq. MEDIA, DEVELOPMENT COMMUNICATION CONSULTANT , TRAINER AND ADVOCATE OF THE HIGH COURT OF UGANDA msserwanga@gmail.com

THE VALUE OF NEWSPAPERS

THE VALUE OF NEWSPAPERS Some good insights about journalism and press media from my Former boss who encouarged me and gave me all the support i needed in my formative career years as a journalist. He sent me to the war frontline too- Mr. William Pike; Mr William Pike, CEO of The Star Publications in Nairobi, gave the keynote address at the inaugural Uganda National Journalism Awards. He focused on the value of newspapers in setting the agenda, defining society and recording history, and the importance of upholding the basic tenets of good journalism. “As most of you know, I run the Star newspaper in Kenya which we started in 2007 with some Kenya shareholders. However I am also the managing director of Capital Radio in Uganda which Patrick Quarcoo and I started with local shareholders in 1993. In 2000, Patrick moved to Nairobi to start Kiss FM and start our Kenyan operations. So we have done both print and electronic media, but today I will focus primarily on print because that is where, I believe, media faces its greatest challenge. I started in journalism in 1978 working on small magazines. In those days pages were made up using phototypesetting, and then plates were produced using films from ‘process cameras’. Only the printing press today is recognisable. Now we design pages on screen and output them straight to plate. The staff from Uganda Times, who I found when I came to the New Vision in 1986, harked back to an even older era – the use of hot metal to create the typefaces and blocks for the press. The New Vision even had a redundant hot metal typesetter that we sold for scrap a few years later. We have lived through a technological revolution in the last 25 years. And that revolution is not over yet. Why are newspapers important? They help us work towards the truth. There is a protocol that we follow of reporters collecting news and then being cross-checked by sub-editors and editors. That protocol is not followed on the Internet which is now the main alternative source for news, where any blogger or writer can present his or her version of events that may be true or false. We do not know. Look at the stories around the disappearance of the Malaysian Airlines plane. Probably it is under the Indian Ocean, but there are also sorts of conspiracies theories online, that the plane was hijacked by the USA and flown to Diego Garcia, etc. Those Internet stories are just opinion. The same applies to citizen journalism. Stories submitted by citizens can be a great contribution, but they only become truly valuable when they have been examined and checked by editors to confirm them, or contextualise them by attributing the source. But if a story is in the Monitor or New Vision, we assume that it is true, or likely to be true, because it is has been validated by a process, by the editors. That is important because political and social debate will be based on agreed facts that eventually some consensus will be reached. It is also important because it provides a historical record, a factual record to which future analysts can refer. For instance, recently Henry Gombya has published in his internet site, The London Evening Post, so-called confirmation that Salim Saleh ordered the killing of Andrew Kayiira in 1987. He quoted an unnamed NRA officer as his source. But in reality this is a one man story. The story has not been interrogated by anybody. How true is it? If you go back to file copies of the newspapers of the day, you will discover many mysteries that are not mentioned by Gombya. In particular, Gombya, by his own admission, had large bundles of money on his bed at the time. And he managed to escape over the gate after the attackers came to the house and killed Kayiira. At the time, the general view was that dissident members of Kayiira’s UFM were responsible. What someone now needs to do is to go back to those newspapers from 1987 and look at what were the agreed facts at the time, and to look at where they confirm or contradict Gombya’s new version of events. I believe that objective analysis of all the information will show that there is a large element of wishful thinking in Gombya’s account. Another area where it would pay to investigate past copies of newspapers is the war in the north. There are versions where academics or politicians claim this or that happened, or provoked following events. But there is an amazing amount of detail in the papers of the time, from reporters who were on the ground, including the New Vision’s late great Caroline Lamwaka, and who were close to what happened. I get annoyed reading academic treatises where there are assumptions about what happened in the past, where the writer has clearly not gone back to the newspaper archives. Someone should do that for the war in the north. Newspapers set the news agenda. Electronic media and the Internet how have greater reach but newspapers drive the news agenda (for stories other than straight news stories). It is the deep stories in print - investigations, exposes, analyses - that very often are followed up in the TV or radio news, or in discussions by bloggers. I personally don’t think newspapers will disappear completely. They provide a format where information is easily accessible. They provide in-depth news and analysis. Longer articles can be read more easily on paper than online, according to research at Columbia University. Anne Nelson tested her students and found they remembered and absorbed more from reading the same article on paper than online. Internet stories also tend to be very brief. The mindset of the Internet is brief. For in-depth stories, we will still need newspapers. But in a world of immediate, short, digital information, newspapers will become a miniroty product, read mainly by the intelligentsia, opinion leaders who are willing to pay for a more in-depth news product. That’s why the Star’s slogan is Smart People Read the Star – we are trying to position ourselves to be that thinking person’s paper in ten years time. The digital age We are now in the digital age. The highest Average Daily Sale of the New Vision was just under 40,000 for the 1996 election. Now I think it is around 30,000. We are in the electronic age and the newspaper is not the first place to turn to get your news. A huge problem with newspapers is the cost of physical distribution. The Star is a small newspaper in Kenya but it still costs us USh 180 million per month to transport it around the country. The world still needs verified, factual news stories. But that checking process costs money. The Star has a readership of its daily print newspaper of about 300,000 people, but it has over 1 million unique visitors online. Our advertising income in the print paper is around Ush1.2 billion per month, our advertising revenue on the Internet site is around Sh10 million per month. This is unworkable. The print paper is paying for the huge free readership of the Internet. At some point Internet readers must start paying for content. This conundrum is destroying newspapers around the world, although in Africa we are probably 10 years behind the digital wave and we have time to find the solution. Probably that solution is some kind of micro-charging for each story that is read. Conclusion Get a strong online news site Keep your print product going, and keep it full of quality content that readers will be prepared to pay for. We are living in a super-fast age. Keep your stories concise and full of information. People don’t have time to waste. Above all, KEEP THE FAITH. Keep producing detailed factual stories that have been cross-checked and balanced with both sides. Remember you are creating history. You are defining society. Unless journalists perform this vital task, society will lose its self-awareness, its consciousness, its sense of direction.”

