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By Christine Nabukeera

Contents

Introduction
Globalization - Its effects on Uganda's social, economic, and political systems
Health Care and Services
Poverty in Uganda
The Extended Family Network
Women as 'Persons'
Women - Custodians of traditional society
The Elderly as Parents
Parents of the Nation - parens patriae
Conclusion
Recommendations

Introduction

My purpose in this discussion is to articulate a vision that entrenches social policy and related services in Uganda’s legislative structure. According to Midgley (1999:16) a service is “a product of human activity aimed to satisfy human need which does not constitute a tangible commodity”. As I explore social relations, I discuss some of the problems that flow directly, from current policies and how these have contributed to the impoverishment that characterized Uganda’s social, economic and political systems. Women, children, the elderly, and persons with disabilities, are specifically targeted, not as special interest groups, but as constituencies integral to Uganda’s social, economic, and political arena in ‘post-modern’ times. I argue that concerted efforts are needed to move beyond rhetoric and to revamp traditional approaches to social policy to a systemic response to peoples needs through the pursuit of new directions that will improve the life chances of all Ugandans. For the most part, this process will entail, harmonizing economic and social objectives, and to ensure that the benefits of economic progress not only reach the population in both rural and urban areas, but transcend ethnic, class, and gender considerations.

In making a case for a consciously formulated socio-economic polity in Uganda, I employ a social development approach, here defined as a “process of planned social change designed to promote the well-being of the population as a whole in conjunction with a dynamic process of economic development” (Midgley 1995:16). Specifically, this can be achieved in three ways: (a) by establishing organizational mechanisms to integrate economic and social policies; (b) a social development approach requires economic growth to have a positive impact on peoples’ welfare; and (c) that the proposed conceptual framework encourages the introduction of social programs that generate rates of return on social expenditures and contribute directly to economic development (Midgley 1995). A social development approach therefore, views the community and individual, the social and the personal, as interwoven and not as separate or distinct entities. Furthermore, proponents of the social development approach argue that it is the responsibility of government to mobilize the major institutions of society, including the market and the community, to promote full participation and an equitable distribution of resources (Midgley 1995). In the case of Uganda, the parameters of its tasks will involve the urgent need to address profound social problems, manifested in lack of health care services, poverty, unemployment, child abuse and/or murder, and social exclusion.

As a background to the discussion, I explore globalization and its effects on health care system, poverty, and struggles for ‘personhood’ on the part of Ugandan women; and how these have combined to bring to the surface, a need to respond to the changing needs of Uganda’s extended family by strengthening the delivery of social services through legislation. In their article “Democracy vs. Corruption”, Kwesiga et al (1999:196) note, “in Copenhagen, the government of Uganda committed itself to create an environment that will enable people to social development, eradicate poverty, allow access to education and health and achieve greater gender equality”. Further, the government adopted policies to achieve this based on (a) good governance; (b) security of property and lives; (c) maintenance of macroeconomic stability; (d) a well functioning and independent judiciary; and (e) reduction of corruption. However, Kwesiga et al conclude that “although Uganda has good policy instruments, most of them are ignored . . . and that the institutional framework is lacking to ensure that recommendations are implemented. Nor has Parliament implemented its mandate to establish functional social, economic, and political systems” (1999:261).

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Globalization – Its effects on Uganda’s social, economic, and political, systems

Anthropologists such as Bodley (1996) hold the view that the “emergence of a global culture has completely changed the problem of human adaptation. The rate of cultural change has become so rapid and its scales so vast that it is becoming increasingly difficult to respond effectively to new problems”. They argue that globalization entails a massive transformation, which is being compressed into a short time – a few years rather than many generations.

What is globalization?

Globalization as an economic and political process of corporate rule, backed by neo-liberal ideology; has come to represent, not only, the demise of long established social and political institutions, but also the redesign of states themselves. As an all-encompassing phenomenon, globalization “extols the efficiency of the free market and promises an open world economy in which all and every player is supposed to be able to win” (Mittelman 1996). It is rooted in the economic principles of the “free market, the absence of government regulation; combined with an aggressive advocacy of uniform global development faithfully reflecting western corporate interests” (Korten 1995).

