UGANDA COUNTRY REPORT

FOR THE FOURTH MEETING OF THE FOLLOW-UP COMMITTEE ON THE IMPLEMENTATION OF THE DND AND ICPD-PA

The Republic of Uganda
28^TH - 31^ST JANUARY 2002
Yaounde - Cameroon

1. Introduction

The Republic of Uganda is situated in East Africa and lies between latitude 4⁰12'N and 1⁰29'S and longitude 29⁰34' and 35⁰0'E. It is bordered by Kenya in the East, Tanzania in the South, Rwanda in the Southwest, the Democratic Republic of Congo in the West and Sudan in the north. The country occupies a total area of 241, 038 sq. km. out of which 82% is land.

The population of Uganda has increased from 4.9 million in 1948 to 16.7 million in 1991. The estimated population for 2000 is 22.2 million. The population density as at the 1991 census was 85 persons per square kilometre, one of the highest in sub-Saharan Africa. The population is unevenly distributed, the density varying roughly according to the rainfall pattern. Among the 56 districts the density varies from over 200 persons per square kilometre in those districts that have high annual rainfall of about 1, 500 mm to below 50 persons per square kilometre in the drier areas with an average rainfall of less than 1, 000 mm per year.

2. Overview of demographic and socio-economic situation.

SOME SALIENT INDICATORS OF UGANDA'S POPULATION

* Poverty level figures 56 and 44 are for 1992 and 1997 respectively.
** Primary school enrolment figure 2.3 is for 1989.

Source: Census 1991, UDHS 1995, UNHS2OO0 & UDHS 2000

Uganda's prevailing demographic, social and economic indices are still unfavourable as can be seen in the above table. The population growth rate is high with a sizeable young population. Fertility levels are high and traditions and cultural practices that encourage high fertility are still strong. The use of modern contraceptives is low and there is evidence of unmet need for family planning and other reproductive health problems.

The country is emerging out of economic decline and has registered over 6.5% annual economic growth during the last ten years. There are, however, still problems of rehabilitation and reconstruction of the infrastructure. Poverty still affects a sizeable proportion of the population. Employment generation is still low and the private sector has not grown substantially to provide avenues for large scale employment.

Government has introduced a decentralisation policy which has inter-alia devolved public service delivery to local governments. The decentralisation policy has brought population and development issues closer to the grassroots.

Although improvements have been made in the provision of safe water, half the population has no access to safe water while a third has no access to proper sanitation.

Infant, child and maternal mortality rates are still high. Considerable efforts are being made towards improvements in the fertility and mortality situation in the country. As a consequence of measures instituted by government in collaboration with NGOs, donors and communities, notable success has been registered in some areas. Reduction in HIV/AIDS infection rates has also been recorded. However, there are emerging health issues that merit attention. These include Reproductive Health problems associated with adolescents and old age populations and the health and socio-economic needs of the marginalised and disadvantaged population groups.

In summary, Uganda's population is characterised by:

• Rapid population growth estimated at 2.5 per cent per annum.

• Young population with a median age of 17.5 years and high dependency ratio at 1.03.

• Very high total fertility rate at an average of 7 births per woman and there is no evidence that fertility will decline soon.

• International migration contributes a very small proportion of about 3% to the overall growth of Uganda's population. However, the current situation in the region may have changed the status because of immigration of refugees.

3. Population Policies and Programme interventions in Reproductive Rights and Reproductive Health.

There is a National Population Policy that was promulgated by government in January 1995. There are other policies in place such as the Gender Policy, the Youth Policy and the Health Sector Strategic Plan 2000/01-2004/05 that are all geared at the improvement of the quality of life of the people.