MAYUGE FARMERS NOW PRODUCING FOR THE MARKET

MAYUGE FARMERS NOW PRODUCING FOR THE MARKET By Moses Sserwanga It’s been a long journey for the farmers of the remote district of Mayuge . They have had to withstand big challenges that included among others poor seed varieties, gender based violence due to mistrust among family members, poor farming methods, effects of climate challenge and the cheating middlemen who pay farmers low prices for their farm produce. Now organized in a growing farmers’ association, the Mayuge farmers who were hitherto, largely producing for the homesteads are now engaging in large scale farming and realizing positive results of their hard earned labour. They have since formed the Mayuge District Farmers Association, (MDFA) which has grown from a membership of 500 in 2000 to 20,000 to-date. Mr. Paul Ojikan the Coordinator of the Mayuga District Farmers Association who is also the Chairman of the National Soya bean Network the Association says that that the registered members work in 666 groups with 30 members each in eight sub-counties of Malongo, Kityerera, Imanyiro, Bukaboli, Buwaya, Busakira ,Kigandalo, and Mpungwe. Originally formed to provide agricultural advisory services to improve food security at household levels for the members, MDFA has now organized smallholder farmers into marketing groups which are producing cash crops for particular markets. Two main crops, particularly the soya bean and maize were promoted for large scale commercial farming after a baseline survey which was conducted in 2007. “ When farmers improved food security at the household level there was a surplus which required markets and thus the need to engage in farming as a business. But at the time, farmers faced challenges of limited access to; improved seeds , regular agricultural advisory services , lack of quality assurance facilities and reliable sustainable market for their farm produce and regular access to market information, “ Ojikan explains . So we sought for partners to help address the challenges which were hindering farmers’ productivity. “That’s why the leadership of Mayuge District Farmers’ Association made a decision to seek for support from aBi-Trust which last year gave the Association an additional Shs. 444m grant to work on maize production, value addition and collective marketing . On its part the association had to contribute shs. 160M for a piece of land where a maize mill and offices will be erected to add value to the farmers crop and coordinate the activities of MDFA, respectively , “ Ojikan said. With aBi-Trust ‘s support, , major interventions were put in place which included among others , access to improved seeds, agricultural advisory services, market information from NARO which were distributed at the group level. Extension field were also recruited to mobilise and train farmers in agronomic and post harvest handling practices . Marketing committees of 5 people were set up in each group to carry out market research so that farmers get a fair price for the agricultural produce. This offered a good opportunity for the farmers to bargain for a good price. . Between 2007-2013, at least 5,130 tons of soya beans were produced and sold by the members of the Mayuge District Farmers Association. Farmers have since been encouraged to grow maize on a large scale because the huge demand for the grain on the market. But as farmers of Mayuge engaged in large sale farming, challenges emerged which needed immediate solutions to maintain a good maize value chain. Other benefits from the aBi-Trust grant to the farmers of Mayuge include, training in agronomy, use of improved high yield maize and soya bean seeds, modern farming practices and proper utilization of farm inputs such as fertilizers and pesticides. The association has also set up demonstration sites at group levels for farmers to appreciate and apply new farming technologies and methods that will help boost soya beans and maize production. Along the maize and soya bean value chain, with the interventions supported by aBiTrust, Ojikan said the farmers have also been trained in gender related concepts where families, plan together, budget together, farm together and share the proceeds of their farm produce together. “Through the gender project , women have been given an opportunity to participate productively in agriculture to benefit both themselves and their respective families. The old traditional practices where women were neglected or their contribution to farming was not recognised are now being abandoned to ensure equality, transparency and accountability at the family level. This has greatly improved relations, reduced tensions and gender based violence and as a result boosted production and family incomes. With support from aBi-Trust and savings of the association Ojikan said that the association has acquired, computers, 3 motorcycles, digital camera, 300 tumplines , 7 moisture meters, 4 standard weighing scales, 10 driers among others. Demonstration centers have been set up where high yielding seeds are multiplied and 80% of the improved seed varieties re-distributed to farmers. Because there is increased farm produce, MDFA has had to link farmers to better markets by providing information about prices for agricultural produce on a regular basis. “ We collaborate with market service providers like Fit- Uganda, farm Gain and Agrinet to get accurate information about the prevailing market prices. This helps farmers to sell their produce at the right price and cut out the cheating middlemen,” Ojikan explains. MDFA is also emphasizing on quality assurance which involves , getting the right seeds, engaging in better farming practices and post harvest handling to ensure quality crop yields for better rewarding markets for farmers products. Indeed, MDFA has put in place structures where Community Change Agents (CCAs) who double as marketing