Investment Case for Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan for Uganda (2016/17 –2019/20)
Uganda has made progress in improving RMNCAH indices over the past 2 decades but RMNCAH conditions currently account for over 60% of Years of Life Lost in Uganda. The RMNCAH conditions thus constitute a major public health problem. Maternal mortality rates fell by only 20% over the past 20 years, decreasing too slowly to achieve national targets. The unacceptably high number of maternal deaths annually in Uganda account for 2% of the annual maternal deaths globally. The major causes of maternal deaths are preventable with the three leading causes being haemorrhage, obstructed labour and complications from abortion. Almost 28% of maternal deaths in Uganda occur in young women aged 15 – 24 years. The overall adolescent birth rate in the age category 15-19 years is at 135 per 1000 livebirths, which ranks among the highest in Sub-Saharan Africa driving both total fertility and population growth rates. Adolescents aged 15-19 contribute 17.6% deaths due to pregnancy related conditions. Stillbirths and child deaths are 50% more likely for babies born to mothers younger than 20 than for those aged 20-29 years.
Uganda realized a steady reduction in child mortality rates between 1995 and 2016 from 156 to 64 per 1,000 live births with the annual rate of reduction increasing dramatically from 1.2% per year to 8.1% per year between 2006 and 2011. While the infant mortality rates have followed a similar trend, neonatal mortality is decreasing at a slower pace with newborns experiencing a disproportionate burden of deaths among this age group. About 42,000 newborn babies died in 2014 out of the 130,900 children who died before their 5th birthday in 2014. Under-five mortality is mostly attributable to neonatal conditions as well as three common childhood illnesses: malaria, pneumonia, and diarrhoea often in synergy with underlying malnutrition. An estimated 33 million cases of malaria, diarrhoea and pneumonia go untreated every year in Uganda representing a critical treatment gap. Neonatal deaths occur mainly from preterm births, birth asphyxia and severe infection. An additional 38,000 babies die each a year in Uganda from stillbirths. This five year RMNCAH investment case is anchored on the revised Health Sector Development Plan targets for 2020 of reducing MMR from 336 to 219 per 100,000 live births, U5MR from 64 to 47 per 1,000 live births, IMR from 43 to 32 per 1,000 live births, NMR from 27 to 15 per 1,000 live births and teenage pregnancy rate from 25% to 14%.