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OPINION

A Snapshot of Uganda’s Health and Education Services

Sarah Ssewanyana and Ritva Reinikka

November 19, 2013

Not every African country has translated impressive rates of economic growth into rapid poverty reduction. Uganda, however, has made simultaneous progress on both these critical fronts. After a brief slowdown, the recovering economy is projected to grow by a worthy 6.5 percent in 2014. And extreme poverty has fallen by more than half over the past two decades, from 56 percent in 1992 to 24 percent in 2010, surpassing the first Millennium Development Goal on poverty reduction well ahead of 2015, the target year.

Alongside these encouraging trends, more children now survive their fifth birthdays in Uganda, and are enrolled in primary school. Yet the prospects of this new generation are not as good as they should be today. Only 54 percent of all children in Grade 3 can read, and just over half of those enrolled in school actually complete the primary level. Mothers remain at high risk of untimely death due to complications of childbirth and a lack of skilled care, and an estimated 40 infants still die out of every 1,000 births.

In short, while there has been much progress, Uganda’s education and health services—which together account for a quarter of the national expenditure—are delivering less than satisfactory results. To reach its national aspiration of becoming a middle-income country as articulated in the country’s Vision 2040, Uganda needs to make a concerted effort to improve the quality of these key public services, so that the current generation can grow into a healthy and educated work force.

On November 19, data from a new nationally representative survey, the Uganda Service Delivery Indicators, will provide fresh insights into the quality of services at primary schools and health facilities—for both public and private institutions. Supported by the World Bank, the African Economic Research Consortium and the African Development Bank, with the support of The William and Flora Hewlett Foundation, these indicators, soon to be available for the first time in Uganda, assess what teachers and health workers know and do, and the environment in which they work. The Uganda survey was implemented by the Economic Policy Research Centre (EPRC), in collaboration with the World Bank.

Already available at the national level for Kenya, Tanzania, and Senegal, and underway in a number of other African countries, these indicators capture provider knowledge, such as mastery of the curriculum or diagnosis of common illnesses; provider effort, such as time on task in terms of actual teaching and patent consultation; and the equipment and infrastructure at their disposal. The findings give cause for concern—for example, too few teachers are present in school and even fewer are actually teaching—and they point not just to low levels of motivation and gaps in knowledge, but also to weak and insufficient management of schools and health facilities at the frontline.

In Uganda, the forthcoming Service Delivery Indicators will highlight a number of issues, including serious regional inequalities that undermine the effort to build cohesion and shared prosperity in the country. To be repeated every few years, the indicators will help strengthen accountability for public services—paid for by Ugandan and donor country taxpayers—and will enable the government, service providers, and citizens to track progress and establish whether systemic reforms are achieving the desired results. This information is absolutely essential, as it ultimately raises the efficiency of public spending. It also ensures that donor funding—such as grant funding for primary education through the Global Partnership for Education—is used to implement solutions for maximum impact in Uganda.

Importantly, Uganda has recently discovered oil, which could contribute greatly to long-term growth and modernization. But natural resources wealth is transformational only if it is invested in people, contributing to a better standard of living for everyone. With adequate attention to the quality of education and health services, young Ugandans stand a very real chance of being able to acquire more advanced skills over the next two decades, and to prosper as new economic opportunities come their way.

Sarah Ssewanyana is Executive Director of the Economic Policy Research Centre, and Ritva Reinikka is Director, Human Development, in the World Bank’s Africa Region.

Watch the Uganda findings presented and discussed at 9.30 A.M. on November 19 at www.livestream.com/worldbankafrica