The current Health Sector Strategic Investment Plan (HSSIP) II in Uganda acknowledges the need for a national compact and multi-sector action. However, practical steps for its achievement are not well articulated. To contribute to national level debate on the role of Inter-Sectoral Collaboration (ISC), the African Centre for Global Health and Social Transformation (ACHEST) undertook a study to assess the status of ISC in achieving Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) in Uganda, with special emphasis on Sexual, Reproductive Health and Rights (SRHR).
The study was undertaken in the period November 2018 to April 2019. The Methodology of the study involved: desk document review of available literature on Uganda Local Government structures, UHC, SDGs and SRHR; key informant interviews, focused group discussions and use of structured questionnaires administered to key leaders at national, district and sub-district levels. The study covered governance and policy structures involved in implementation of programs for SRHR and achievement of SDGs at national level and in four selected districts of Lira, Luwero, Masindi and Ngora. In addition, the study also included interactions with selected CSOs and development partners. Data was analyzed qualitatively using patterns, themes and codes which were generated from the study objectives.
Study findings revealed that SDGs are fully integrated into the National Development Plan (NDP) II and implementation structures are in place. The National Planning Authority (NPA) has a clear SDG implementation Framework coordinated by the Office of the Prime Minister. However, there is limited implementation of this Framework due to sector budgeting and implementation arrangements which are in silos. For a long time, the operationalization of the NDPs into Programs and Budgets has not changed. Instead, the mandates and structures of Government ministries have remained static in silos since independence. Transition towards ISC in line with SDGs framework has not been implemented. A mind-set change in the public service, as well as the political will to transform current implementation modalities within ministries from silos mode to a more desirable Inter-sectoral collaboration approach is needed
Decentralization laws in Uganda delegate implementation of government programs to the Districts which serve as a converging point for ISC. The study found that structures for ISC are in place at the District Local Government level. These include District Councils, Chairpersons, Chief Administrative Officers and District Planning Committees. This arrangement is repeated at Sub district level with Sub-County and Parish councils and administrative structures. It is at the District level that practical ISC should manifest itself in terms of better services delivery to the people through coordinated programs and operations. Although there is evidence of joint planning, nearly all Government program at this level are still being implemented in silos.
The linkages and collaboration required from the non-health sectors were found to be weak across all levels. Health engagement and accountability of non-health sectors was found to be sporadic and non-visible. For instance, other sectors perceive the issue of SRHR to be the sole responsivity of the health sector.
The study found evidence of erosion of social and cultural values which is affecting the upbringing of the young people. This erosion in social and cultural systems and other emerging negative issues require collaborative efforts across all sectors of society to mitigate their impact.
Following conclusion of the study, ACHEST conducted a consultative meeting with various stakeholders drawn from different Government Agencies (MDAs) like NPA, NPC, UBOS, MoH, District leaders, Community leaders, Development partners as well as policy makers. The call from these stakeholders was to test the feasibility of implementing ISC at community level for Integrated People Centered Primary Health Care (IPHC) through the “Whole of Society Approach” as the vehicle for accelerated achievement of UHC and SDGs in selected districts in Uganda with a view to fully scaling it up in the whole country.