However, Mittelman (1996) adds, “globalization has been hailed as one of capital’s triumphs, encoding the values of the free market, and the inevitable progress in a market utopia”. It is a utopia because the ideal market has never existed. It is asocial because it dispenses with social aspects of capital accumulation whereby the ‘accumulation’ becomes an end in itself, defining human worth and potential primarily in terms of the processes of consumption.

I would like to acknowledge, though, that globalization is about opportunities arising from re-organizing governance, the economy and the culture throughout the world. However, it presents challenges emerging from the loss of control by individual states and cultures. Proponents of globalization have tended to advance a mythology that in the world economy everyone will benefit. As this myth is being propagated, there is overwhelming evidence that Uganda is more impoverished than ever before. Arguably, the onslaught of ‘globalization’ necessitates the building of strong local entities as hedges against the massive influx of a global culture. Its effect on the people of Uganda, if not planned, is expected to be massive deprivation and possibly genocide. Given this background, the State is urged to recognize the negative effects of globalization through policy formulations and program development to promote qualitative improvements in people’s lives. 

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Health Care and Services

It has been well documented that the rate of HIV/AIDS infection in many African countries is disproportionately high. At the end of 1999, the Joint United Nations Program on HIV/AIDS and the World Health Organization estimate there will be 23.3 million adults and children living with HIV/AIDS in Africa. For Uganda, health indicators reveal that the health status of the population is generally poor, reflecting economic and social conditions as well as the deterioration in the health care system due to the long-standing civil wars and Structural Adjustment[1] policies imposed by the World Bank. For example, large parts of the population live far from health facilities. Among adult population (14-45) AIDS is the number one cause of death. Many Ugandans are malnourished, have compromised immune systems, experience excessive levels of stress, and suffer from stress-related complications. The Health Care system in Uganda has been singled out as dangerous to the people it purports to protect, thus raising serious ethical concerns by some members of NGOs that have recently worked in Uganda’s health sector. 

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Poverty in Uganda

Uganda has a tropical climate with a high level of precipitation making Uganda one of the most lush and fertile countries in Africa. It has a population of about 18 million, increasing at a rate of 3 per cent (FPAU 1998). In spite of current positive economic development, with GDP per capita of $330, Uganda is one of the poorest countries in the world. Poverty is more pronounced in rural areas where a majority of the populations live. Almost 50 per cent of children under five years of age were classified as suffering from arrested growth in 1988/89. The relative frequency of growth-arrested children is clearly greatest in rural areas, reflecting the rural population’s insufficient access to balanced nourishment, education and health facilities (FPAU 1998).

The cultural and socio-economic context within which women in Uganda live has inherent limiting factors that have a bearing on their health. The rural women have been most disadvantaged as the socio-cultural environment is still tightening its prohibitions on nutrition and other health-seeking behavior. Additionally, poverty increases women’s domestic burdens because family responsibility falls more heavily on women. Lacking, political and cultural power, women are in no position to counter the rising economic and familial obligations placed upon them. Women’s awareness and access to family planning control is very limited, resulting in extremely high birth rates. Each woman of childbearing age gives birth to an average of 7.3 children. Many of these children die in infancy (118 per 1000 live births). Furthermore, women suffer high mortality rates due to complications during delivery. Teenage mothers constitute a high-risk group. In 29 per cent of first-time births mothers are aged between 12 and 15 (FPAU 1998).

Women’s resistance to disease is low compared to that of their counter-parts due to the strain of repeated child bearing and breastfeeding combined with poor nutrition, and long hours of hard work. Furthermore, rural women are handicapped by low educational levels, low income hence dependency on men, as husbands and relatives, low status in the family and the community, and poor access to health care and to inadequate nutrition. The rural women have limited knowledge and skills in growing, preparing (cooking) and serving agricultural foods available to them in a way that provides a balanced diet. Due to lack of information on signs and symptoms of nutrition deficiency and related sicknesses, often times they do not seek medical services for themselves and their children until when the condition is critical.

