Dr Peter Waiswa
EC Village Verification

By Dr. Peter Waiswa

There has been a lot of discussion in Uganda on economic transition from low to middle income status by 2020 according to government projections. My guess is that with current per capita income of about $770, achieving per capita income of above $1,070, which is required for a middle-income status in the next three years will be a challenge.

Where should Uganda invest her money to achieve and guarantee sustainable economic growth and shared prosperity? It has been said that human capital is the engine of economic growth and development, even beyond natural resources – oil, gas, and other minerals. Indeed, countries such as the Asian tigers did not necessarily develop on the basis of natural resources, but invested heavily in human capital development. To this, add trade.

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Achieving middle income status will require that every Ugandan is working at their full potential in a conducive and supportive environment. But it is critical that the human brain is developed to be exploited to its fullest. Scientists argue that most brain development occurs during the first 1,000 days of life, which is literally from conception to the end of the first two years. If brain potential is lost during that time, it may be impossible to recover in later years. As a country, we must reflect on what programmes are being implemented and what policies exist to ensure child development that would guarantee a people who can fully engage in economic activity in future.

The latest Uganda Health Demographic Survey (UDHS 2016) shows that Uganda has made major improvements in child health, with child deaths reducing from 151 to 64 deaths per 1.000 live births over the last 15 years (2001-2016). However, the burden of child deaths and illness remains high. Indeed, during the 15 years, Uganda did not make a single reduction in newborn deaths. It is estimated that Uganda loses nearly 80,000 babies at birth (39,000 as neonatal deaths and 40,000 as stillbirths) per year.

Another 6,000 lives are lost as maternal deaths. Health economists compute this as loss of future economic gain and opportunity. The actual situation may be worse as we do not have any estimates of illness around the time of birth. Surprisingly, the highest numbers of neonatal and stillbirth loss are in the presumably well off regions of Uganda, namely Buganda and Ankole, followed by Lango and Acholi.

The story is beyond the mothers and babies that are lost within the first 1,000 days. Again, according to the UDHS 2016, Uganda has very high rates of malnutrition. It is estimated that almost one in three children (29 per cent) under five years are stunted, and another 4 per cent have severe wasting. The highest rates of these conditions are around age one and a half years, most likely related to a period when many mothers conceive again and the care for the baby worsens.

Scientists have shown that children who are stunted or wasting have less brain matter, and may never recover from it later in life to achieve their full potential even if comprehensive interventions are done after two years. Research has also shown that children who stay in institutional centres for abandoned children or so called babies’ homes, have similar bad outcomes.

It is unimaginable that we still lose so many mothers, newborns and children below five years to preventable deaths. I know that government and development partners are investing a lot in interventions such as immunisation and malaria control but …we may need to invest more.

So back to the question: Where should Uganda invest her money to ensure a sustainable and prosperous future society? It seems clear to me that care during pregnancy, at birth and the first two years should be the area of priority focus. As a country, we should not be having 29 per cent stunted children yet we are a food basket.  It is unimaginable that we still lose so many mothers, newborns and children below five years to preventable deaths. I know that government and development partners are investing a lot in interventions such as immunisation and malaria control but as seen from the demographic survey statistics, we may need to invest more.

The government has presently prioritised infrastructure – roads, the energy sector – as well as security and politics. While these are important areas, they require people who are alive and healthy enough to support the economy.

As Stenberg and colleagues wrote and ably noted in the Lancet Series (2014), it is the investment in women’s and children’s health that will secure high health, social, and economic returns to any nation. They further estimated that increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits.

These returns include greater Gross Domestic Product (GDP) growth through improved productivity and prevention of the needless deaths. Yes, Uganda needs more money for health, but within health, we must prioritise maternal, newborn and child health, if we are to guarantee future sustainable economic growth and development.

Dr Waiswa is an Associate Professor and member of the SPEED project and the Director, Makerere University Maternal and Newborn Centre of Excellence.