The Government of Uganda had instituted an explicit and comprehensive National Population Policy in 1995 with a view to influencing future demographic trends and patterns in the desirable directions in order to improve the quality of life and standards of living of the people. It has embarked on major programmes to address the population concerns of the country. The major programme areas named below were aimed at addressing these population concerns and they included:

a. Primary Health Care (PHC) to improve on access to health care in order to address poor health concern of the population.

b. Water and Sanitation programme to improve access to safe sources of water and sanitation in order to address environmental health concerns of the population.

c. Universal Primary Education (UPE) to increase literacy rate in the country especially among the female population.

d. Feeder roads - rural road network to improve access to market for peasants to sell their crops and improve household income.

e. Plan for Modernization of Agriculture to improve household incomes, nutrition and availability of food resources to the population.

f. Poverty Eradication Programme as a way of improving household income and basic needs of the population.

Affirmative action towards equity and empowerment of women is beginning to yield positive results. A Ministry of Gender, Labour and Social Development has been created with functions of policy formulation and review of gender issues and supporting gender responsive legislation among others.

4. HIV/AIDS

It is two decades now since the first cases of AIDS were identified in Uganda. Since then a number of multi-sectoral approach has been put in place to combat the scourge. AIDS control activities are coordinated by the Uganda AIDS Commission at the National level and the District AIDS Coordination Committees at the district level. Under the multi-sectoral approach, all line ministries are actively involved in AIDS control and most have initiated AIDS control programmes. There are also a number of Non-Governmental Organisations involved in the fight against the scourge.

Currently, 1.4 million people are living with HIV; 100, 000 people are living with AIDS; 4% of rural population is living with HIV; 8% of the urban population is living with HIV; Average HIV/AIDS prevalence is 6.1%; 25, 000 annual mother to child transmissions; 2.2 million cumulative HIV infections; Approximately 800, 000 have died of AIDS. (Source HIV/AIDS surveillance report MOH, June 2001)

5. Prospects for Fertility Decline

The demographic characteristics of the Uganda's population are influenced by a number of factors. These include rapid population growth, fertility, mortality and to a certain extent migration. In addition, there are underlying issues such as poverty, social, cultural and gender inequity, which contribute to the people's choices about fertility, development and resource management. These factors affect the day-to-day decisions and choices made by individuals, women and communities, often creating circumstances where they are forced to maintain high fertility. For this reason, it is crucial that the government tackle concerns which have wider policy issues if efforts to meet our fertility transition and objective for sustainable development are to be achieved by:

• Design interventions targeting the rural men and adolescents.

• Support strategies to address high unmet need across the country and avail contraceptives in the rural areas for quality reproductive healthcare and family planning information and services.

• Promote safe motherhood programs with particular emphasis on Birth Preparedness.

• Support education programs on population and interrelationships at schools, beginning at primary level

• Support enrollment of adolescent girls in post-primary training institutions.

• Support advocacy to promote Family Planning - focusing on policy and decision makers at national, district and lower levels.

• Support strategies for women inequity for quality reproductive health services.

• Support strategies for addressing wide spread poverty in the rural areas.

• Involve civil society organization in population programmes.

• Support private sector to provide family planning services and education.

6. Recommendations for Policy Oriented Actions

There is need to aim at building upon and consolidating the achievements made in the past. There is a need for a fuller understanding of the interrelationships between population and development to allow a more informed articulation of the nation's vision in this regard. Such understanding should be the foundation for a long term plan for addressing population issues. Accompanying this need is the strengthening of data utilisation and capacity to collect, analyse and use the data for micro-level planning, reproductive health service delivery and advocacy.

The political and legal framework is in place for addressing population issues. Gaps in laws and policies that retard the realisation of National Population Policy (NPP) goals will have to be addressed.

In order to take full advantage of decentralisation and the present system of governance, the requisite personnel should be placed at the various levels of decision-making (viz sub-county, district, national and with NGOs). This requires building adequate capacity for development planning and programme implementation at all levels and to advocate for attitudinal change especially among civic leaders.

There is need to strengthen the health care system by providing adequate health infrastructure, and enhancing the utilisation of services. In particular, reproductive health services should be made accessible, affordable, and user-friendly for all. Promotion of adolescent Reproductive Health and male involvement should be key strategies in this endeavour. Health issues which had hitherto not been given due attention should be addressed. These include genital cancers, infertility and reproductive health problems associated with old age. Efforts should be made to extend services to marginalised population groups.