Interview with H.E. Gilbert Balibaseka Bukenya, Vice President of the Republic of Uganda

Q: Excellency, thank you very much for taking the time to talk to us. What, in your opinion, are the major issues Africa is facing in terms of health-related challenges today?

First of all, Sub-Saharan Africa has been struggling to control infectious diseases -- and has overall been doing very well. However, two new issues have come up. Firstly, malaria and HIV/AIDS have developed resistant strains which do not respond to simple treatment and require the administration of more complex and expensive drugs. The other problem we are facing is the rapidly increasing number of non-infectious diseases, such as hypertension, diabetes and cancer, which are not controllable at this point.

This is what I was referring to in my presentation with regards to the new emerging problems Africa has to face. We need to readdress our health systems, in order to cope with these new issues. We have too few health care workers to rely on. The USA and Europe have more than 10 health workers per 1000 people. Uganda, on the other hand, has less than 1 health worker per 1000 people. This small number of health care workers cannot cope with the new emerging diseases. And we cannot increase the number health workers, because of our financial constraints. So this is why, in my presentation, I was insisting on the fact that what Africa has to do is look at the gap between health systems and the community. It is about finding more effective ways to address health issues with and within communities, rather than only among existing hospitals and health systems.

It is also necessary to integrate elements such as the environment and its protection into government planning. Currently, charcoal is used for lighting, but suppose the government introduces solar renewable energies instead... People would no longer be constantly surrounded by smoke, which also has an impact on their health. Those simple things can be used to help address not only environmental concerns but also health issues.

As I proposed yesterday, the vision for Africa must be to help their people move away from poor, backwards communities to modernity.

Q: In your presentation, you argued Africa should use DDT to address malaria. Why DDT?

If any particular disease has stopped Africa from developing, then it is malaria, which is currently the largest cause of mortality. We have tried everything. Bed nets help, but the problem of malaria still persists. The parasite grows resistant to antimalarial drugs, so we have to come up with new treatments, which tend to be very expensive.

Now what do you do in that predicament, when your population is infected 2 to 3 times a year and, as a consequence, is away from work for 3 to 5 days each time? The amount of lost work days is too much for Sub-Saharan Africa. What we have to do is put special effort in to address the problem. As a politician, I argue that we maybe have to become poorer for a short period of time. Let us use DDT as a disparate last measure, fully knowing that Europe would probably not want to buy our crops for a while, because of the residues of DDT in the food. And many countries like Uganda and Mozambique will be OK in the interim, while they cannot do business with Europe as much, but we will kill malaria. We need to do what Europeans did a long time ago, even Britain used DDT.

[Editor's note: DDT, Dichloro-Diphenyl-Trichloroethane, is a synthetic pesticide with a long and controversial history. In the 1970s and 1980s, agricultural use of DDT was banned in most developed countries. About 1,000 tonnes of DDT per year are still used today in countries where mosquito-borne malaria is a serious health problem.]

Q: A serious conundrum affecting health systems in Africa is that people often leave once they become educated -- the infamous "brain drain". What can be done about brain drain? Is the answer to train more lower-level health professionals, as some argue?

Middle-level health professionals can be one answer. In my opinion, we shall continue to train highly qualified people. We also have to train more lower-level health personnel. However, this cannot be the only answer to brain drain. Indeed, the world must debate this question.

I believe that the African countries and governments should aim at four measures: 1) household income generation, 2) training people about specific best practices, 3) training people in concrete skills, 4) training people in serving to address their problems, such as health insurance issues and so on. African countries must ensure their citizens have a minimum package for people, in terms of their housing situation, basic education, etc. 

A country like Uganda has free primary and secondary education, and then university with sponsorship and scholarship programs to produce highly skilled health workers. However, these highly-skilled health workers often then move to places like Geneva. For example, imagine that one of them is among the best doctors to operate on heart patients. He might be much appreciated in Geneva, but it could be easy to forget where he came from. Because salaries here are much higher than in Uganda, the doctor might not want to go back to his country of origin. Switzerland thus benefits from someone who was educated in Uganda, at the expense of the country called Uganda. I would not want to disturb the doctor working in Switzerland and ask him to move back to Uganda, but Switzerland, being a developed country, can indirectly support Uganda, help it strengthen its health systems. This would be some kind of compensation.

There must be compensation, and thinking about how to do it. It is not just about money, but rather a meaningful formula. A country indirectly helping Uganda, this can be described as a positive side of globalization. Uganda may not need a heart surgeon now, because the facilities are poor and not equipped to deal with complicated heart operations. So the issue is to think more long term to maybe see how facilities could be developed ten to fifteen years from now, to give the heart surgeon the possibility later to actually find a job in Uganda.