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close this bookSafe Blood in Developing Countries - The Lessons from Uganda (EC, 1995, 151 p.)
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

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.