Voices Inspiring Change Uganda Part 2
Meet Joseph Ngobi Mwoga, who advises the World Health Organization (WHO) in Uganda on essential medicines policies and more recently, as a coordinator of the health system. Joseph worked for the Ministry of Health prior to joining the WHO where he has been for 13 years. ACS met with Joseph prior to the COVID-19 pandemic.
Q. How is the WHO thinking about universal health coverage (UHC) specifically in Uganda?
Joseph: UHC is our number one priority. The WHO has developed a framework to strengthen the systems to deliver UHC. That framework has four angles: 1) improve access to essential services, 2) improve the quality of essential services, 3) improve the demand for essential services, and 4) improve the resilience of the system. Each country has its own unique path and should decide how they want to move towards UHC. What we focus on is the end result. Are you having more people accessing health services? Are you having better quality services?
Q. Each sector in Uganda is given a target under UHC, but what I’m hearing from you is, it’s more of a strategy to achieve UHC.
Joseph: It is a strategy, and the meaning of that is, each of the different sectors in Uganda has a role to play and you need to ensure that those different players meet their commitments and then you give them targets. That’s the weak link in our system now, how do we monitor the input of other sectors on this journey? That’s an area that needs to be improved. Health cannot deliver UHC alone.
Q. Is the roadmap an effective and equitable way to move towards UHC in Uganda?
Joseph: Yes, because the roadmap process started around the time the government began thinking about developing the next five-year national development plan (NDP). The roadmap informed the NDP and the NDP is for everybody. All sectors. I think that factor helped to include the engagement of other sectors because if the health sector did it alone, maybe the response wouldn’t have been as strong.
Q: Who are some of the other actors that don’t necessarily come to mind but are critical to advancing UHC in Uganda?
Joseph: We need community development workers. They are outside the health sector, but they are important for UHC. There are many different actors doing different things at various levels, both at the community level and the policy level that need to be engaged and involved to deliver UHC. Let me give you an example, road traffic accidents are one of the big challenges, often constraining health care funding and the health care system. How do you help solve the problem of road traffic accidents? You must engage police officers, the whole system that is overseeing traffic, etc., if you’re going to fight that problem. You need everybody from the police officers to the Ministry of Transport because they need to have the right policies in place to reduce road traffic accidents. If you visit the hospital, specifically the surgical ward, you’ll find that 90% of the patients are road traffic accident victims. That’s a big strain on the health system. There are so many examples of why you need to engage other people to move towards UHC. We must create information and demand in the community so that people get to know about and utilize the services. Another stakeholder is the media…how much should they be engaged or informed? What role should they play?
Q. How do we communicate UHC to the community- to the people- to understand the value?
Joseph: I think communicating availability of a service, communicating that the user has a right to comment about a service, whether they like the service and if it’s of quality or not, is critical. The community should be empowered to comment on services received and know that their feedback is taken in good faith. The provider side should not be vindictive to people who comment because it’s supposed to be a continuous process. The other message is letting community members know that they can and should ask for what they need. They should have a say. That’s very, very core for UHC.
Q. Despite the challenges, what motivates you to continue to do this work? As you look back on your career, what is it that you’ve hoped to accomplish?
Joseph: [My role] exists because we [WHO] are trying to work to solve problems that countries face. I’m motivated by bringing a smile to someone down. And you cannot see that when you are in board rooms and offices. You can only see it when you go to the field. To demonstrate my answer, whenever I go to a health worker or a facility and I find a happy health worker, I get motivated. I sit down, I want to listen to them. I want to do my best to help make them even better in their role.