Uganda’s ABC Strategy Revisited

During this last week or so I’ve been reading about the history of HIV/AIDS in Uganda. The international charity Avert has an excellent webpage which discusses this and how strategies such as the ABC campaign helped to significantly reduce the rate of HIV infection.

This ABC campaign started in 1987 and encouraged people to Abstain from sex and to delay the age at which a young person first has sex or Be Faithful to a lifelong partner and if you are unable to do these, then use a Condom.

The good news is that some 25 years later the most recent AIDS survey shows that more than 9 out of 10 women and 8 of every 10 men can still tell you that remaining faithful and using condoms are the best ways to avoid becoming infected with HIV.

Condomize

UNAIDS Executive Director Michel Sidibé said at the recent AIDS 2012 conference in Washington:

Let us not forget that the condom remains the cheapest and highly effective method we have to stop the spread of HIV… It is time for all of us to condomize!

However this same survey also shows that during the last 12 months for those that had more than one partner, only 1 in 8 used a condom the last time they had sexual intercourse. Condoms can be very effective but only if used correctly and consistently.

Condomize deflated

So it seems that Public Health professionals cannot solely rely upon people behaving as they know they should and we cannot rely solely on the correct and consistent using of barrier methods such as condoms. We need to combine these together with biomedical methods of prevention such as earlier treatment of those already infected, treating more of those who are infected, treatment for the non-infected partner in a discordant couple, eliminating Mother to Child transmission and voluntary male medical circumcision.

I enjoyed reading an article about this same issue by Andrew Green in Voice of America last month.

Exam Time

I sat in the exam room staring at the paper and slowly it dawned on me, I couldn’t answer any of it. I could feel the panic rising and, as is normal in this situation, I was buck naked.

Last week International Health Sciences University, in Kampala Uganda, held its 2nd Graduation Ceremony. 91 students graduated, 35 of whom successfully attained their Master of Public Health, MPH.

Justice Julia Sebutinde awarding degrees to the Master of Public Health students at IHSU.

This is still a very young institution and for those in the UK, these numbers might seem quite small, but I think they are significant for these two reasons.

According to the WHO World Health Statistics Report 2011, Uganda has just 1.2 Physicians per 10,000 population and 13.1 Nurses/Midwifes. In the UK these same counts are 27.4 and 103 respectively. Uganda has a serious shortage of trained doctors and nurses.

In the last few months I have had discussions with directors of health service providers in Uganda who are finding it very difficult to recruit and retain such trained medical staff, especially for rural up-country settings. One of the challenges facing us is that Donors and NGOs are also actively recruiting such staff and they are willing and able to offer higher remuneration packages. This is somewhat ironic when you consider that the aims of these worthy organisations is to help strengthen the country’s health system. The positions being filled are most often programme design, implementation, management and evaluation, not clinical roles. So we see Clinicians being removed from clinical roles and appointed to programme management.

Wouldn’t it be so much better if these roles were filled by non-clinicians, trained and skilled in public health? That’s one of the ways in which IHSU is trying to make a difference to the delivery of healthcare in Uganda; by providing well trained, willing and able graduates who can implement and manage public health programmes, leaving the doctors, nurses and midwifes to continue treating and caring for our patients.

My second reason is that studying for your MPH involves a lot of relevant reading, discussion and, most importantly, critical analysis. It is my own personal experience that such exposure helps make us much more considered in how we approach the design, implementation and evaluation of required interventions. I think I’m a lot less naive than I was a few years ago. I used to wonder why we couldn’t just get on with it, to do it, to make it happen and quickly (whatever “it” was).

Some of my recent public health conversations have been about the reported unmet need of family planning; according to Guttmacher, 7 out of every 10 women in Uganda who want to avoid pregnancy, cannot easily and regularly access such services. I can hear you say, “surely that must be easy to fix, and it’s cheap, an IUD costs just a few pence.”

Of course it is much more complex and there might be many reasons why an unmet need exists. There will be numerous hurdles to overcome to ensure a sustained delivery of accessible and affordable service.

Those MPH students graduating last week are now well equipped to tackle such matters and better placed than they were before to now ensure successful achievement of the desired outcomes.

Hopefully I’ve now finished my exams and can move on to starting my research and learning some more. Many years ago I used to have the dream (nightmare) outlined above, thankfully it’s never been reality.

Poor Housing Increases TB Infection

By Joe Nam, New Vision, published November 07th, 2011.

A study carried out in Makindye Division in Kampala, Lira Municipality and Wobulenzi town council has established a co-relation between poor housing and prevalence of tuberculosis in urban centres.

The research carried out by International Medical Foundation engaged 1,366 adults in 1,366 households. The majority of the respondents live in slums in conditions of what is considered poor housing.

“…we don’t have the capacity to stay in good houses. We stay in houses we can afford to pay for. We stay in houses without windows and our roofs leak. When you think of going back to the village, then you think about the hard life there…the places in which we live are surrounded by drainage channels, which flood, making it easy to contract diseases. However, we find ourselves in a situation we have no control over…” a respondent in Makindye says.

The survey found that awareness of TB was high in the population, mainly through some form of contact with a TB a patient. Myths and remarkable deficiencies in knowledge of TB cause, symptoms, transmission and prevention, however, abound.

The survey also found that although majority of slum dwellers are well within reach of a health facility, significant barriers in terms of actual service delivery exists due to lack of drugs, absentee health workers, prohibitive user fees and lack of transportation to health facility, hampered treatment of TB. TB-related stigma was found to be high in communities, with negative perceptions towards persons with TB due to association with HIV/AIDS.

The study recommended planned housing in urban centres for low-income earners, participatory engagement with slum dwellers to improve their environment, enforcement of the Public Health Act minimum standards in the construction of toilet facilities and improving access to medical care.

The study also recommended pegging of TB screening to HIV testing programmes due to the tendency to take HIV AIDS testing more seriously. Uganda is among the 22 countries in the world with the highest number of TB cases, with 100,000 new infections annually.

Advent: Day 18 1st Graduation Ceremony at IHSU

Masters in Public Health students graduating at IHSU

On Saturday 18th December IHSU held its first graduation ceremony.

In the photo above The Chancellor, Hon. Justice Julia Sebutinde, awards 31 students their Master of Science in Public Health. The Vice-Chancellor, Dr. Nick Wooding stands with her and The Chairman of Council, Dr. Moses Galukande looks on from the stage behind. The Dean, Prof. Dr. David Ndungutse, can be seen having just read the name of each graduand.

The graduation is another significant milestone in the development of International Medical Group.

International Health Sciences University is a niche university offering health-related courses. IHSU provides professionally-trained workers for the health sector in various specializations and continuing medical education for health professionals already working in the field, with the specific aim of making a difference to health care in Uganda.