committee members provide farmers with information on the prevailing market prices on a regular basis. Village Saving and Loan Associations , (VSLA) have also been set up to promote the culture of saving and investment among farmers. There are now 300 VSLA in Mayuge where members save and loan to each other to increase farm production. They farmers also collectively market their produce at established bulking centers and as a result have a better bargaining power which fetches them better prices Again, aBi-Trust’s support has come in handy here , with the VSLA members being trained in financial literacy on how to keep records . Each VSLA is given ledger books, a stamp, inkpad and passbooks to keep proper accounts. Through the Mainstreaming Gender in Soya Bean Value Chain project, families are trained to work Together and realize and appreciate the role of women, youths and men in sustainable agricultural production with a focus on farming as a business. But all is not rosy for the farmers of Mayuge. They still face big challenges like the effects of climate change which results in prolonged drought,. The cheating middlemen still exist and the many sugarcane plantations are a threat to food security in Mayuge. The writer is a Media and development Communications Consultant and Advocate of the High Court of Uganda mssewranga@gmail.com

Youth and Women engage in agricultural entrepreneurship in post conflict Northern Uganda

The youth and women are a critical mass for social and economic development and in the war torn northern Uganda, they are leading the recovery efforts to rebuild communities that were destroyed during the 20 year civil unrest. In the remote sub counties of Kwera and Kangai in Dokolo districtthe YouthSocial Work Association (YSA) a Ugandan Non Governmental Organization is working with 2,000 households to empower youth and women to increase their agricultural business competitiveness . The organization which was founded in 2005, according to Mr. William Osal (28), the Project Officer, promotes the welfare of children and youth . YSA is currently operating in the districts of Gulu, Pader Dokolo, Bushenyi with it’s head office in Kampala. In the 2008, YSA started working with Orphans and other vulnerable children (OVC) in Dokolo district with a focus on core programme areas of education, health, child protection, Social economic support, food and nutrition as well as care and support. Osal says YSA has since distributed goats, provided household care items, uniforms and scholastic materials to orphans and other war affected children . Training of caregivers for abandoned children was also carried out. “ While offering these services we noted that there was a big gap in business competition and gender inequalities among the youth and women in the war affected areas . So we wrote a proposal to aBi Trust to secure funds to promote business competiveness among women and youth sunflower producers to attract better markets and reliable incomes, Osal flanked with fellow youth, John Baguma (24) and Cate Alumo (26), explains . He says that the vulnerable farmers had to be trained in agricultural production and product handling that sustains buyer needs in terms of quantity and quality. The abi Trust was accepted YSA proposal and in offered a grant of shs.400m aBi Trust support beaars fruits After securing the finacial support from aBi Trust YSA has since December 2012 trained 100 women and 20 youth groups in Kwera, Knagai and Agwata sub counties in Dokolo District. At least3,600 farmers from 100 women and 20 youth groups each with 30 members in 3 sub counties in Dokolo district have been equiped with technical skills in sunflower production and marketing to sustain threshold yield and quality crop production that is attractive to targeted buyers. The farmers are also organised in groups to improve marketing of sunflower through collective bargaining . Gender mainstreaming in 3,600 sunflower growing households for better utilization of proceeds from sunflower sales hence improved livelihood of both women and men has been undertaken. And with increased incomes at the family level ,the farmers have been encouraged to set up village Savings and Loans Associations to inculcate a culture of savings and investments to stir economic development in the rural areas. The farmers have embraced the VSLAs concept and Osla says that from 120 groups savings portfolio has grown from zero to shs.260m. “ This a remarkable achievement for us . Because the farmers are now in position to plan together and budget for their resources .men and women are working together which was not the case before ,” he says. Sharon Akello, an extension work says that gender relations have greatly improved following the introduction of gender training session in the communities .“ cases of gender related violence have substantially reduced and the people are happy to work together . We have also mobilized 100 and 20 new women and youth groups for support in sunflower value chain. Farmers have also been trainedin entrepreneurship, business development, negotiation skills, making of records and collective business plans“ akello stated. Because farmers are organised in groups , 480 pre-season planning meetings for timely and coordinated sunflower production operations have been held. The preseason planning meetings are helld once every year at the beginning of the first season per group. The farmers with support from aBiTrust ,have received 360 Kg of certified hybrid sunflower seeds from Mukwano company for planting in one acre demonstration gardens in each group and carry out the demonstration using farmer field school methodology. The demostration gardens help farmers to acquire skills and knowledge in sunflower agronomy, disease and pest control, post haverst handling produce management. Couples have also bee trained in 3,600 households to carry out joint planning