The Ugandan Government’s commitment to the Right to Health: A focus on Village Health Teams (VHT) and the rural poor

This study is about the Government of Uganda’s commitment to fulfilling the right to health of its rural poor with a focus on the Village Health Teams (VHTs). The study was based on fieldwork conducted in Luwero District in July-August 2011. In the study, the origin of the VHT concept is traced to the 1978 Alma Ata declaration, where health was entrenched as a basic human right (Gillam 2008; 536). At Alma Ata, member countries agreed that Primary Health Care (PHC) through the VHTs was the means through which universal health would be achieved (WHO 1978). This study was particularly guided by comparisons between three Latin America countries of Costa Rica, Nicaragua and Colombia with Uganda that adopted the Alma Ata guidelines for PHC implementation. Key to the study was and understanding of how the Human Rights Based Approach (HRBA) and Alma-Ata guidelines enabled successful VHT interventions in Latin America and the lessons this has to offer for successful VHT implementation in Uganda. Successful implementation of the VHT model in the Latin American countries shows that VHTs have a strong potential to solve the health manpower gaps prevailing in rural areas. However, although official government documents show compliance to the HRBA and Alma Ata guidelines, empirical data from Luwero reveal great discrepancies. It is apparent that political commitment, a key aspect of the Latin American successful intervention is inadequate to sustain the program in Uganda. This was manifested through the inadequate motivation, incentives and haphazard training which compromise VHTs ability to perform their roles. Further, the absence of an integrated health system to integrate data from the community into the formal health system undermines the opportunity for evidence-based health planning at both local and national levels. More general reflections on the Ugandan experience, made at the end of study, were possible due to an unpublished situation analysis on VHT practiced, obtained from UNICEF offices in Uganda.