of small bribes, as well as formal fees for services falling outside of the basic health care package. Those who can afford it, often resort to private health centres and pharmacies to obtain both care and prescription drugs.124 A comparative study found that Ugandans paid some of the highest out of pocket expenses in the region.125 Some progress has been made, such as improving the rates of women delivering at health centres, which had risen to a high of 63% of births in 2018/19 until the COVID-19 pandemic frustrated progress.126 Maternal mortality rates, while still unacceptably high, have fallen significantly from highs of 578 per 100,000 live births in 2000 to hold steady about 336 per 100,000 live births in 2018/19.127 And maternal mortality rates for women who deliver at a health centre have fallen steadily since 2012, from 168 to 92 deaths per 100,000 live deliveries.128 There have been slight improvements in access to family planning Health services in Uganda The Ugandan Government offers a form of universal health care through the Uganda National Minimum Health Care Package (UNMHCP), which was introduced in 2000. The UNMHCP provides access for all Ugandan citizens to a minimum package of health services. Maternal and child health is one of the four core components of the UNMCHP. The delivery of the UNMHCP is the responsibility of Uganda’s decentralised health system, which includes both public and private health facilities. At the national level, the Ministry of Health provides overall strategy and policy. There are two National Referral Hospitals that serve as teaching hospitals and provide both general and specialized care and fourteen Regional Referral Hospitals that operate semi-autonomous health centres and deliver a range of medical services. Most health care, however, is provided through the district health system, falling under the responsibility of district local government. This district health system has several tiers of service, including community health initiatives, Village Health Teams, Health Centres II, III, and IV, as well as general hospitals. A private healthcare system operates alongside the public one and includes Private-Not-for-Profits (run mainly by faith-based institutions), Private Health Practitioners, and Traditional and Complementary Medicine; there are also private pharmacies. These private healthcare facilities all operate on a fee-paying basis. services and improvements to the number of health centres able to provide critical services such as Caesarean Sections and blood transfusions.129 But despite the progress, the lingering problems in the healthcare system have left many Ugandans, particularly women, with a sense of powerlessness and frustration. 130 People in rural communities often feel shut out, since there are few avenues for participation or grievance redress. In addition, those living in poverty have little means to seek alternative health care. This makes them feel as though they have been “forgotten” by 52 Chased Away and Left to Die

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