and benefit sharing and gender roles in sunflower value chain. Farmers welcome aBi Trust support Syndrella Ebil (27) a member of the Oraibaing youth group said that the farmers have benefited alot from the trainings which have been extended to them by YSA with the support of aBi Trust We are now preacing the gospel of education because we can now save and take our children to school. Our farm yeilds have improved and everyone is happy because we are getting better income,“ she stated. Ebil’s comments were supported by those of Moses Otim(40) another member of the group who said that their group had mobilised savings of shs.2m and families were peacefully living togther. Achievements  Increased productivity using the improved hybrid sunflower seeds as opposed to the local hybbridie from 400kg per acre to 600kg per acre leading to increased income among farmers ie from 320,000= to 480,000= respectively.  Initiated and Promoted savings within groups and individuals up to the tune of 260,000,000= as saving portfolio.  There is a drastic reduction in the cases of domestic violence and improved gender relations due to intensive sensitisation carried out by gender change Agents. For example gender based violence cases have reduced from 30-340 cases to 5-10 cases reported in a month in three sub counties.  YSA registered 120 women and youth groups with the sub counties as viable enterprises. This has guaranteed for them support from other government interventions and development partners.  There is increased knowledge and skills in growing sunflower hence increase in production ie on average, individuals are now growing at least two acres compared to half or nothing before the intervention. Challenges  Sunflower as an enterprise is dominated by Mukwano as the supllier of seeds and a buyer of the proceeds, this tend to make framers adhere to unfair business terms offered especially pricing.  It is becomig extreamly difficult for the VSLA groups to manage thier saving portfolios as they continue growing. Therefore theirs need to set up Saccos that will help manage farmers’ savings better.  Unfavourable weather patternsresulting to poor harvest by farmers.  There is also problem of transporting the farmers produce to the nearest market. For the members of Oraibaing youth group the nearest market is in Kwangwata which is a long distance .  Women are also faced with the problem of accessing land due to traditional barriers. The writer is a development communications consultant, media trainer and advocate of the High Court of Uganda msserwanga@gmail.com

THE MEDICINES PROCUREMENT PROCESS AND QUALITY STANDARDS AT NMS

THE MEDICINES PROCUREMENT PROCESS AND QUALITY STANDARDS AT NMS By Moses Sserwaga Chronic shortages of medical supplies were the mainstay in many government health facilities in the late 1980s and early 90s largely due to the mismanagement of funds that used to be disbursed to the districts to purchase medicines. The Ministry of Finance used to release funds directly to the districts to procure medicines and other medical supplies for government health facilities. But in many cases the medicines would not be purchased leading to shortages of drugs in hospitals and health centers. The government then took a decision to recentralize the procurement, storage and distribution of medical supplies when it set up the National Medical Stores, (NMS) on December 3rd 1993. Twenty years down the road, there has been remarkable progress in the availability of medicines in all government hospitals and health centers across the country. National Medical Stores (NMS) now procures a range of health commodities (about 2,400 items) using a stock list guided by government health facilities procurement plans. The individual facilities procurement plans are aggregated to form the NMS procurement Plan and subsequently the NMS stock list. The items procured include;Medicines, Hospital Sundries and Consumables, Hospital Equipments, Antiseptics & Disinfectants; Orthopaedic supplies; Laboratory and Diagnostic products, Hospital Stationary, Dental supplies, and Assorted stockless Inventory. National Medical Stores being a government body, procurement is regulated by the Public Procurement and Disposal of Assets Authority (PPDA).National Drug Authority(NDA) as the regulator for the quality of medicines and medical supplies in the country is also a key stakeholder in the procurement process. According to the Head of Procurement at the NMS, Mr. Natamba Alfred Turyahika, most of the medicines and medical supplies are goods in joint demand (e.g. injectable and syringe). NMS therefore puts measures in place to ensure that all the items are available at all times according to the facilities requirements. “Additionally, All the medicines we procure must be appropriately embossed to deter pilferage” he says. NMS has built a wide supplier base to ensure that the required items can easily be sourced to the satisfaction of the health facilities. The supply base consists of local pharmaceutical importers, local manufactures, international suppliers and manufacturers. The suppliers are identified through a rigorous prequalification exercise that is conducted after every three years. NMS has a fully fledged quality Assurance Department .The role of the Quality Assurance Department at NMS, is to work closely with the National Drug Authority to ensure that all medicines and medical supplies that have been manufactured locally or imported in Uganda are highly efficacious (i.e. of good quality), says Ms. Caroline Abalo,the Quality Assurance Officer. Quality Assurance Department is involved in the procurement process right from setting specifications for the items to be procured to the actual evaluation exercise. Ms. Caroline Abalo, the Quality Assurance Officer, said that NMS has strict quality control mechanisms to ensure that only medicines and medical supplies of high