Uganda like any other developing country is facing challenges within its healthcare system that can be linked to the pedagogy of the oppressed through the following points
Health management information system: Critical think and make action
Health management information system is one of the building blocks for a health system that aims at strengthening healthcare system within public and private settings. Health management information system stands as a back up to the various activities within the health system through provision of adequate data and analysis. Uganda had progressively advanced from paper based work to computerized system however there are several challenges hindering the full implementation of the programmer. For instant lack of information technology materials such as computer , poor funding, lack of trained personnel and resistance to change specially the health record personnel that are comfortable to paper based. Much as these challenges are listed there is a lack of political motivation to accomplish a full functional system.(Umezuruike, 2017)
Treatment based on class (Injustices)
Paulo stated that persons who are deprived of their voices and cheated are the oppressed and they understand their situation better than anyone else as well as the struggle for freedom.
The Uganda Health Sector Strategic plan 2006-2010 clearly state its key action is to ensure universal access to health care for all its citizens where health care in the public health facilities will be free. Most people who access this services are the poor segment of the community who are unable to pay for private clinic, however this public facilities have poor quality of services coupling with lack of essential drugs hence the poor segments are left in dilemma of where to go, some of them ending up going to traditional doctors who are not recognized to seek treatment that they can afford. Women reported of poor treatment by health workers compared to the traditional birth attendant who take good care of them and their new born, The government also talked of free condom distribution but yet it’s not free you can’t walk in to any facility and your given condoms, the poor who are unable to buy condoms hence they received condoms indirectly through other programs such as immunization. (Bakeer et al.,2009)
Most of the health facilities are located in big towns compared to the villages that have few or none and it has greatly affected the population in seeking for health services where the majority cannot afford to travel to big towns. For instance the once who end up seeking treatment at the mobile clinic are faced with challenges of community health workers such as poor knowledge due to lack of proper training .(Musoke et al., 2014)
Poor Payment and treatment of Health works
Health workers are the backbone of the health system they work tirelessly for the achievement of a better health and through their hard labour the permanence of health is projected, however they are frustrated and unhappy with their job as a result of Poor management, corruption, poor treatment in terms of payments, benefit and working condition resulting to many of them wanting to quit their job and look for better opportunity abroad. Poor management and corruption were regarded as the underlining problem, where the difference in salaries has been noted. For the few who tries to do their best and remain devoted regardless of the above situation they are met with poor working conditions such as lack of equipment and supplies resulting to resulting to poor service delivery (Hagopian et al., 2009)
Community Participation and Ownership of Project:
Paulo talked about interactive education between teacher and students, this method of education create an environment where both teacher and student discover new concerns from different prospective.
Community participation is important in formulation of all health policies and priority setting this allows the community to take fully responsibility and ownership of projects, but this had not been the case in most of the district of Uganda .As much as decentralization is important in bringing change in health system of Uganda, public participation remains a big challenge and had been linked to the inheritance from the former centralized system where health was provided to the people without their full involvement. The achievement of decentralization system of health is influenced by the capacity of the community but at most time districts health official lack the knowledge to take full responsibility and run projects due to luck of empowerment and operationalizing of policies. Uganda health system need to adapt what Paulo said about education (Kapiriri,et al.,2003)
More dependency on donor for aiding health projects:
Freire talks of cultural invasion as one of the “anitidialogical action and he further said that invades penetrates cultural contexts of another group, they impose their own views of the world upon those they invade and inhibits the creativity of the invaded”, this is typically what is happening in Uganda heath system in relation to the donor funding and support verses ministry of health priorities,this is exactly what is happning in the healthcare of Uganda.
According to the Abuja Declaration on health in 2011, at list 15% of a country’s annual budget should be allocated for its health sector with support from other donar, however this is not the case in Uganda, where the spending per capital is lower than most Sub-Saharan Countries. For instance in 2009 the government annual budget for was at 8.22% and 9% in 2010/2011 respectively. This low allocation of budget to health is posing more challenge to the government in achieving equitable health for its citizens. (UHSA, 2011)
Uganda health Strategic and Investment plan indicated that about half of the country’s health finance is derived from household as out of pocket payment even more that the government and donor funding, these high expense of household on health is exposing them to suffering to a greater extend whePedagogy of the Oppressed was written in 1968 by Paulo Freire an Educator by profession, he was born in Brazil, his main area was Education and he worked with poor communities in Brazil and Latin America.Padagogy of the oppressed was first published in Portuguese and later on translated to English.
The book is divided in to four chapters, chapter one focus on the dehumanization of the oppressed by the oppressor and how the oppressed become submerged in the situation that they think it’s normal and that’s how life is supposed to be without critically thinking and asking questions. In chapter two Paulo talks of the banking method of education as tool by the oppressor, where the students don’t develop cognitive thinking about a situation all the know and believed is what their teacher said. Chapter three and four is about dialogue and its importance to the oppressed as well as the different antidialogical theories used by the oppressed to impose their agenda.