Children are exposed to harsh living conditions. The struggle to survive dominates a child’s first 5-6 years of life. Hard physical labor, undernourishment or malnutrition, frequently follow this period, and severe illnesses coupled with a complete lack of or inadequate schooling. Many children are orphans, homeless or merely abandoned. Children constitute one of the largest poverty groups in Uganda. Illiteracy is widespread. Only a little over 50 per cent of the population over the age of 10 can read and write (FPAU 1998). Although the education sector has expanded considerably since independence, the quality of teaching has declined in recent years. Today, unqualified teachers make up about half of total teaching staff in primary schools. Even qualified teachers are badly prepared for their careers, as conditions in teacher training colleges are similarly inadequate. Motivation and morale among teachers are low because of dramatic declines in the real value of their salaries. School buildings and other physical facilities have fallen into disrepair due to lack of maintenance.

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The Extended Family Network

Poverty and ill health in Uganda have combined to threaten Uganda’s extended family. The once vibrant and economically viable extended family unit can no longer sustain itself. The extended family had acted as a cushion against the stress that afflicts people in western countries. “We did not need psychiatrists here because the warmth of the extended family insulated us from emotionally and socially-induced illnesses” (The Monitor, 2000). As individual members shun the extended family, there are no adequate substitutes to cater for those unable to fend for themselves.

Hitherto, poverty in Uganda has been ‘absolute’. Absolute poverty in its strictest sense assumes the barest of circumstances and envisages Uganda’s poor dying off like flies. Conversely, a social development approach is a socio-economic strategy aimed at raising the conditions of the poor to levels where their conditions can be defined in relative terms and therefore would not be tied to mere subsistence. In this respect, Allahar (1999:50) contends “human beings are social and must be judged by relevant social comparisons, not by some statistical or absolute imperative that ignores concerns for human decency and dignity”. He further argues “people are poverty stricken when their income, even if adequate for survival, falls markedly behind that of the community”. 

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Women as ‘Persons’

Women are beaten, raped, sexually violated, and some have had their genitals mutilated, practices that have all become normal and acceptable occurrences. These practices dehumanize and debase women. As much as it has been difficult to talk of building any form of progressive agenda for civil society under dictatorships that characterize Uganda’s political culture, it is even more difficult to suggest that it is possible to create meaningful political space for women in a profoundly patriarchal, capitalist context. Women in Uganda are exposed to particularly adverse living conditions. Child Care and the welfare of the family generally are the responsibility of women. Women’s situation in Ugandan society is directly related to poverty. The main reason for women’s continued inequality is limited access to basic education and to a poorly functioning health system and, not least, to land.

Culture in Uganda has over the years under estimated women’s potential and devalued their participation and contribution to national development. However despite efforts by the current government to improve women’s place in society, they are discouraged by the burden of entrenched cultural practices. “If I grow more than 5 bags, my husband would sell the excess and use the money to get himself another wife.  I would rather keep the family going on five bags” (The Monitor, 2000). “Sometimes it is no use getting a job because if we take over some of our men’s responsibilities, they squander all their money instead of saving it” (FPAU 1998). Some men have viewed government support for women as removing women from the ‘kitchen’ where they belong. “My wife knows better than to tell me anything about women’s rights, at home she is my wife period” (Vision 2000). Such views regard women’s struggle for social justice as encroaching on values that have kept Ugandan communities together for ages. Ostensibly, while women have kept these communities together, they are neither valued, nor respected for the role they play in society. They are, instead, blamed for humanity’s imperfections, “ None born of a woman is perfect” (Lawrence Mukasa Federo.com). “Women just can’t wake up one morning and try to change what has been in our culture for years”.