quality are purchased and distributed to government facilities for public consumption. Abalo assured Ugandans that NMS does not compromise on the quality of medical supplies it procures for government hospitals. “We take great care and we cannot put the lives of Ugandans in danger. We check and test everything we send out for public consumption we ensure total compliance to local and international set quality assurance standards,” She emphasized. According to the Head of Procurement, a number of innovations have been made to ensure that the requirements of the health facilities are met all the time. These include; • NMS advocated for separate regulations for procurement of medicines and medical supplies. The procurement laws have been amended to include separate regulations for procurement of medicines and medical supplies. This will go a long way in ensuring that procurements are concluded in time and medicines and medical supplies availed to the population • NMS enters into framework contracts for supply of medicines and medical supplies. These allow for quick flexibilities in case of changes in demands for the required items • Expansion of the suppler base to include international manufacturers and suppliers will enable NMS to procure good quality medicines and medical supplies and in the quantities required by NMS to satisfy the health needs of the Ugandan Population As NMS celebrates 20 years of existence, Alfred promises that NMS will continue to efficiently and effectively procure quality and affordable medicines and medical supplies for the Ugandan population and called upon all Ugandans to be vigilant and ensure that drugs and other medical supplies delivered at government hospitals and health centres are not sold to the public. He also appealed to the health workers to ensure that their needs are properly and timely communicated in form of procurement plans to enable NMS avail them in a timely manner. Writer is a communications, media and legal consultant msserwanga@gmail.com

A HISTORICAL PERCEPECTIVE OF UGANDA’S HEALTH SECTOR 1889-TODATE Achievements and setbacks

A HISTORICAL PERCEPECTIVE OF UGANDA’S HEALTH SECTOR 1889-TODATE Achievements and setbacks By Moses Sserwanga The health sector is primarily composed of institutions and resourcesdevoted to the healthcare of the people which include among others provision of safe water, sanitation, adequate food and diet, medical care and access to hospitals and drugs and protection of the environment. It’s important to note that while the period 1986 – 2013 has witnessed fundamental reforms and innovations in the health sector,the period 1889 – 1962 was characterized by the establishment of modern healthcare facilities under the British colonial rule; 1962 – 1970 was post-independence period which saw the consolidation and expansion of healthcare infrastructure and improvement to cater for a growing population, while the 1971 – 1986 period was a bloody scene of civil conflict, mismanagement and destruction of the state infrastructure and the health sector was not spared either . From 1986 to-date there has been marked economic, health sector reforms and innovations to mitigate the anarchy and destruction witnessed as a result of armed rebellions. It’s only recent that peace has been restored to western Uganda following the bloody rebellion of the Allied Democratic Forces (ADF); armed cattle rustling in Teso / Karamoja and Jospeh Kony’s two decades of brutality in northern Uganda. A Historical Health Sector Analysis 1889-1962 Advancedmedical care was first introduced in Uganda in 1889 by the Imperial British East Africa Company (IBEAC), a trading company. The IBEAC brought doctors and nurses to look after its own staff and not for the native population. But owing to successive epidemics of plague, syphilis, sleeping sickness and small-pox, IBEAC was forced to extend medical services to native Africans. These services were eventually taken over by the colonial government. It was the missionaries who started medical services devoted to Africans. Dr Albert Cook opened the first hospital at Mengo in 1897. By 1909, three health centres had been established at Mulago, Mityana and Masaka, devoted to the treatment of venereal diseases (VD), a new epidemic brought to Uganda by Europeans and Indians. Mulago became a hospital for treatment of VDs in 1913, and later a general hospital in 1923. More hospitals and dispensaries were established in provincial and district headquarters throughout Uganda. By 1961, 27 hospitals had been established with over 100 outlying health centres and staffstrength of 1,288 for a population of seven million. Basking in the independence glory 1962-1970 After independence in 1962, twenty-two new hospitals were built bringing the total number in the country to 49 by 1970. The period saw the development of one of the most outstanding networks of health services on the continent. It consisted of hospitals, health centres, a medical school for training doctors, and training schools for nursing, medical assistants and health inspectors. The network of health facilities supported by roads and railways, plus public health nurses and health inspectors ensured easy access to healthcare and improved nutrition, food security, and hygiene. Infant mortality rate (IMR), which is a general indicator of health status of a population, declined from about 350 to 120 per 1000 live births between 1900 and 1970. A period marked with total destruction of health infrastructure 1971 – 1985 After the 1971 military coup which led to political upheavals culminating in three decades of devastating civil wars,the country lost many trained personnel who left the country for personal safety abroad , witnessed decline in economic activity that characterized rising inflation, mismanagement, neglect, and wanton destruction of physical health infrastructure that reduced the hitherto excellent