Sick country of illiterates

By Flavia Nassaka

Reflecting on the country’s advancement in education, healthcare

As Uganda marks 53 years of Independence from Great Britain, the country has a lot to celebrate. Key among them is that Ugandans now live longer as life expectancy has increased from 45 years in 1962 to 59 in 2012. The population has also increased from 7.2 million to 34.9 million according to the 2014 census figures.

In terms of education, Uganda has made tremendous progress in increasing literacy and access to education at all levels by introducing policies and programmes to improve enrollment. By end of 2014, enrollment for primary school stood at 8.4 million yet for secondary 1.2 million from 124000 in 1986. University graduates increased from 5400 from one university to more than 30 accredited universities producing over 150,000 graduates annually.

Education sector expert, Fagil Mandy toldThe Independent that increased enrolment was a result of government programmes aimed at ensuring access to free education for all. Before that, many people could not afford paid for education.

Mandy say adds that Uganda’s education system was initially designed to serve the interests of the missionaries until after Independence when several commissions were instituted to change education into that which suits Ugandans.

In 1963, the initial commission chaired by E.B. Castle advised the Independent government on changes in education system based on Ugandan interests.  The commission recommended that secondary education and teacher training be expanded and that junior education be abolished in preference to extending the primary school education from six to eight years and later to seven years.

It was the Castle recommendations that guided Uganda’s education until 1977 when another educational policy review commission was appointed headed by the late Prof. Senteza Kajubi. It produced the Education White Paper that put emphasis on enrolling more children into school, expansion of the girl child education and giving adult education a place in the national education system.

When Universal Primary Education (UPE), a government programme to increase access to free primary school education was introduced in 1997, the number of pupils enrolling jumped from 2.5 to 7.5 million in 2008, reaching a level of 82% of eligible pupils being enrolled.  Furthermore, the introduction of Universal Secondary Education (USE) and Universal Post Primary Education Training (UPPET) in 2007 increased secondary education enrollment by 25%  from 814,087 in 2006 to 1,088,744 in 2008, with girls constituting 46%. In the same period, enrolment in technical institutions increased by 46% from 25,682 to 47,298. This has led to improvement in the national adult literacy rate from 69% in 2005/6 to 73% in 2009 according to Uganda Bureau of Statistics figures.

Currently, however, quality is lacking in the education offered Uganda like other countries in East Africa.

This sentiment was expressed by Ambassador Kristian Schmidt, who is the Head of the European Union Delegation in Uganda. He told The Independent that numbers in school are good, but what matters even more is ensuring the learners get the right quality of education.

In May, Uwezo a program of Twaweza, an accountability organization launched a report on education quality in three East African countries in 2014. The report indicated that education quality tested was highest in Kenya, followed by Tanzania, and Uganda respectively.

While many children are in school, report findings indicated many children across the region are not learning basic literacy and numeracy skills, with only two out of ten pupils (20%) in the third year of primary school being able to read and do basic mathematics.

Commenting on quality in education issue, Mandy told The Independent that there is need for minimum programmes that every young person has to go through in order to become a responsible citizen. He said the vocational and university education on offer is not yet supporting the development of the workforce with appropriate skills even though the government has been advocating hands-on learning and science.

Currently, the number of students enrolling for science and technology courses at the university is below the recommended 40% minimum requirement in areas of applied science and technology disciplines for rapid and accelerated economic growth and effective contribution in the global knowledge based economy.  At university level, according to Uganda National Council for Higher Education (UNCHE) report for 2013 which is their latest says, 70% of enrollment is in arts courses rather than the much advocated for science and technology courses.

Alex Kagume, the Deputy Executive Director of UNCHE says inadequate academic staff and other infrastructure like libraries, laboratories and lecture theatres are impacting greatly on the quality of University education offered.

Kagume, who is also a former Vice Chancellor of Uganda Christian University, says middle level institutions are needed to complement the poorly facilitated universities. He added that universities need to invest more in research, especially at undergraduate level since some of the research currently done is not linked to market needs or to solving problems of the country.

For those looking for good news, Uganda has a competitive edge over the other counterparts in the region in attracting foreign students right from secondary to university level. UNCHE statistics show that the number of foreign university students was 21,046 in 2013 from 17156 in 2011/ 2012 academic year. This despite Kenya having more schools and doubling the country’s number of universities.

