Prioritize investment in child health to guarantee future human capital
This week from the 16th to 18th August, 2017, Makerere University School of Public Health, in collaboration with the Ministry of Health, are hosting a symposium on Universal Health Coverage (UHC) under the theme “Health
Financing for Universal Health Coverage: More money for health AND more health for the money”. This symposium is coming at a time when there has been a lot of discussion in Uganda on economic transition from low income to middle income status by 2020 according to government projections. While these are statistical projections, the National Planning Authority indicates a different projection, and my own guess is that with current per capita income of about US$770, achieving per capita income of above US$1070, which is required for a “Middle-income” status in the next three years will be a tall order to climb.
Reflecting on the symposium theme, I indeed concurred that we need more funding for health, but quickly asked the question: where should Uganda as a country 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 rather invested heavily in human capital development. To this, add trade.
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 human brains are developed to be able to be exploited to their fullest. Scientists argue that most brain development occur during the first 1000 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 programs are currently being implemented or rather what policies exist to ensure child development that would guarantee a people ready to fully engage in economic activity later in their years.
The latest Uganda Health Demographic Survey (UDHS 2016), shows that Uganda has made major improvements in child health, with child deaths reducing from 151 deaths to 64 deaths per 1000 live birth over the last fifteen years (2001-2016). However, the burden of child deaths and morbidity or illness remains high. Indeed, during the same period of fifteen years, Uganda did not make a single reduction in newborn death. It is currently 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 morbidity around the time of birth. Surprisingly, the highest numbers of neonatal and stillbirth loss are in presumably the more well off regions of Uganda, namely Buganda and Ankole, then followed by Lango and Acholi.
The story is beyond the mothers and babies that are lost within the first 1000 days. Again, according to the UDHS 2016, Uganda has very high rates of malnutrition. It is estimated that almost one in three children (29%) under five years have stunting, and another 4% 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 once again given our known high fertility, 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 with comprehensive interventions if they 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.
So back to the question: where should Uganda be investing its money to ensure a sustainable and prosperous future society? It seems clear to me that care during pregnancy, birth and the first two years should be the area of priority focus. As a country, we should not be have 29% of 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 immunization and malaria control. However, as seen from the Demographic survey statistics, we may need to invest more than we are currently doing. Currently, the government has chosen to prioritize infrastructure: roads, the energy sector, security, and politics. Yes, these are important areas in their own right, but these will require people who are alive, healthy, and vibrant, good 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 also within health, we must prioritize maternal, newborn and child health, if we are to guarantee future sustainable economic growth and development.
*Blog by Dr Peter Waiswa, an Associate Professor in the Department of Health Policy Planning and Management at MakSPH and also heads the Makerere University Centre Excellence for Maternal Newborn and Child Health.