Paradigm Shift to Right Health Sector Priorities – A Preventive Approach

“Prioritize Preventive Health in Uganda; 75% of diseases in country are preventable, the need for a  paradigm shift in setting health priorities, Allied Health Professionals being the answer”  

Dear fellow Ugandans and East African Community at large, 75% of diseases in Uganda are preventable,  hence the need to rethink (paradigm shift) in setting health priorities to invest more in Preventive disease control as opposed to curative, Allied health professionals being the answer.  

As you may be aware, the world over, countries failed to sustain curative services including but not limited to the USA. Africa and especially the sub-Saharan region of WHO (Eastern Africa), where TB, HIV, Malaria,  among other tropical diseases, remain a public health concern and endemic; causing morbidity, mortality and looming poverty gives more reason to embrace and invest in preventive approach to disease control and management rather than Cure.  

According to the respective global reports, (2021); the aforementioned conditions form the largest morbidity  and mortality especially in the 30 high TB burden countries (including Uganda), where 86% of new world TB  cases occur whereas, It has been put that Uganda is among the 11 countries that form 80% of world malaria  burden, (Surprisingly, Kenya, Rwanda among other neighbors were not part, what did they do differently  that we are not doing yet they are part of the great lakes region/East African Community? (Global Malaria  report, 2019) I want to believe that their magic could be investment in prevention; with Kenya having a  separate ministry for public health.  

Going further, these preventable conditions sometimes act synergistically as co-morbidities if preventive  approaches are not in place (especially in those with low immune status due to a number of factors including  but not limited to a mere poor nutrition) exacerbating the burden of disease in our already struggling poor  economies. For instance, by 2015, it was put that 70% of People living with HIV/AIDS (PLHIV) were co 

infected with TB translating to 14.8% global burden of co-infection then (WHO, 2016).  

Fellow health workers, Ministry of Health and Implementing partners, it is on record that recently, on 15th  October, (2021); WHO stipulated that a patient with latent TB is more likely to develop Clinical stages and  that once HIV+, they are 18 times more likely to develop TB disease. This further explains why in 2020, 85%  of TB patients had HIV in Africa.  

Question?, can Uganda achieve the presidential fast track initiative goal to end HIV by 2030, just six  years from now through the 95/95/95 strategy? Keep the answer, if ‘no’ just like we failed to achieve the  MDGs, 90,90,90.Yet TB & HIV and malaria among other infectious diseases can effectively be prevented, but  we are stuck to investing heavily into Curative while ignoring preventive aspect and failing to utilize the  Allied Health Professionals who are technical in these areas, the test and treat cannot happen without  Laboratory, Radiography and Imaging Services and beyond that; disease Surveillance (by appropriate cadres,  Public health Officers, Environmental Health workers, Vector Control, Health Educators, and Medical Clinical  Officers at OPD) is very essential. Unlike today, Uganda instituted a combination of prevention strategies of  Biomedical, social behavioral and structural Primary prevention through which we (as a country) managed to  drastically bring down the HIV prevalence from 30% in 1980s-1990s to 6-9% by the start 21^st Century and  recently at 5.5% (higher among women (7.2%) than among men (4.3%), Uganda – PHIA Project, 2022)

Using strategies like Zero grazing campaign spearheaded by Medical Clinical Officers, Nurses, Environmental  Health Officers, Lab, Medical Officers to mention but a few, collaboration and Community based efforts,  actually the UNAIDS report 2018 specifies Medical clinical Officers as key players in Uganda in this  achievement. This is still the same, for other countries that are recording even better progress, As  recommended by WHO(2021); in the 12 approach of collaborative aimed at prevention and disease treatment  of infection and diseases respectively. 

Fellow Ugandans, as you may be aware, better performing countries and Organizations are prioritizing  Primary Health Care. Similarly, Uganda NDP III priority areas lie in Community Health/PHC/preventive  Medicine. Indeed, recently Community Health Strategy was developed by the health Sector (MOH), as a way  to ensure better service delivery but the major stakeholders serving 83% of the population in the rural areas of  Uganda, the allied health professionals are hardly involved in these strategies, and their role in the same yet to  be fully identified. As such, it would be of great importance to note that’ support to the health sector of  Uganda is donor funding, and a big question would arise, If Donor countries like USA failed to sustain  curative services, how do you plan to sustain then in the country that is being donated to? 

There changing world population demographics, industrialization and urbanization dictate that environmental  degradation result in altering the ecosystem hence the changing disease epidemiology, emerging and  reemerging disease epidemics, drug resistance among other consequences of population over growth,  urbanization and industrialization, if not properly thought about; in terms of paradigm shift from curative to  preventive, then vision 2040 may not be achieved.  

Uganda is already suffering a triple burden of disease, communicable, Injuries (most due to Road Traffic  Accidents, RTA; 29 car deaths per 100,000 people, WHO, 2022) and Non-Communicable (41%) where  Cancers, Diabetes, Hypertension among others are ravaging the country and if left unchecked from the  preventive mind, we shall be in real trouble soon.We have documented a lot of success in preventive strategies  but we quickly forget to replicate the result into planning to prevent future disease outbreaks. Same approaches  are used for all tropical diseases, including those not mentioned lung diseases like COVID-19, Ebola  prevention, contact tracing, early treatment, and Early appropriate referral that can help us achieve universal  health coverage and NDP III, vision 2040, SDGs, Malaria elimination project, 2030; UNAIDS 95-95-95  among others.  

Comrade let’s embrace harmony, collaboration and the fact that prevention is better than cure In all ways and  putting in mind that prevention is not only primary but ranges from primary, secondary and tertiary. The first  two requires public/Community Health and community participation/ community oriented cadre respectively  whereas tertiary purely requires early appropriate referral for Curative and rehabilitative care (Physiotherapy,  Orthopedics, Language therapy etc..  

In Health economics, Disability adjusted life years (DALYs) is a measure of very costly curative investment to  try and restore health, whereas prevention is directly linked to Quality adjusted life years (QALYs) and its cost  effective preventive measures. Last but not least, a health population prevented from disease translates to a  better economy as opposed to a sick population that requires hospitalization, investment in drugs, lost days of  income due to hepatization, disability due to disease.

Written By Dr Alex Kachwano, & Kyaterekera Paul, Senior Clinician and Public Health Specialist, PhD(C)