Voting for your health: Uganda Decides 2016

I first wrote this article 4 years ago and it struck me that as the next election cycle comes up in 2021; we seem to be in the same place and perhaps even worse with the Covid-19 layer pushing everything else aside. So I ask again, will we vote for our health in 2021?

February, 2016

This past week, years and months of preparation on who leads our country for the next 5 years came to a head. As we watched a whole gamut of emotions, actions and reactions unfold; it got me thinking about whether I voted wisely with regards to our health and wellbeing. As a diabetes advocate, in particular for type 1 diabetes, the jury is still out on whether my vote counted. In drawing analogies with our voting process, I have my national ID card and finally got my voter number but as a country I am not aware of a central national registry that tracks our citizens living with diabetes especially children. In desk research I conducted, I discovered that the Ministry of Health conducted a Non-Communicable Disease Risk Factor Baseline Survey in 2014 using the World Health Organization (WHO) STEPwise approach to Surveillance instrument. According to this survey, the magnitude of raised fasting glucose including diabetes was estimated at a prevalence of 3.3%; with the prevalence higher in the urban (4.8%) than in the rural areas (2.9%). There was no significant gender difference in the prevalence of raised fasting glucose (males 3.7% vs females 3.2%). Of the participants with raised blood glucose, 89% were not on medication nor aware of the raised fasting blood glucose status. This means that there is an estimated 530,224 adults who could have diabetes. Let’s put this number in context of the associated costs. According to Schwartz et al[1] , if we use China as a reference country, it would cost $500,000 per capita per year to conduct a diabetes education media campaign, up to $500million for the treatment of uncomplicated diabetes and up to $1billion for complicated diabetes.

I still have not found recent national statistics that show the prevalence of the condition in the age group 0-18 years. All I could find was some information with attendance statistics from various diabetes clinics across the country and I remain skeptical on whether I can rely on it as most of it was undated or not referenced. In the absence of understanding the magnitude and impact of childhood diabetes, it becomes very difficult to craft a national diabetes policy, treatment and care protocols for health workers and families, and to attract the kind of strategic partnerships and alliances that enable a holistic, sustainable approach to living positively and healthy with diabetes.

As a nation, we have committed in principle to the Sustainable Development Goals as per the United Nations Agenda 2030 for Sustainable Development, which finally firmly puts Non-Communicable Diseases (NCDs) on the new global development agenda as a universal priority that must be addressed in order to realize sustainable human development. However, the question that comes to mind is, where is our national policy and action plan on NCDs? Should I have hope that in the interests of a healthy nation, we shall see selfish interests put aside for a multi-sectoral and multi-stakeholder approach that is needed for Uganda to fulfill its obligation to ensure healthy lives and promote wellbeing for all?

I am aware that there have been initiatives by government and various partners to put in place guidelines for health workers on the management of NCDs, to relieve the pressure on the national and regional referral hospitals by equipping health centres and upskilling their staff to run diabetes clinics and we want more of this kind of action. Novo Nordisk through the Changing Diabetes program have committed to “breaking the one rule”- that is the “rule of halves” that highlights the key challenges in the management and care of diabetes using research conducted by the International Diabetes Federation in their 7th edition of the Diabetes Atlas. Based on the “rule of halves”, only half of the estimated 415 million people with diabetes have been diagnosed and only about half of those diagnosed receive professional care. Of the people receiving care, only about half achieve their treatment targets and of those, only about half live a life free from diabetes-related complications. I suspect with a reasonable degree of certainty that the figures in Uganda are higher.

So whether you are for truth and justice, going forward or steady progress, in the case of diabetes, we the voters, have the power to demand for adequate resources for our health systems and services, to work with government and the private sector to provide access to affordable medicines and/or treatment, to delay and/or avoid the un-forgiving complications of diabetes and to continuously strive for people living with diabetes to live full and healthy lives. I urge you to hold your elected leadership accountable to make sure that you voted wisely for your health.

[1] Jeremy Schwartz, David Guwatudde, Rachel Nugent and Charles Mondo Kiiza, “Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data”, Globalization and Health 2014.