The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better Health for Africa in the New Millennium

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas: 1) leadership and governance for health; 2) health services delivery; 3) human resources for health; 4) health financing; 5) health information systems; 6) health technologies; 7) community ownership and participation; 8) partnerships for health development; and 9) research for health. This paper describes a framework constructed for implementing the necessary activities in each of these priority areas; and proposes recommendations for consideration by Member States in the development of their own country frameworks. The frameworkfor implementing activities related to health information and research for health which have been taken into account in the Algiers Framework are discussed separately elsewhere in this issue

Voices of the poor: Health is important but badly managed

This paper has been prepared based on the findings of the studies carried out by the Uganda Participatory Poverty Assessment Project (UPPA) in nine districts of Uganda. The nine districts are Bushenyi; Kabarole; Kalangala; Kampala; Kapchorwa; Kisoro; Kotido; Kumi and Moyo. The author reviewed the nine reports; from which common themes were identified which are the basis for the paper. The reflections in the paper are to a greater extent those of the poor people in the nine districts. It is strongly believed that although the study by UPPAP involved only nine out of the then forty-five districts in the country; the views from the nine districts generally represent the interests that are shared by all the districts. The author has picked on the points brought out by the nine district reports and looked at them in line with the policies and development in the health sector and the poverty eradication action plan in general. The views and recommendations reflected in the paper are therefore not those of the author but rather views of the poor reflected in the perspective of the on-going developments in the health sector and the nation at large. While there are district variations in the way the communities perceive poverty; all the districts reviewed share a common view that health is an important factor in poverty both as cause and effect. Poor health and inadequate health services were indicated to be major causes of poverty at individual; household and community levels. The factors mentioned responsible for poor and inadequate health services include long distances to health facilities; inadequate drug and medical supplies; user-fees; untrained and inadequate health personnel; negative attitude of health personnel to patients/clients; poor infrastructure; and lack of referral system associated with poor transport systems in the districts. The communities also point out that the health sector policies are not well explained to the communities are not clear about what is being offered and what is expected of them. Poor health hinders the ability to work and therefore leads to decreased production. This may affect the individual persons that are sick but also family and community members who have to care for them. For example; in two of the four sites visited by the study team in Kisoro; it was reported that when an individual falls sick and requires to be taken to hospital; because of lack of transport; because of the lack of transport; a group of able bodied men including members of the family and other members of the community in the neighbourhood have got to accompany the sick person to hospital. This often means that at least a whole days work is lost for everyone involved. At times when a person fall sick; in order to get treatment and the necessary care; there may be no alternative to selling off the few assets the family has. The effect of loss of such assets on the poverty status of the individual and the family can be devastating. Communities have clearly identified malaria and AIDS as leading causes of death among their population. Specifically with reference to AIDS; it is reported that deaths; especially of the breadwinners; have resulted into family disintegration and more dependence. Whereas the family may e become an added burded to some other family. Where there is nobody to lean on; the family social and economic status may drastically change negatively. A case study of Basigayabo Anastazia ellucidates the point. Anastazia is a widow looking after six orphans. She underwent a surgery and currently she could not no most of the hard work. She solely depends on the son to cater for basic essentials. She feels that without the son; she cannot survive. She has no help from any of the other relatives. In some cases; after such deaths; windows and orphans may lose their land to relatives; the only land that would have helped them through