health services to an appalling state by 1975. Public outcry about the deterioration of health services led Idi Amin’s government to institute a commission of inquiry in 1977. But the commission’s recommendations were never implemented. In the meantime, NGOs and church missions continued to increase the intensity and scope of their services, contributing up to 40% of the national health services. The private sector, which was small in 1960s, increased rapidly in response to the gaps left by the deteriorating public health services. The breakdown of law and order, however, made it impossible to enforce statutory controls over private practice. This led to an explosion of illegal private clinics with indiscriminate peddling of drugs by quack medical workers. The painful reforms that turned around an ailing health sector: 1986-2013 When the National Resistance Movement (NRM) assumed power in 1986, it inherited a broken down health system. The new government put in place a Health Policy Review Commission in 1987. The commission came up with a two-pronged strategy: rehabilitation of existing health infrastructure and development of primary Healthcare services. Based on this report, the Ministry of Health prepared a ten-year National Health Plan 1990-2000 outlining 8 critical areas to be addressed namely : recommit to Primary Healthcare; promote community participation through health committees; decentralise health care; promote inter-sectoral collaboration and coordination between ministries, NGOs and donors; promote private practice and its regulation and control; integrate traditional medicine into the national health system; reorganise the health system into first, secondary, tertiary and apex levels; promote alternative methods of financing health starting with user-fees and community financing, and later explore the feasibility for health insurance. Innovations reversed by donor interventions Following the prouncement of the new government’s interventions to revap a sick health sector the donor community expressed concern that that the health budget far exceeded available resources . Donors argued that a much smaller “minimal package of services”should be the basis of the national health plan. The World Bank andother donors thusincreased their involvement in the redefinition of Uganda health sector priorities and in 1992; a three-year plan 1992 -1995 was developed. This health sector framework came up with five policy recommendations which included interalia: • No further expansion of health care infrastructure • Restore the functioning of existing health facilities • Reorient the health system to Primary Healthcare • Use a basic health care package approach based on needs and available resources; and promote user-fees as a way of health financing Around the same time $110m grant was extended to the government of Uganda to deal with the HIV/Aids pandemic (1988 to 2002) to promote awareness, the ABC strategy (Abstain, Be faithful and use Condom) of reducing HIV transmission, and to mitigate social and economic impact of AIDS. The same resources were applied to make anti-retroviral treatment to take off. Under the health system, a few selected hospitals and health centres were renovated but not enough to improve the overall health care. Therefore another loan of $75m was subsequently secured in 1995 to reform the health system. Another reform was decentralisation of health servicesto encourage community participation, promote local self-reliance and accountability, overcome administrative obstacles, and promote coordination. But this reform had down side to it, decentralised administrative units began to be created as rewards for political loyalty and not because they were rationally assessed to be viable for effective health service delivery. The health functions of districts and sub-county local governments far outstripped available resources at their disposal. Health statutory bodies born Several other reforms were undertaken and these saw the establishment of the National Medical Stores (NMS) and National Drug Authority (NDA). While the NDA was created to ensure good quality of medicines and promote rational drug use based on an essential drug list, the NMS was created to procure, store and distribute essential drugs to public sector health facilities. Public-private-partnership (PPP) is one of the recent reforms to be introduced. Based on the belief that the private sector is inherently efficient, and the public sector cannot provide all the services people need, a partnership between the two was to be established and promoted. However, although the policy is not yet fully approved, its implementation has been in progress for at least 15 years with the partnership between the government and missionary health services. The latest reform, since 2005, has been to bring in the for-profit private sector on board. Indeed, small scale partnerships with the private sector have been ongoing. But as yet there are no concrete benefits of such partnerships. The Sector-wide approach (SWAP)SWAP has also since been adopted to address the multiplicity of actors and funding channels in the health sector. It was defined as a partnership among donors, the government and other stakeholders for “a negotiated programme of work”. In Uganda, Swap started in 1999, and by 2005 funding in the health sector had increased substantially. Under the SWAParrangement, achievements were made in national programmes such as immunisation, HIV/AIDS, TB management. Writer is a communications, media and legal consultant msserwanga@gmail.com

UGANDANS ENJOYING BETTER HEALTH SERVICES

