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Act on health, education challenges – World Bank

By Julius Businge

A new survey released by the World Bank and other partners- Uganda Service Delivery Indicators (SDI) indicates that Uganda is still failing to achieve optimal performance in schools and health centres. The Independent’s Julius Businge interviewed Ritva Reinikka, the World Bank’s director for Human Resource Development for African Region about the findings and the way forward.

What is the Service Delivery Indicators (SDI) initiative by the World Bank and other partners?


SDI is Service Delivery Indicators. It is an effort to measure the immeasurableand to get into the quality issues on the supply side of services from the citizens’ perspective. We see often that primary six children are unable to read primary two paragraphs; this is quite astonishing and it indicates that pupils are not learning at school.

There is a lot of progress in reducing mortality rates in countries, but there are areas that require strong health systems to work. So the SDI tries to see what is between the money and the results and why is it that the money is not the same as results and it does it from a different way from the past.

In the past we used to focus on inputs like building of clinics, number of doctors, beds, basins etc…but now are fundamentally focusing on the key provider, the doctor and the teacher. We believe that in education, teachers are the key and in health it is the health workers that are the key.

SDI tries to see what teachers, health workers can do and what they can’t do so that policy implementers and other concerned parties can take action. We plan to do this across Africa and across time. We have done five countries and more are coming. It is in simple terms an initiative that tracks performance and quality of service delivery in primary schools and health facilities across countries.

What is the scope of this year’s survey like?

This year’s survey was based on 5, 300 teachers and health workers in 400 primary schools and 400 health facilities.

How important are these indicators to a country like Uganda which is slow at implementing policies?

I think this type of data is really actionable; it really goes right to the frontline in schools, clinics,looking at key elements there. So it is much easier to act using such data, if at all policy makers really care about the sectors.

So what in general terms is your description of the situation in our schools and health centresyou visited?

Teacher absentee rates have not changed in the last 10 years. Uganda was one of the first countries in the world to measure teacher absence rate, so having these numbers up is not good. We found out that most teachers were not mastering the curriculum they teach especially the one for mathematics.

Also most teachers recruited lacked teaching skills. What surprised me was 90% of the schools had no text books (in both private and public) as opposed to other countries.In health,we found out that many health workers keep away from work and patients visit the health centresand don’t get treated. This is a serious issue. The issue of drugs is a mix; there are drugs in most some health centres but others don’t have.

But good enough infrastructure is pretty good-Uganda does well here compared to other countries where we have been. It is at par with Kenya and better than the other countries like Senegal,Tanzania and Nigeria. Uganda has also done well in terms ofensuring that the pupils go to school.I think the diagnosticaccuracy for health workers needs a lot more attention, so is prescription.

Most people perceive private institutions to be doing better in most areas than public ones. What did you find?

I think in health there is a little gap. The situation is somehow similar in education; the teachers are not fundamentally that different in both private and public. In Kenya we saw the same thing where private school teachers taught 50% more than the public school teachers and here in Uganda we see the same thing. We believe teaching more hours is good for kids and has a positive impact on their results.

In the report you note Vision 2040. Howimportant iseducation and health when it comes to achieving the targets in that Vision?

I think these are two key sectors that can lead Uganda to a middle income country. The government spends 25% of its resources on these two sectors which is good. But investing the money when actually kids are not learning, health workers are not attending to patients is a waste of time.

And for many, primary schools are the only places where they can get skills; it is the foundation of one’s career-that is why it needs to be high quality so that you become a more productive farmer orentrepreneur.

In your view, what will happen to Vision 2040 when the current challenges in the two sectors are not properly handled?

I think these challenges are not for government alone; they are for government, private sector, development partners, the parents, local authorities, head teachers, NGOs etc…these need to work hard to change these results.

Primary completion rate in Uganda is 30%, this is low and that is attributed to kids not learning as a result of teachers’ absence in class. This is not good for a country that has an ambitious Vision 2040 target. You need to motivate teachers, health workers by giving them incentives, monitoring their work and above all give them the required skills.

You talk of 25% of our budget going to these sectors…yet, according to the report, there seems to be no value for money…

Well, I think what has happened is that schools expansion has been very fast and teacher recruitment has also been very fast. So that has created a number of teachers that are not prepared to be teaching. Like I said, these teachers need to be motivated, viewed as mothers of the sector and valued in society. The same should happen to health workers if value for money is to be realised.

Uganda has one of the fastest growing population rates in Africa (3.2% per year). I see this putting more pressure on the two troubled sectors?

It does put pressure but I think putting girls to school and keeping them there for secondary school is one of the best ways of preventing very early marriagesand motherhood. Ensuring that girls can gain the power of education is good for a country like Uganda.

When mortality rates reduce; which is the case in Uganda, and fertility rates do the same, then you will have what is called demographic transition. Once this happens, then the economy will do better because that is when you have more people working against the dependants.

It is good that you did the study and came out with evidence on ground; but I am not pretty sure whether our policy makers will make use of this report…won’t that be a waste of resources on your side?

I have faith in Uganda’s system (laughs) and the stakeholders. I think Ugandans value education and health. So I do not think we are wasting our time.

When I used to work herechild mortality was very high now it is low, poverty levels too were very high, and now the rate has gone down dramatically, meaning good things can happen in this country. This country looks very different from what it looked in 1994 when I fast came here.Let us focus on big things which includehealth and education.

How do you compare the situation in Uganda to that of other countries where similar studies have been carried out (say Kenya, Tanzania & Senegal etc…)?

There are a couple of areas where Uganda is better but most of all Uganda comes out the weakest particularly on teachers failing to mastermathematics curriculum and when it comes to having text books. Also the absence rates are high both in classrooms as well as other places including health compared to other countries. However on the area of infrastructure (electricity, water, and sanitation) Uganda is doing well compared to the other countries.

So, what is your general recommendation to policy makers in as far as these two sectors are concerned?

There is no single solution. But my general recommendation would be holding a national dialogue to digest measures that will help Uganda do better. This issue of having teachers striking is not good. It should be changed fast by getting on one table and discussing the issues.

Without competent teachers and health workers, whatever we want to happen will not happen. The government, teachers’ unions, private sector, civil society etc…should deal with these issues in unison to achieve success in the two sectors.

What risks are there if say, Uganda fails to find lasting solutions to the challenges in the two sectors?

I come from a society (Finland) where every person is highly educated. The whole society is completely different, brilliant, and proud of their work no matter where they go to work. For Uganda to be like my country it is a must for it to pay attention to the challenges in health and education.

Where do you see Uganda in the next few yearsif we put right what is wrong in the two sectors?

I think putting right all things in the two sectors is important for growth. The issue of youth employment and productivity need serious attention. Once these are sorted out, poverty will reduce, the economy will grow and everyone will be happy. Uganda needs to motivate teachers and the latter should have the will to work. The same should apply in the health sector.

Your last word…

I think the survey was good and I hope in the next two years, we will find different data from the one we have today. I urge all those concerned to act, act and act on the challenges in the two sectors for future benefits.

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