In Uganda, we approach health with two strategies, just, I imagine, as it is done in many Countries. The two strategies for health care and promotion are: preventive health care and curative interventions, if somebody gets sick.
The preventive health care includes the following: Nutrition through sensitization and education because Uganda does not lack food of any type (carbohydrates, proteins, fats, vitamins, other micro-nutrients, etc.). What is, sometimes, lacking is knowledge of what is needed and why. Consequently, some people over-eat, others under-eat and others mis-eat (eat what they do not need and fail to eat what they need). Income inequalities, especially in the towns where there are unemployed persons that no longer have access to land, sometimes causes malnourishment.
Hygiene – hand-washing, proper waste disposal – including latrines and water-borne sewerage etc. This eliminates many diseases such as cholera, intestinal worms, hepatitis-A, etc.
Safe-water – through bore-holes, gravity flow schemes, protected springs and piped tap water, that eliminates many water- borne diseases such as cholera, worms, guinea-worms, bilharzia, other hazardous contaminants like heavy metals that can lead to cancer, etc.
Vaccination that prevented small-pox and Vaccinations that prevent the following diseases: Polio, severe forms of TB, Tetanus, Whooping cough, Diphtheria, Hepatitis, cases of pneumonia (Haemophilus influenza and Pneumococcal bacteria), severe diarrhea (due to rotavirus, measles, rubella), Yellow fever, anti-HPV and Covid-19.
Malaria – prevention through the use of larvicides, draining of stagnant water, the use of treated bed-nets, etc.
Behavior change that has helped us to deal with HIV/Aids, Corona-19, Ebola, etc.
Life-style diseases such as hypertension, diabetes, heart attacks, kidney diseases, cancers, alcoholism, etc. These can be prevented, in many cases, by appropriate conduct- e.g. not over-eating, not smoking, not taking excessive alcohol, exercising, etc.
Protecting the environment, especially the quality of the air, that can help us to prevent some of the respiratory canal diseases. Some of the pollutants can go through the food chains – e.g. agro-chemicals. Polluting water sources becomes, therefore, crucial; those sources must be protected by ensuring that there are vegetation belts around the water bodies (e.g. forests, shrubs, etc.).
By being serious on the above 8 points, you eliminate 75% of all the possible diseases that can afflict our People. That, then, leaves us with the 25% to deal with. It is here that the curative network comes in. In Uganda, we have a Health Centre III per Sub-county and there are 2,184 Sub-Counties in Uganda; Health Centre IV at a County (Constituency) and there are 353 Parliamentary Constituencies in Uganda, out of which 167 have the Health Centre IVs. A Constituency has around 100,000 persons. The third-tier, has a District Hospital. These should be 147 in Uganda. However, we now have 45 of them. There are, then, Regional Referral Hospitals which should be 21. We now have 16 of them. There is, then, the National Referral Hospital at Mulago, plus other Specialized National Health Assets such as the Women Hospital, the Joint Clinical Research Centre (JCRC) for Aids. All the above are Government Health Facilities. There are, however, many private health facilities belonging to private People – Churches, Islamic groups, private people (Local and Foreign). We are now working on eliminating medical referrals abroad, mainly for the heart, kidney diseases and cancers, that, sometimes, involve organ transplants that have been taking US$ 70 million per year.
We are going to have reverse medical tourism by providing this super-specialization service to patients from abroad, also taking advantage of the good high-altitude climate of Uganda for the recovery of these patients. Uganda’s elevation is between 621metres and 5119 metres above sea level. That is why you find permanent snow on the Equator. The picture of the Rwenzori here clarifies that point.
Snow-capped Rwenzori Mountain
Uganda is moving well on the issue of health. The pressure is to cause our doctors in the Districts and nationally, to put more emphasis on public Health – avoid the sicknesses instead of waiting for people to be sick and, then, get treated. That is how our population has risen from 14 million in 1986 to now more than 43 million.
There are two areas where we are moving on our own, but where we would welcome collaboration, if available. This is in the areas of pharmaceuticals and vaccines. It is not correct to continue with the present arrangement where, in the global share of pharmaceutical production of US$ 1.42 trillion, Africa’s share is only US$ 16 billion. Uganda and Africa are better placed to produce many of the pharmaceuticals on account of the plants that we have in our area. Chincona which helped humanity with Malaria from the year 1630, was a tropical plant. There are other sister plants in the tropics that can help man with many of the health problems. During the Corona-19 pandemic, one of our Professors, Professor Patrick Ogwang, cross-matched an ancient anti-viral plant product, that our People in the North-East of Uganda (Teso), have been using since time immemorial against measles, caused by the virus rubeola, with the treatment for Covid-19 and it saved so many lives. Uganda, with a population of over 43 million, had 170,694 cases of Corona-19 and we lost 3,632 people. You very well know what happened in other parts of the World. We are also working on developing all the types of vaccines needed for the humans and for the livestock. Our Scientists have, for instance, discovered an anti-tick vaccine.
On the side of diagnostics, we are moving well as we are doing on the side of sanitizers. Being one of the biggest producers of bananas in the whole World, since ancient times, it was easy to enhance the production of sanitizers from the alcohol base and from bananas. In the Great Lakes Countries of Kenya, Tanzania and Uganda, you will even come across many names of: Maarwa, Wamaalwa, – all referring to alcohol from bananas or from sorghum and millet.
In conclusion, from Uganda’s point of view, we invite friends and brothers (Africans) to cooperate with us in the production of vaccines and pharmaceuticals for the improvement of global health. Collaboration between the USA and Africa will enable the World to get cheaper medicines and vaccines. In our research for vaccines development, we found that we need 17 input chemicals and reagents, including the one known as Beta-propio-lactone. Our Scientists told me that this was from cassava that we easily produce in Uganda. It is not correct to produce unaffordable medicines on account of using expensive inputs when Countries like Uganda can produce those inputs cheaply.
Our part of the World, the Great Lakes area, had little contact with the outside World until 1841 when an Arab man by the name of Ahmed bin Ibrahimu became the first non-Black person to come to our area. In those times, people were travelling by ships and walking on foot for 1000 miles from the Ocean. That slow way of movement, nevertheless, did not stop those travelers bringing the terrible smallpox (omuze, ebikacha, kawaali) of 1894 that killed so many People. If epidemics could spread in spite of the slow pace of movement of those days, how about now when people can hop from continent to continent in a matter of hours by aircrafts? The recent phenomenon of Covid-19 has clearly shown this. This, therefore, means that, especially with epidemics, the health of one is the health for all.
By HE Yoweri Museveni
President of Uganda.