UGANDANS ENJOYING BETTER HEALTH SERVICES By Moses Sserwanga The state of a country’s health sector is manifested in the available infrastructure and human resource to cater for the health needs of the people because a healthy and productive population is vital for socio-economic growth and nationaldevelopment. That’s why in its2011-2016 manifesto,the National Resistance Movement (NRM) government led by President YoweriMuseveni promised a number of interventions to turn around Uganda’s health sector. Among the issues the government set out to address was the lack of adequate qualified health workers at both nationalreferral hospitals and local health centers, II, III and IV. The Ministry of Health has since re-allocated an estimated Shs5.7 billion to recruit staff at Health Center IVs. At least 400 graduate health workers have been directly posted to local Government health Units. According to the current Uganda Health Sector Review Report, staffing in public health facilities improved from 58% in 2011/12 to 63% in 2012/13 though still below the recommended target of 70%. The increase in staffing level was a result of thetargeted recruitment for Health Center IVs and IIIs in 2012/13. District level staffing increased from 55% to 60.5%. However, the report indicates that 7,619 of new health workers recruited into the system from Government of Uganda and donor fundsis relatively low due to internal movements i.e. health workersmoving from hospitals to Health Center IVs and IIIs and from one rural district to a more urban district. Hence, the net increase in staffing is not significant. The results of the last health panel survey findings of 2010/11 received in 2013 indicated absenteeismat Health Center II and III level had increased by 2% from 46% in 2009/10 to 48% in 2010/11 instead of adecrease by 20% as per set target. There is need to establish an institutional mechanism foractive monitoring and reporting of health workers absenteeism. Medicines and Medical Supplies available to all government facilities The Health Sector Review Report notes that the National Medical Stores (NMS) continues to supply medicines and health supplies to public health facilities andachieved several of the planned outputs. Notably there was increased access to MaamaKits to82% of mothers delivering in public health facilities. During the financial year 2012-2013, NMS commenced supply ofmedicines and health supplies to all health facilities in the UPDF, Police Force and Prisonservices. The availability of the six tracer medicines (first line antimalarials (ACTs), Depoprovera, Sulphadoxine / Pyrimethamine, measles vaccine, ORS and Cotrimoxazole) in both public andprivate health facilities has continued to improve over the last four years with the percentageof facilities without stock out of any of the 6 tracer medicines increasing from 21% in 2009/10to 48% in 2011/12 and is now 65% in 2012/13. This is a positive trend compared to the recommended target of 60% for 2012/13. Performance of semi-autonomous institutions According to the Review, all the semi-autonomous institutions including; Mulago National Referral Hospital, ButabikaNational Referral Mental Hospital, Regional Referral Hospitals, Uganda Cancer Institute, UgandaHeart Institute and Uganda Blood Transfusion Services showed improvement in provision ofsecondary and tertiary referral services and specialized services and infrastructuredevelopment. The major challenge was inadequate resources (financial and human). Uganda Cancer Institute The Uganda Cancer Institute was able to provide a range of services which included; Outpatients: 12,096 patients; Inpatients: 2,652 patients; Physiotherapy: 2,652 patients andmedical social support: 14,748 patients. The Institute carried out Laboratory: 69,156investigations and Imaging: 9,870 investigations. The Institute achieved almost all of the planned outputs aimed developing the Institute. The 5year strategic plan is being finalized and over 70% of the planned works were completed. Thecancer research coordination structures have been established and the research agenda beingfinalized. Hospital Performance Hospital outputs were assessed using the Standard Unit of Output (SUO). The 14public referral hospitals and fourlarge Private hospitals (Lacor, Nsambya, Mengo and Lubaga) attended to a total of; 2,537,666 Outpatients; 89,626 deliveries and 339,670 admissions among other outputs. On average eachhospital attends to; 140,981 outpatients, conducted 4,979 deliveries and 19,981 admissions. The SUO for these hospitals increased from 5,361,005 in 2011/12 to 8,189,908 in 2012/13. Average staff productivity increased to 2,724 from 1,534 SUO/Staff in 2011/12. Mbale RRH and Masaka hospital had the highest SUOs of 858,116 and 792,551 respectively. The report shows that a total of 110 hospitals offering general hospital services and reporting through the District Health system wereassessed. They collectively attended to a total of; 3,754,144 outpatients; conducted 150,276deliveries and 690,621 admissions among other outputs. On average each hospital attends to;35,080 outpatients, 1,392 deliveries and 6,412 admissions. The total SUO for GHs has increasedfrom 10,506,636 in 2011/12 to 15,129,354 in 2012/13 with notable increase in performance foradmissions, outpatient attendances and deliveries. However, there was a decline in the immunization contacts at the government hosiptals. The 5 top performing hospitals were Iganga, Busolwe, Bwera, Mityana and Pallisa. The Top 5 performing maternal health care facilities In addition to performing Caesarean Sections, 193 Health Center IVs were also assessed using the SUO. In total Health Center IVs attended to 4,473,744 outpatients; conducted 123,610 deliveries; and admitted 395,898 patients. The 5 top performing Health Center IVs in 2012/13 were Bugobero ,Kawempe , Mukono Town Council, Serere and Luwero. Management of HIV/Aids The health sector maintained a positive trend in performance for the HIV/AIDS prevention, care and treatment services. