Cover Image
close this bookSafe Blood in Developing Countries - The Lessons from Uganda (EC, 1995, 151 p.)
View the document(introduction...)
View the documentQuotation
View the documentForeword by the Uganda Minister of Health
close this folderForeword by Commissioner Professor Pinheiro
View the document(introduction...)
View the documentWhat the blood transfusion service has done for Kabarole hospital
View the documentSome facts about Uganda
close this folderSection One - Introduction and summary
close this folderChapter One - Safe blood and HIV/AIDS: The Uganda achievement
View the document(introduction...)
View the documentThe tragedy of the haemophiliacs
View the documentInfections carried by blood
View the documentThe unique features of Africa
View the documentThe global blood safety initiative
View the documentThe Uganda blood transfusion service: A portrait
View the documentThe wider contribution of the UBTS
View the documentThe view from an up-country hospital
View the documentThe matter of costs
View the documentThe dynamics of the project
View the documentA complex organisation
View the documentA view from Mulago hospital, Kampala
View the documentFour questions about AID
View the documentThe first visit for the EC
View the documentDr John Watson-Williams enters the scene
close this folderSection Two - Background: Uganda's history, health, and the HIV/AIDS epidemic
close this folderChapter Two - Uganda's political and physical health: A brief history
View the documentA. The political background
View the documentB. The health of the nation
View the documentC. Safe and unsafe blood in Uganda
close this folderChapter Three - AIDS in Uganda: A glimmer of hope?
View the document(introduction...)
View the documentExtent of aids in Uganda
View the documentMobilising to deal with HIV/AIDS
View the documentThe evidence for 'a glimmer of hope'
View the documentVoluntary mass HIV testing as a route to behaviour change
close this folderSection Three - The story of the Uganda blood transfusion service
close this folderChapter Four - How the European commission got involved
View the document(introduction...)
View the documentDr Lieve Fransen's report
View the documentThe 1987 plan
View the documentThe 1987 starting position
View the documentThe role of the Red Cross
close this folderChapter Five - Phase one of the project 1988-1990
View the document(introduction...)
View the documentA plan for blood donors
View the documentThe problem of laboratory space
View the documentThe problem of staffing
View the documentStaff structure and training
View the documentThe need for special skills
View the documentReconstruction of the Nakasero building
close this folderChapter Six - Phase two: Creation of a national service 1990-1991
View the document(introduction...)
View the documentRole of other donors
View the documentStaff recruitment
View the documentRegional blood banks
View the documentVoluntary testing for HIV
View the documentSupervision and quality control
close this folderSection Four - Evaluation: The view from Kampala
close this folderChapter Seven - The costs and benefits of safe blood in Uganda
View the documentA. The costs
View the documentB. The benefits to HIV prevention
View the documentC. Some other benefits
close this folderChapter Eight - Interview with Dr Peter Kataaha, Director, Uganda blood transfusion service
View the document(introduction...)
View the documentFlying to the rescue
View the documentChapter Nine - Interview with Dr Samuel Okware
close this folderSection Five - Key issues in blood transfusion: The Uganda experience
close this folderChapter Ten - The search for safer blood and the drive for voluntary, unpaid blood donors
View the document(introduction...)
View the documentCosts of relatives versus volunteers
View the documentFuture strategies: Donor clubs
close this folderChapter Eleven - The organisation of a blood transfusion service
View the document(introduction...)
View the document1. A centralised organisation
View the document2. A regional system
View the document3. A hospital-based system
View the document4. A mixed system
View the documentThe Zambian solution
close this folderChapter Twelve - Blood transfusion takes many skills: The importance of training
View the document(introduction...)
View the documentA. Training of Nakasero staff
View the documentB. Training of hospital staff
View the documentC. Residential courses for hospital staff
View the documentD. Training at schools for medical assistants
View the documentE. Training of senior professional staff
close this folderChapter Thirteen - Other issues, and their solutions
View the document(introduction...)
View the document1. Which diseases are screened against - and which are not? and why not?
View the document2. The special problem of malaria
View the document3. Adapting laboratory methods
View the document4. The start-up equipment - and computer
View the document5. Transport, for people, supplies, and blood
View the document6. Voice and data communications - or lack of
View the document7. Funding staff salaries in a time of inflation
View the document8. Keeping records, or trying to
View the document9. All or only some hospitals?
View the documentThe editor adds:
close this folderAppendices
View the documentAppendix 1: EC support for safe blood in developing countries
View the documentAppendix 2: Useful references