But Mandy cautions on this front too.

“Uganda being the best education exporter in the region may not last longer. Our graduates are not problem solvers,” he told The Independent.

According to him, the course contents and mode of delivery where a student has to cram for purposes of passing exams does not make Uganda compete favorably on the international market.

Health

The government has been over the years been increasing its spending on health from as low as 3% to 9% currently.  Although this is below the expenditure of Kenya and Tanzania which stand at 13% and 11% respectively, Dr. Sarah Opendi, the State Minister in charge of Primary Health Care says the government has increasingly invested in health infrastructure. There are 4,722 health facilities as of 2014 from just a few built by missionaries before 1962.

In 2001, government also abolished user fees in hospitals to enable more people to access medicine. But thehospitals are overwhelmed by patient numbers that doctors cannot handle. Many patients are not seen by doctor and many more fail to get prescribed medicine from the public facilitiesy.

Uganda’s doctor to patient ratio remains at 1:150,000, which is way below the recommended World Health Organisation (WHO) ratio of 1:10,000 for Africa. Even though Kenya is doing equally badly at 1: 17, 000, many Ugandan patients who need specialised care are referred there.

However, this year’s independence happens when countries are evaluating themselves on whether they attained Millennium Development Goals (MDGs) that were adopted 15 years ago. Like other members of the United Nations, Uganda agreed to Goals 4, 5 and 6 for reducing child mortality by two thirds and improving maternal health by reducing mortality by three quarters in addition to combating HIV, malaria, and other diseases.

In terms of maternal health, Uganda has made some strides. It has reduced deaths from 670 to 360 per 100,000 live births.

Opendi says currently 44% of mothers deliver in attendance of a medical worker up from less than 20% in the 1990s.  In Kenya however, as of 2014, 62% of the mothers were assisted by trained personnel. Its rate maternal mortality is 360 yet in Tanzania it’s still high at 460 per 100,000 live births.

The UN Resident Coordinator Ahunna Eziakonwa told The Independent that commendable strides have been made in other MDG indicators, there’s slow progress on maternal health as the recommended is 147 per 100,000 live births.

“We are launching a new set of goals. Countries need to re strategize because they’ve not achieved all the health related MDGs”.

Currently in Uganda, infant mortality stands at 54 per 1000 births from 122 and child mortality has reduced from 160 per 1000 to 57.  In Kenya, child mortality rate currently stands at 53 and infant mortality stands at 40.7 per 1000 live births yet Tanzania stands at 38 for infant mortality and 54 for child mortality according to East African Community Facts and Figures 2015.

Opendi attributes increased children survival to increased immunisation coverage.

“Immunization has improved both in terms of numbers of immunisable diseases and immunized population. The diseases have increased to 11 from less than five years ago. Immunisation coverage is 90%”.

As regards, HIV Uganda still has the highest prevalence rate in the region at 7.2%.  Opendi said to combat this, government is investing in behavior change programmes and also ensuring increased access to antiretroviral drugs to those who need them.

Uganda, like other African Union member countries in 2005 pledged to realize universal health care by 2015 at the meeting held in Botswana. For Uganda, it has remains a dream.

Meanwhile, in the neighbouring Tanzania, the National Health Insurance Fund (NHIF) started operating as early as 2001 where formal sector employees make a mandatory contribution of 3% of their monthly salary.  As of 2013, Tanzania’s NHIF was estimated to be covering about 6.6% of the population. In Kenya, the National Social Health Insurance Fund (NSHIF) is also operational with contributions being made by those aged 18 and get a monthly income of more than Kshs1000.

Opendi said the National Health Insurance Bill 2007 which is supposed to establish the fund is still with the Ministry of Finance awaiting approval.

But, says Dr. Michael Lulume Bayigga, a member of the Parliamentary Committee on Health, Uganda is still far from achieving public health insurance because it lacks the physical infrastructure to support it. He told The Independent that there is need to first create trust that the taxpayers’ money will not be swindled and also creating a system that ensures that drugs, machines and the human resource are available to cater for the public’s health needs.