Building Capacity in Uganda

Pathologist and educator Raphael Owor, 69, has spent a lifetime working to improve medical resources and access to medical care in Uganda, where the AIDS epidemic has dropped the average life expectancy to 44. Now, as director of the Uganda National Health Research Organization (UNHRO), a coordinating body, Owor says his country is beginning to understand that the road to economic recovery will be paved by doctors. In other words: health makes wealth.

“The biggest challenge facing doctors in Uganda is there is so much work to do, and sometimes we don’t have enough laboratories or investigative resources,” says Owor. “Physicians use clinical signs and symptoms for diagnosis. Many times, we can be wrong. But we have to do our best.

“The second challenge is that while physicians work so hard, often without sleep, remuneration is never commensurate,” Owor continues. “Ugandan doctors are paid very little and most patients have to pay for their own care–government spending on health is only 9 USD per capita per year. This magnitude of a funding gap cannot be closed by efficiency gains alone. Still, with the little money we have, we could do better. What we need are more coordinated health systems, to develop the capacity for using what resources we have more efficiently.”

Since 1986 the government has worked to stabilize and rehabilitate an economy ravaged by civil wars and political turmoil. Until then, the government often diverted resources for medical programs to other areas of need.

During much of that time, Owor was working as Director of the Kampala Cancer Registry (1972-1982) and as a Professor of Pathology at Makerere Medical School, where he himself had studied. In addition to undergraduate teaching, Owor took full responsibility for developing post-graduate training in surgery, pathology, and other specialties, during a career spanning 32 years. He was named Dean of the Faculty of Medicine at Makerere in 1981.

As Dean, Owor developed degree programs in dentistry, pharmacy, anesthesia, physiology, pharmacology and anatomy, as well as a community-oriented curriculum. He established the Child Health and Development Center, training health personnel to improve child survival. Finally, with the support of the Rockefeller Foundation, he developed the Clinical Epidemiology Unit. The unit is associated with the International Clinical Epidemiology Network.

Since retiring from teaching in 2001, Owor has focused on health issues of national concern, coordinating Essential National Health Research (ENHR) activities and working with the Ministry of Health in the development of the Uganda National Health Research Organization (UNHRO).

Among the top national health priorities Owor and his colleagues have identified are maternal and child health, infectious diseases, particularly malaria, tuberculosis and HIV/AIDS, and health systems. With limited resources, the emphasis regarding cancer in Uganda is on control and prevention. “The Ministry of Health takes a proactive approach,” Owor says, “with the idea that each person is responsible for his or her own life. We are teaching the people to help themselves in providing basic necessities like clean water and clean latrines. Another important government program is health education in schools, so that children can learn how to promote good health and prevent disease.”

As president of UNHRO, Owor is working to secure national funding for coordinated health research, and is seeking the support of international bodies as well. For instance, some AIDS research is being funded by the Medical Research Council of the UK, he says. American and other groups also are providing resources and personnel to work together with Ugandans.

Owor also is leading the African Health Research Forum, a new organization that promises to bolster collaboration among African nations and to strengthen the continent’s voice in setting and implementing the global health research agenda.