Archive for October, 2013

Are global health leaders in Uganda effectively strengthening local public health systems?

October 23, 2013

Global health leadership in Uganda is linked with the provision of billions of dollars via large-scale global health aid NGOs.  Generally, most of this aid is distributed into vertical programs, focusing on specific diseases.


The Baylor College of Medicine-Bristol-Myers Squibb-Texas Children’s Hospital-Children’s Clinical Centre of Excellence at Mulago Hospital, Kampala, funded by PEPFAR

 As well as their specific goals, most of the NGOs explicitly incorporate health system strengthening into their objectives. But are they doing enough to ensure that the rhetoric becomes reality? It is difficult to be convinced of the contrary, when one observes the disparities between the provision of high-quality care to patients enrolled in NGO-funded programs, to that which members of the same community receive in the public health system.

ImagePublic health system-funded ward at Mulago

A roughly two-fold situation may exist: NGOs may not be effectively strengthening local public health systems as well as they might; in addition there may exist some potentially adverse (while inadvertent) consequences of vertical programs on public health systems.

 Clearly, strategies to ensure Ugandan health system strengthening must be a collaborative effort between donor and recipient. The 2008 NGO Code of Conduct for Health System Strengthening was created to serve as a guide for NGOs working to limit their harmful effects and maximize their contributions to strengthening public health systems. In addition to this, the Ugandan Ministry of Health has launched the Uganda Health System Strengthening Project, a government initiative set out to assist the country achieve the Uganda National Minimum Health Care Package, with a focus on maternal health, newborn care and family planning.

 While applauding the undeniable progress made by vertical programs funded by today’s global health leaders, in the future we must strive to build on these efforts while ensuring true health system strengthening and ‘Health for all’.