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Primary health care in post COVID-19 era

Local Governments have a role in budgeting to promote primary health care

COMMENT | OSCORD MARK OTILE | Health, as defined by the World Health Organisation in 1946, is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Since the Alma-Ata conference on primary health care in 1978, the objective of national health systems of countries including Uganda has been the extension of health care to all people. Alma-Ata conceived that primary health care should address the inappropriateness of health structures to deal with predominant health problems.

In Uganda the mandate for implementation of primary health care lies with the Ministry of Local Government which is charged with the responsibility to create systems, guide, supervise and ensure that there is a sustainable delivery of health services in local governments (LGs). The Ministry of Health has done well especially with regard to building health infrastructure up to the parish level.

However, as far as the concept of health by Alma-Ata is concerned, this may be an indication of failure in the sense that by constructing more health facilities it is admission on the part of government that more Ugandans are out of the health bracket and are often falling sick.

It is almost as if the government is sending a message to citizens that it is okay for them to fall sick since the health facilities are there to treat them. I think this perspective of provision of health care is too expensive and neither does it guarantee provision of quality health service delivery.

The government needs to rethink this approach and adopt promotion of primary health care which is a cheaper alternative that will save government a lot of money that can be allocated to improve services in other sectors. This is especially considering that 75 per cent of Uganda’s predominant health problems are preventable.

In every budget cycle, health is among the top three highly funded sectors in the budgets for LGs. According to a study undertaken by ACODE in 2019 titled “Financing Local Governments in Uganda”, the analysis of the proposed national budget for FY 2019/20, revealed that in terms of share of the total sector budget, the Health sector came second with 21 per cent allocated to LG Programmes. The total funds proposed in the national budget for the health sector for allocation to LGs was Shs521 billion.

Most local government leaders are usually chest thumping on their performance basing on indicators such as the number of patients that were treated in their facilities, covering the staff gaps and many others. They forget that the filth in their municipalities or town councils for example could be the reason why children are suffering from malaria because of the breeding places for mosquitoes which is caused by failure on their part to collect garbage. That could also be the reason why children suffer from diarrhoea. It is important for LG leaders at all levels to understand and appreciate that when they perform their functions as is required of them, then they are actually making a contribution to promotion of primary health care.

Local governments should ensure that their programs are equitable, ensure community participation, use appropriate technology, use multi-sectoral approaches and put emphasis on health promotion activities.

If for instance you are the district engineer, when planning and budgeting you should be able to appreciate that if the district roads are properly maintained and are in a good state, then you are actually making a contribution to the promotion of primary health care; people will be able to walk or jog on the roads without being afraid that a motorist would knock them – a proper planned road is likely to reduce on the number of road accidents, hence reducing on the amount of money that government would spend to treat accident cases. If you are the district education officer, when planning and budgeting you should ensure that every school in the district has a water source to promote hand washing; a playground to promote physical exercises and adequate pit latrine stances.

Local councils and officials, parish development committees, religious leaders, traditional healers, teachers, community volunteers, and other people who have a strong influence on the decisions that are made about activities that affect the health and growth of children and families should consider themselves agents of change in their LGs and organise health care promotional programs in communities.


Oscord Mark Otile is a Research Officer with the Advocates Coalition for Development and Environment (ACODE)


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