ALFORD and Health
Overview: the role of the ALFORD, and health sector
The health sector comprises, Government agencies, NGOs, private and community providers, and various partners. It exists to promote better health outcomes through the provision of preventive and curative health services. Its responsibility stretches to the community provision of sanitation services in Uganda. The health sector is slowly recovering from the general decline in social services witnessed during the periods of economic and political mismanagement in the 70s and 80s. The burden of disease, however, remains high. In 1995, over 75% of the life years lost due to premature death were due to mainly preventable diseases. Prenatal and maternal conditions, malaria, acute respiratory tract infections, AIDS and diarrhea diseases together account for over 60% of the total national death burden. Health care is delivered by the private sector, including commercial units and NGO or religious facilities, as well as by Government. In Uganda, the majority of consultations are with private facilities, and the poor are proportionately more likely than their wealthier counterparts to depend on the public sector. In 2002, 44% (19%) of household in the poorest (top) quintile who consulted a health unit used a public facility. There is little overall difference in the pattern by gender.
ALFORD aims to support in community health by supporting people in fulfilling their rights to physical, mental and social wellbeing, and to offer good-quality essential services.
There is a vicious circle of ill health, poverty and social exclusion. Inequalities in wealth and access to essential services impair people's ability to maintain their health and wellbeing. This prevents them from fulfilling their potential and from participating fully in their communities and national programs.
Lack of Basic services
Millions of people in Uganda lack access to adequate basic services including clean water, sanitation, food security and healthcare, a situation exacerbated by the HIV and AIDS pandemic. Inadequate mental health and welfare services reduce individual wellbeing and exacerbate social exclusion. If disadvantaged people could exercise their rights to these services, much poor health and social exclusion would be prevented in communities.
Interventions in the package were chosen to target the most common diseases using the most cost-effective interventions. The achievement of the ALFORD is not yet affordable in its entirety. These reforms were designed to shift spending towards areas of greatest effectiveness. These include: increased resource allocation for primary health care(PHC) activities, The major priorities identified during the biannual joint sector reviews under HSSP, include: immunization, malaria control, health education, reproductive health, sanitation and HIV/AIDS.
Important subsectoral actions include:
• The revitalisation of EPI, which has provided increased service points backed by increased funding,
• Public provision of anti-retrovirals (ARVs)
• The extension of voluntary counselling and testing services, and services for prevention of mother-to-child transmission
• A multidisciplinary approach to treatment of HIV/AIDS has to be developed. Health care workers have to be trained to undertake the delivery of antiretroviral therapy and the treatment of their side effects as well as potentially high rates of immune reconstitution that may be seen. There is a need to integrate counsellors adapting already learned techniques and incorporate arising issues, as treatment becomes more available, nutritionists, etc.
• Launching of the Home-based management of fever programme for combating malaria in 10 districts; 74% of under-five children in these areas will receive appropriate treatment within 24 hours of onset of symptoms and mortality and morbidity will have to fall.
• The prices of insecticide treated materials (ITMs) have been reduced by waiving taxes on bed nets and insecticide, and a national policy on ITMs has been prepared and disseminated ITMs, however, are still not yet affordable by the majority of the population especially the most vulnerable groups; only 15% of adults and 8% of children sleep under a mosquito net.
• ALFORD will enter into partnership with the Government for the procurement and social marketing of ITMs.Based on a national voucher system which has been developed to make ITMs available especially to the most vulnerable groups.
• The introduction of free primary care in public health facilities.
Priority actions in the health sector
priority is given to preventive care, including hygiene promotion and sanitation, insecticide treated nets for malaria contral,working in partnership with village health teams, provision of Anti Retroviral Therapies and IEC messages.
Community health
We work with government and non-government partners to improve management and delivery of services. We support community-based services (including primary healthcare) and outreach work in both health promotion and treatment.
Addressing causes
We work hard to tackle the underlying causes of social exclusion and ill health. This includes work on the provision of clean water and sanitation, health promotion in areas such as the recognition and management of malnutrition, and support for the development of appropriate social services.
Water and sanitation
Overview
This section considers water supply and sanitation. The sector has developed sector investment plans for rural water. Are likely to be fiscally constrained. Hence there is a need to prioritise within this sector to achieve the highest-priority objectives.
Rural water supply
Improved access to water supply has two potential benefits: improved health and savings in time collecting water. Water-borne diseases are an important part of the disease burden in Uganda, though more study is needed of the magnitude of the effects of improved water on these diseases. However, there is increasing concern that despite improving access to safe water supplies, the quality of water when finally consumed is frequently diminished as a result of poor domestic hygiene practices in maintaining a safe water chain. The time burden of water collection falls mainly on women and girls in rural areas, and can be very significant.
Data from the Directorate of Water Development (DWD) shows that the percentage of people with access to safe/improved water sources increased from about 20% in 1991 to 55% in 2002. Notably, the data does not take into account over utilisation, which may lead to long queues. In 1999, the absence of safe water sources was still a key problem, and households identified water supply as a priority. There was little change in rural water collection times between 1995 and 2000; Time saved by the children from fetching water from long distances permits them to attend to school. For some households, the distances and time are much longer; a study in Eastern Uganda found that households were spending 660 hours a year on water collection. Water use is also low. Average water consumption ranges from 12 to 14 litres/person/day in rural areas, compared to a national target of 20 litres/person/day. Shortage of water also affects the quality of health care and education.
The cost of investment in rural water supply makes it almost prohibitive as an up-front investment for most rural communities. There is however, more scope for private sector involvement in rural growth centres, small towns and urban centres where population densities are higher, alternative options are lacking and factors of privacy come in to play. , but the cost of producing water has also been rising, so that the rate of coverage has grown fairly steadily.
Sanitation
Sanitation includes the appropriate disposal of human and industrial wastes and the protection of the water sources. Sanitation and hygiene promotion needs to be better mainstreamed in development context, at the present; promotion of sanitation and hygiene is mainly in Education institutions at parish level. ALFORD is involved in the construction of well ventilated improved pit latrines and solid waste disposal.
Issues in allocation of the water grant include equity and efficiency. ALFORD is allocated funds to enable every community to reach the same level of coverage by 2015. This is regionally equitable; however, the simultaneous implementation of the programme in every district of the country, under coverage. May have some efficiency cost because contractors have to move equipment between districts.
The benefited communities so far covered are satisfied with the service delivery of the water and sanitation installation .Rural water supply is maintained under the supervision of Water User Committees. Previously maintenance has been a major problem, which drives up the effective costs of delivering water supply. The challenge, however, is to develop an effective participatory system than achieves successful community management.
Priority actions in the rural water sector
• ALFORD will continue to invest in expanding rural water supply, taking efficiency measures to ensure that the facilities are maintained and that costs are kept down.
• In order to achieve ALFORD’s targets in these areas of coverage, there is need to do massive fundraising within this sector towards rural water supply.