Responding to these and similar cultural discourses on women, Mukwaya, Uganda Minister for Gender and Community Development, contends that “such attitudes have made women susceptible and vulnerable to abuse especially by husbands. She further contends that such attitudes only encourage dependence, subordination, domestic violence, forced marriages, accelerated ‘girl-child’ marriages and the termination of girl’s education (www.cbie.ca/cida). However, when commenting on progress made by Mukwaya’s Ministry, Kwesiga et al (1999:197) argue “activities … are caught up in bureaucratic routine and have not had an impact on policy”.

One of the greatest challenges in mapping out the political and cultural landscape in Uganda has been the co-optation of women’s activities and organizing by the State. From 1986 to the present, which represents the years in which Mr. Museveni has been in power, women’s issues became constant rhetoric in Uganda’s public arena. However, this rhetoric has not been grounded in any progressive social policy and or legislation. Secondly, the structure for organizing has been a top down hierarchy, which meant that wives of top ranking military and government officials dominate the headlines as ‘women leaders’. The programs are top-down creations with little or no input from ordinary women. Furthermore, most well funded programs rely on patronage, through which they co-opt and coerce organizations and individuals who they believe can give them some form of credibility. The issues promoted by the women involved in these state-driven programs are based on welfarist, apolitical agenda. Arguably, the State has used women as a ‘novelty’ to divert attention away from other crucial issues of concern to people by using women as an artificial power base (www.ccd.or.uk). The result is a social and political climate that continues to not only safeguard the status quo but to maintain the ‘conspiracy of silence’ regarding atrocities[2] committed against women and children.

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Women - Custodians of traditional society

Women play a critical role in health care in their communities and particularly in their respective extended families. Secondly, the World Bank (1993) put Ugandan women’s heavy workload at 15 to 18 hours a day as compared to 8 to 10 hours worked by men. Thirdly, women are central to food security in most rural families with all the food-related tasks being solely left to women. Therefore, for food security to be assured at household level and for nutritional standards to be adhered to in peoples’ feeding habits, women need to not only be specifically targeted, but also supported through substantive programs grounded in a progressive legislative framework. Again, traditionally, men were responsible for providing clothing, paying school fees, and for providing for general household needs, responsibilities that have since been passed on to women. Arguably, women’s state of poverty, and general lack of control over economic resources cannot enable them to meet these requirements.

Concerned with social, economic, and political exclusion of women, Adeke argues “any strategy for change in {Uganda} has to come from the active involvement and participation of civil society, which will in turn involve the harnessing of the skills and talents of both men and women” (www.cdd.org.uk). A significant change in society can only be brought about if power relations are reconfigured, and political, social and economic structures re-analyzed from a gender perspective – i.e. the impact of all these on both men and women as opposed to creating societies based on men’s experiences alone. Further, “as a minimum requirement, both men and women in {Uganda} need relief from poverty, social justice and equity. Since women suffer several layers of oppression, it is even more important for women to be actively involved in shaping their own destinies (www.cdd.org.uk).

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The Elderly as Parents

Uganda’s aged population was once provided for within the same extended family network, but as economic conditions deteriorate, the elderly most of whom have taken up the care of their orphaned grandchildren, cannot cope with the day-to-day tasks of raising a child. Many of the elderly suffer from cognitive impairment, chronic illnesses, and their mental health is affected by the continued loss of their children who are dying before them. From a socio-economic policy perspective, practically nothing is known about the physical and mental health status of the elderly, including those women who are approaching or have passed menopause. Their nutritional status is bound to be worse than that of their daughters, and peri-menopausal menstrual disturbances are likely to increase the risk of aneamia in this cohort. Yet, with the impact of the AIDS epidemic and the increasing number of AIDS orphans the grandmothers are assuming an increasingly important role in society as the caretakers of the next generation. Their welfare should therefore be of equally increasing concern to the society.

