Are lessons from the education sector applicable to health care reforms? The case of Uganda.

The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.