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 32% in 2011/12 to 46% (47,444 children) in 2012/13 . The performance is still below the set target of 55% for the year. There was also remarkableimprovement in the percentage of eligible persons receiving ARV therapy to 76% (total of566,444 of whom 524,603 adults and 41,520 children) from 59% in 2011/12. This achievement was also above the set target (65%) for the year. In FY 2012/13 193,000 new patients were enrolled on the life saving ART against the planned target of 110,000 new patients. This enrolment for the first time exceeded the number of estimated new infections (140,000) over the same period marking a tipping point in the ART programme. This was a result ofstrengthened programs of; accelerated accreditation of health facilities, scale up of Option B+,Web Based ARV Ordering Systems, supply chain rationalization which strengthened the PSMand improved overall support to health facilities by the MoH and Implementing Partners. Impact of government interventions in the health sector The Ministry of Health recommends implementation of the child survival strategy at all levels of care inorder to achieve the Millennium Development Goal four. The review shows that thesector continues providing key interventions like vitamin A supplementation, mass dewormingand health education to sustain improvement of the under-five nutritional status andreductionofanemia. There is need tocontinue community mobilization and involvement in the new community based interventions.Data from the 2011 AIDS Indicator Survey (AIS) revealed an increase in the HIV prevalenceamong adults from 6.4% in 2004/05 to 7.3% in 2011. This trend is attributable to both newinfections and improved survival. Access to a comprehensive rangeof HIV/AIDS care services has been improved through accelerated accreditation of ART siteswhich increased number of health facilities providing ARVs to 1,160 excluding specializedclinics, research programmes and private clinics. A total of 400,000 out of 1,000,000 (40%) Theproportion of pregnant women living with HIV receiving ARVs increased from 50% in 2009 to96% in 2012. There was an increase in the number of malaria patients reported in the outpatients from13,263,620 in 2011/12 to 15,997,210 in 2012/13. Malaria remained the leading cause of morbidity and mortality among all age groups and accounted for 20.6% (5,079/24,651) of allinpatient deaths in 2012/13. The sector improved malaria case management through increasedaccess to medicinesand use of Rapid Diagnostic Tests at HC IIs and IIIs without microscopes. IndoorResidual Spraying was conducted in the 10 target districts for the last 2 years with up to 92%coverage, protecting more than 2.6 million people. There was remarkable reduction of indoorresting vector population reduction as well as remarkable reduction of malaria prevalence intarget districts. Coverage for immunization services showed an increase in the percentage of under oneyear immunized with third dose of pentavalent vaccine (DPT3) from 85% in 2011/12 to 87% (1,319,860 children out of 1,520,347 target, of which 88% were males and 85% females)which is above the HSSIP target (83%) for the year. The DPT3 coverage of 85% in 2012/13 isabove the HSSIP target (83%) for 2012/13. Regarding measles immunization, 85% (1,285,020 children out of 1,520,347 target, of which 86% were males and 83% females) of one year old children were immunized against measles in 2012/13 . Recommendations for better health services The Review recommends that the health sector should focus on interventions geared at improving service delivery at the primarycare level specifically through improving the existing health infrastructure, provision of basicequipment, dissemination of guidelines for standard precautions and infection prevention andcontrol, providing appropriate diagnostic facilities and essential medicines by level of care. Allthis should be augmented with provider training to enhance their knowledge and skills. The Ministry of health needs to carry out further analysis to identify additional factors affecting functionality of HC IVs. KEY FACTS: • National government health budget declined from 8.3% in 2011/12 to 7.4% in 2012/13. • Still below the9.8% target for the year which is also below the Abuja target of 15%. Demographic Information • Demographic Variables Proportion Population • Total Population 100% 35,356,90 • Children below 18 years 56% 19,799,864 • Adolescents and youth (young people) (10 – 24 years) 34.7% 12,268,844 • Orphans (for children below 18 years) 10.9% 3,853,902 • Infants below one year 4.3% 1,520,347 • Children below 5 years 19.5% 6,894,596 • Women of reproductive age (15 – 49 years) 23% 8,132,087 • Expected number of pregnancies 5% 1,767,845 UBOS 2012 Midyear Projection New health facilities to be constructed Staff houses to be built at district hospitals of Moroto,MubendeMiyana, Masindi, Kawolo, Iganga, Anaka,Moyo,Kitgum, Itojo, Kiryandongo, Entebbe, Nebbi, Apac, Nakaseke, Buwenge and, Bukwo. Under World Bank loan hospitals to be upgraded and rehabilitated; Mubende, Moroto Regional referral hospitals and the 17 general hospitals. Installation of solar systems in 156 health centres is under way. The facilities that are benefiting from this programme include; Kibale, Mityana, Mubende, Kabale, Kanungu, Luweero and Rukungiri. Installation is also ongoing in Nakaseke, Kitgum, Apac, Amuru, Kaberamaido, Adjumani and Dokolo. And procurement of ambulances for 27 Health Center IVs, 17 general hospitals and two hospitals is in progress. An ambulatory transport scheme for Kampala is also being worked on. Construction of three general hospitals in Kampala i.eKawempe, Makindye and Rubaga in addition to the newly constructed in Naguru. This will help in the decongestion of Mulago National Referral hospital. A loan of (USD88 million) from the African Development Bank has been approved for the construction of hospitals in Kawempe and Makindye. The writer is a communications, media and legal consultant Based in South Sudan msserwanga@gmail.com