Uganda is a landlocked developing country in East Africa with an estimated population of 24.8 million people (2002 census). At independence (in 1962) Uganda was a very prosperous and stable country, with enviable medical services in the region. This, however, was destroyed by a tyrant military regime and the subsequent civil wars up to 1986, when the current government took over the reigns of power.

The 2000/2001 Uganda Demographic and Health Survey (UDHS) and the 2002 census report revealed several poor demographic and health indicators. The data showed a high population growth rate (in excess of 3% per annum) due to the high fertility rate, estimated at seven children per woman. The age structure is therefore young, with about half the population below 15 years of age. The infant mortality rate was 88 per 1000 live births and maternal mortality rate 50.4 per 10 000 live births. Life expectancy was 43 years. Gross domestic product (GDP) per capita was around US$300.

By the mid-1980s, the economy had been destroyed and many of the medical personnel had left the country. The net effect was the current low GDP and poor health indices, which, however, have gradually improved over the last decade or so. The continuing civil wars in the north and northeastern parts of the country continue to drain valuable national resources, and the affected areas have very poor socio-demographic and health indices.

The net effect has been a dilapidated infrastructure and psychosocial problems, mainly manifesting as post-traumatic stress disorders. Uganda is one of the countries in sub-Saharan Africa that was hard hit by the HIV/AIDS epidemic; however, with a sound government strategy and a timely response, HIV infection has been reduced from a prevalence of 20–28% in the mid-1980s to the current 5.6%. Uganda stands as one of the few developing countries that has succeeded in reversing the tide of the HIV epidemic (UNAIDS, 2004).

Health reforms

The government has developed a new health policy (1999) and health sector strategic plan (2000), for which primary healthcare (PHC) was the basic philosophy and strategy for national health development, so that equitable services could be offered to the population.