Doctors for Africa

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The Uganda-UK Health Alliance, based on the immensely successful Zambia-UK Health Workforce Alliance, has been set up in recognition of the mutual interest of Uganda and the United Kingdom in promoting co-operation and interaction in healthcare between the two countries- inspired by their common principles and complementary objectives – and wishing to extend the existing professional, governmental and non-governmental contacts between the UK and the Ugandan health care systems.

The previous evening, fellow Doctors For Africa members Ronald Lukandwa, Rita Suubi and I attended a reception at the UK parliament where we interacted with members of the House of Commons and the House of Lords and other personalities and stars in global health. This networking event, in the premises of that imposing and august UK institution, provided a platform to motivate and stoke the aspirations of a burgeoning UK-based international health army.

The 12th February conference began with a presentation of Uganda’s national health strategy and health priorities by Dr Mukone and an overview of nursing and midwifery in Uganda by Mrs Enid Mwebaza. It emerged that Uganda’s health is on life support with shocking health indicators. For example, in 2011, her infant mortality rate was at 54 deaths for every 1000 live births, her under-five mortality rate was a jarring 90 deaths for every 1000 live births and her maternal mortality rate a woeful 438 deaths for every 100 000 live births. Even for Africa, this is an abysmal performance. Noting that Uganda’s life expectancy was now 52 years, Dr Mukone, who is past that age, acknowledged that the sword of Damocles hangs over his head. He is, effectively, a Ugandan living on borrowed time, literally. That woke the audience and had them oscillate between chuckles and borderline guffaws!

Mrs Enid Mwebaza, eager and crisp in her delivery, mentioned that Uganda has 6724 nurses and 4656 midwives who collectively make up 60% of the health workforce in Uganda but deliver 90% of the health services in the country. Hot on the heels of that statement, she made an impassioned case for the importance of nurses and midwives in delivering on Uganda’s health priorities, especially in reducing Uganda’s unsettling maternal mortality rates and in increasing access to post-abortion care.

Another point that came out vividly from the conference was that Ugandans must take the helm of international health initiatives operating in their homeland. This was thoroughly refreshing and music to the ears of many, especially the Ugandans in attendance. Sadly, past experience has shown that such well-meaning ventures can quickly turn venomous and crippling when one side of the alliance adopts a condescending holier-than-thou my-way-or-the-highway attitude while the other party genuflects, begging bowl held high. As Moses Mulimira, chairman of the Uganda Diaspora Health Network reiterated, it is imperative that this alliance remain a partnership cognizant of the benefits of a two-way learning and development process. Indeed, Lord Nigel Crisp, in his book Turning the world upside down, has long called for the move from international development to co-development and mutual learning:

I have argued elsewhere that we need mentally to ‘turn the world upside down’ because those of us living in the richest countries have a great deal to learn about health and healthcare from people who, without our resources and, without our vested interests, are innovating and dealing with problems that we are unable to address adequately. There are examples throughout the world which range from clinical practice to service design and from product development to policy making. In other words, everyone has something to teach and everyone has something to learn. We should learn to think not in terms of international development, but in terms of co-development.

Dr Neil Squires, the Head of Profession (Health) at the UK’s Department For International Development, pledged the UK government’s continued support to the improvement of health in Uganda and made it clear that the UK attaches grave importance to the establishment of stronger systems of accountability, to reduce the risk of corruption and to ensure that the human rights of all Ugandans are respected. Coming in the wake of Uganda’s brazen corruption scandals and subsequent suspension of aid, this was a sobering awakening to the fact that the conditions in Uganda and, sometimes, the intentions coming from there are far from ideal. Another jarring reality that he deftly articulated is that volunteer and aid organizations, in their well-intentioned quest to make impact, sometimes end up increasing their carbon footprints with their frequent parachuting in and out of countries. Short-term volunteer trips with no solid sustainability plans end up doing more harm than good to the environment.

Building up on that, Professor Ged Byrne, director of the University Hospital of South Manchester Academy, was spot-on in his call for the alliance to consistently produce best practice volunteer and aid activities while having clear and robust exit strategies.

The UK-Uganda Health Alliance seems to have started off on the right foot and audaciously bursts the dual bubble of arrogance and ignorance. This alliance is a noble, timely and measured response which makes it clear that no one has a monopoly of knowledge and skills for health service design and delivery. The take-home message was that we have to learn from each other especially since our fates are inextricably bound: We cannot walk alone!  For those of us who believe globalization must be collaboration, not standardization, this is music to our ears.

Tuesday the 17th. DFA Charity Registration No. 1125670. Campaign for Affordable Medical Solutions
Copyright 2012

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