A. The political background

'With a per capita income of under US$ 170, Uganda today is one of the poorest countries in the world: indeed, it is a living testament of the havoc caused by the political turmoil and economic decline brought about by more than a decade of despotic rule.'

This is the verdict on Uganda that begins the World Bank survey of Uganda, entitled Growing out of Poverty, published in 1993. After being a British protectorate for 70 years, Uganda gained independence in 1962. At that time, the country had much going for it. It was one of the most vigorous and promising economies in sub-Saharan Africa. It had a good climate and fertile soil: it was self-sufficient in food, and its agriculture, along with textiles and copper, earned enough foreign exchange to pay for imports and still show a surplus. Savings stood at 15 per cent of GDP, enough to finance a reasonable level of investment, and the country had a good system of roads, railways and air transport. But in 1971 the first president, Dr Milton Obote, was overthrown by a military coup lead by General Idi Amin.

'The Amin regime radically reversed the economic and social progress attained since independence, and the ensuing civil strife resulted in tremendous loss of human life. It is estimated that as many as 500,000 Ugandans lost their lives during Amin's eight-year dictatorship and as many as one million more were internally displaced from their homes and farms,' says the World Bank. Amin was eventually deposed, but this was not the end of Uganda's troubles. Dr Milton Obote resumed power in 1980, but according to the London-based Independent newspaper,

'The 1980 election, now widely regarded as fraudulent, resulted in the return of Milton Obote... [but] the country was plunged into a barbarous civil war which exceeded any atrocities committed during Idi Amin's rule.'

The toll taken by two long periods of civil strife was terrible. Skilled people left the country, Uganda's GDP declined by 25 per cent in the decade 1970 to 1980, exports by 60 per cent, and inflation rose to 70 per cent a year, under the pressure of heavy military spending and bank borrowing. In particular, government spending on education and health had by 1985 sunk to 27 per cent and 9 per cent of the levels of the 1970s.

This literal decimation of health expenditures was all the more disturbing because at independence Uganda's social indicators were as good as, or better than, most of Africa, with a good health service that had pioneered many low cost health and nutrition programmes. There was an organised network of vaccination centres, and an immunisation programme that reached 70 per cent of the population.

By early 1986, when the National Resistance Army (NRA) and its political wing, the National Resistance Movement (NRM) took power, the country was in dire straits. The NRA leader, Yoweri Museveni, was declared President and the NRA quickly took control of the country except for sporadic resistance in the North and East. But the infrastructure and the economy had been destroyed by the fifteen years of civil war and mismanagement. The roads were in disrepair (journeys of 80 km took over two hours), the railways were not working, telephone lines were destroyed, water mains and pumping stations were broken and the electrical supply was irregular, inconsistent and dangerous due to inadequate generation and overloaded transformers and distribution lines.

Government pay was six months or more in arrears and inadequate to provide the necessities of life. Government workers worked either a few hours a week or not at all. If they came to work there was nothing to do. To survive they had to spend as much time as possible growing food and working in what was left of the private economy.

The new government soon achieved the confidence of European and other Western governments. With emergency aid major roads were rebuilt and the utility services underwent a complete survey and essential repairs. Health care services were revived as far as possible, and health expenditures began to increase again. But the task of rebuilding the nation was immense.