Abstract
Uganda faces a complex policy landscape as it simultaneously addresses infectious diseases and noncommunicable diseases (NCDs). The health system has been overwhelmed by the growing burden of NCDs across all socioeconomic strata. In this study, we sought to understand the policy context around NCDs in Uganda, the roles of actors both within and external to the government, and the factors shaping the development and implementation of NCD policies and programs in Uganda. We conducted in-depth interviews with 30 policy actors from the Ugandan Ministry of Health (MOH), nongovernmental organizations, and academia to understand the roles of different actors in the Ugandan NCD space, the programs and policy measures in discussion, and how to bridge any identified gaps. A thematic data analysis was conducted. All national actors viewed funding constraints as a critical barrier to developing and executing an NCD strategic plan and as a barrier to leading and coordinating NCD prevention and control efforts in Uganda. The crowding of nongovernment actors was found to fragment NCD efforts, particularly due to the weak implementation of a framework for action among NCD actors. Relatedly, limited recruitment of technical experts on NCDs within the MOH was viewed to further diminish the government's role in leading policy and program formulation and implementation. Though recent MOH efforts have aimed at addressing these concerns, some skepticism remains about the government's commitment to increase budgetary allocations for NCDs and to address the technical and human resources gaps needed to achieve NCD policy aims in Uganda. This study highlights the immediate need to mobilize more resources, reduce fragmented efforts in the NCD space, and prioritize investment in NCD prevention and management in Uganda.
Highlights
The rising prevalence of noncommunicable diseases (NCDs) is a growing concern globally, in low- and middle-income countries, where the burden of disease is transitioning from infectious diseases to NCDs
Environment/occupational, and behavioral risk factors, high blood pressure and high fasting plasma glucose respectively were the sixth and seventh most correlated with death and disability among Ugandans in 2019.10 A nationally representative household survey conducted in 2014 further revealed that nearly 80% of Ugandans diagnosed with NCDs were unaware of their own status; for example, only 7.7% of individuals with hypertension were aware of their condition, and among those who had hypertension, 76% were not being treated for their condition.[11,12]
To better understand the NCD policy landscape, we conducted in-depth interviews with 3 types of NCD actors: (1) officials from national government (MOH and Ministry of Finance) with authority to make programmatic and policy decisions for their relevant work areas; (2) researchers from local universities in Uganda working on health policy or familiar with the NCD space; and (3) individuals from nongovernmental organizations (NGOs) and development partners working in the NCD space
Summary
The rising prevalence of noncommunicable diseases (NCDs) is a growing concern globally, in low- and middle-income countries, where the burden of disease is transitioning from infectious diseases to NCDs. We sought to understand the policy context around NCDs in Uganda, the roles of actors both within and external to the government, and the factors shaping the development and implementation of NCD policies and programs in Uganda. Methods: We conducted in-depth interviews with 30 policy actors from the Ugandan Ministry of Health (MOH), nongovernmental organizations, and academia to understand the roles of different actors in the Ugandan NCD space, the programs and policy measures in discussion, and how to bridge any identified gaps. Limited recruitment of technical experts on NCDs within the MOH was viewed to further diminish the government’s role in leading policy and program formulation and implementation. Though recent MOH efforts have aimed at addressing these concerns, some skepticism remains about the government’s commitment to increase budgetary allocations for NCDs and to address the technical and human resources gaps needed to achieve NCD policy aims in Uganda. Conclusions: This study highlights the immediate need to mobilize more resources, reduce fragmented efforts in the NCD space, and prioritize investment in NCD prevention and management in Uganda
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