Paulo starts by defining the oppressed as an abstract category and sees them as persons who are deprived of their voices and cheated in the sale of their labor, he added that the oppressed are the ones who understand their situation better than any one else as well as the struggle for freedom.However the oppressors them selve become afraid for the struggle
Liberation is a struggle and the oppressed can not get libration for free,it’s a sacrifice they have to work for it through dialogue,however during liberation straggle the oppressed are faced with many challenges they become afraid to struggle for their freedom beacuase they have adopted and duplicated the strategies of the oppressors about them selve and communities and they tend to believ that that’s how life is because they don’t know the other side of the story,and so the are afraid of new responsibilities that they would aquire in an indepencence state. Further more he added that oppression leads to dehumanization of the oppressed and consequently they become mistreated,in these process they don’t think critically because they are benefitng from that situation unless the come out of such situation this is wnen they would start to think critically and start questioning to know and understand why are things happening they way the are and what could be the causes,.
In this chapter Paulo analysis the banking system of the education and disclose its importantance to the oppressors as a method of decreasing students trust. In this method of education the teacher is the only depositors who believes that he knows everythingwhist the student listen attentively and memorise without analysising and questioning what is being thought,Paulo said education is sick and is suffering from narration,education is not about litening but a process of understanding and sharing of knowledge where students develop critical consciousness. Paulo believes that problem-posing education and dialogue gives both the sudent and teacher the chance to learn from each other and becomes effective and efficient citizen.
The Author further analyse this sytem as a way where student don’t become tranformers of the world but rather fully accept submissive role imposed .
In this the chapter Paulo talk of dialogue and he highlighted the importance of dialogue in the context of oppressor an oppressed relation as a means of further oppression, and he added that dialogue involves two people and shouldn’t be dominated by one group and the important part of dialogue is the communication which is words spoken and this words can either be transfer reality or denial of reality.
Successful dialogue involve two person with the existence of love and sacrifice, oppressor who are benefiting from the oppressive system are unable to take part in dialogue because they are not willing to be displaced from their comfort zones and once they are put in any dialogical position they would only be focusing on maintaining their position within the oppressive system.
The banking method of education kills the dialoging skills of students because they just listen and memorizes everything given to them without questioning, analyzing and understanding what have been thought to them, this method doesn’t allow students to contradict and communicate what their depositors said. Politician who failed to achieve liberation because for them they want to win the peoples confident and trust to their side rather than liberating with them, the language the communicate with onset match with
True dialoguers require critical thinking and questioning the differences surrounding the world and men, that’s why revolution is differentiate from a military coup because it lacks the elements dialoging.
In this chapter Paulo repeatedly emphasized on the action and reflections that differentiate animals from human kind, he noted that animals do not mater about their surrounding rather than human beings who symbolizes the world, understand and hence transform it’s the oppressed take part in a revolution processes it’s advisable for them to critically think about the subject of change ,however their dichotomy might facilitate the rise of sectarian environment leading to installation of governments that undermine revolution.
In this chapter Paulo highlight the different theories of cultural actions resulting from anti-dialogical and dialogical conditions ,he stated that the conquest is an important part of anti-dialogical theories where they seizes every means and opportunity to conquer others and imposes their objectives to defeat the oppressors who acquires this shape and make it part of them.
Divide and rule is another oppressive theory used by the oppressor to weaken the unity of the oppressed and manipulate them by rendering them powerless , the oppressor believes and acknowledged the fact that the more the oppressed are united the more they are able to achieve their strategy and salvation as a whole.
In this theory of divide and rule the oppressor focus much on the head or leader of the small group where they inject their different oppressive language and cause the oppressed to focus much on their sub-group or tribe rather than the whole community at large. The oppressors uses this theory to favor certain groups and leaders among the oppressed who executes their agenda such groups are called the dominant class, this class identified leaders and potential leaders among the oppressed whom they believe is a treat and manipulates their focus.
Manipulation is another anti-dialogical tool used by the oppressed as the divide and rule where by the dominate class who are call themselves bourgeoisie implements this tool and disorganized the community focus. Paulo added that the majority of the oppressed working classes who lives in the town are the fertile ground and beneficiaries of the oppressor system as such they don’t care and critically thinking about the revolution they are comfortable where they are.
The oppressed faced challenges with populist leaders who they trust and believes as their leader unknowing has a double standard where the manipulate and dominate instead of organization. The last theory of the oppressors is cultural invasion where the invaders comes informs of friends and through those who are involved in promoting change and gain access through the different cultures and inject their agenda resulting in the loss of their creativity and damaging it.Cultural revolution can positively be use as a means of bringing together all the different groups to dialogue and participate in power.
Finally Paulo stated that in every revolution the leaders must structure themselves as well as their supporters and avoid an augmentation that comes from different angles.
re by majority of them are from the poor and vulnerable.Uganda donor aid is received through bilateral or multilateral forms that support the government through different projects, however most of the founded projects are parallel to the government health priority hence resulting to duplication and more preferences to certain projects, donors take advantages of the poor leadership and system within the health system where they boycotting the government and channel the funds through National and international Organization and the government doesn’t have the capacity of monitoring this funds, reports indicated that some of these organization spend around 70% of the project funds for organizational and administrative cost . ( Nabyonga et al.,2009