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‘Parent of the Nation’ – parens patriae

All children in Uganda must be cared for by the State, particularly those at risk[3]. This is a relationship between the State and Uganda’s extended families. The fundamental concept shaping this relationship is known as ‘parens patriae’ or parent of the nation. When this doctrine becomes part of Uganda’s legal system, it can be used with the humanitarian intent of protecting children from physical and sexual abuse including protecting them from death, but it also provides a power and rational for considerable state intervention into family life.

In any case, this doctrine and the power of the State provide the framework for child welfare and the concept underlies the legislation and social policy that will be developed to deal with neglect[4] and other child welfare issues. Furthermore, the legislation should articulate the principle of the State’s right to evaluate the suitability of a child’s environment and allow for the removal of a child from that environment if this is deemed to be in the child’s interests. However, debates based exclusively on protection of class and cultural rights may operate to deny children needed care. In these instances, Child Care mandate should focus on protecting children from social forces that negatively affect well-being. Accordingly, Swift (1999:55) defines child abuse and neglect as “those human created or tolerated conditions that inhibit or preclude development of inherent potential of a child”.

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Conclusion

Non-governmental Organizations (NGOs) have proliferated during the last fifteen years. Cutbacks in public health expenditures have resulted in the privatization of state-provided services as well as in the rising role of NGOs. In Uganda, both foreign and indigenous NGOs, have been responsible for a big part of Uganda’s social service sector. In the health sector alone, they provide at least 40 percent of all health services (Aslanbegui 1994:87). However, these NGOs do not always locate where they are most needed; foreign staff members rarely speak the local language and may have little contact with the population. Secondly, most of the NGO work in isolation and have lacked a legal and/or administrative framework to effectively coordinate their efforts. Understandably, some of these NGO’s have implemented programs and services based solely on their own interests and not necessarily balancing them with Uganda’s social welfare agenda. For the most part, these services have lacked consistency and continuity, their funding is usually short-term; and work under the code of “flexibility” which is euphemistic for operating from one project to the next, which leaves no room for institution building. Henceforth, a Child Welfare Act and related legislation will provide guidelines for all these players to work within a consolidated mandate. A mandate aimed at protecting the lives of Uganda’s most vulnerable population irrespective of their class, ethnicity, religion, gender and region of residence.

The issues being raised here are salient and have profound implications to all societies in Uganda, particularly given a dysfunctional social, political, and economic system that Kwesiga et al describe. Although some attempts in the development of social policy have been made to address some of these problems, but the absence of a political will from current governments to vigorously pursue a social agenda, the implementation of these policies and programs has not followed suit. I have argued that Uganda needs to pursue a new direction – a new political process that not only preserves, and respects, but one that values human worth and dignity.

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Recommendations

Therefore, to respond to the changing needs of Uganda’s extended family, the State is challenged to develop social, economic, and political policies that aim to:

• assist the extended family provide for its members through the provision of agricultural inputs and other economic development projects; and improved and accessible health care services;

• improve our abilities to protect children to restore the emotional and mental health of children who are growing up in wars, hunted for ritual murders, and the rising pre-occupation in ‘girl-child’ marriages;

• meet the material, educational, and emotional needs of orphaned children and those who are deemed homeless;

• ensure that Uganda’s education and learning systems prepare children and Youth to live and work both locally as well as in a global society;

• promote attitudes among children that foster equality and respect between males and females, that reduce sexual stereotyping, discrimination and violence against women and children;

• achieve equal participation for, and address the unique needs of persons with disabilities;

• address the unique health, material and physical needs of the elderly; especially those who have become parents;

• invest in public education programs that specifically target cultural practices that dehumanize and debase women in order that they can be eliminated;

• through retraining programs, improve the quality and accessibility to services by addressing issues of discrimination based on class, ethnicity, gender, and ability. These issues have been known to affect service delivery in Uganda.

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References Cited

Allahar, Anton and James E. Cote. (1997). Richer & Poorer: The Structure of Social Inequality in Canada. Lorimer & Company Ltd. Toronto. Ontario.