The Millennium Development Goals Report

2015

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UNITED NATIONS
NEW YORK, 2015
4 | The Millennium Development Goals Report 2015

Overview
At the beginning of the new millennium, world leaders have saved the lives of millions and improved conditions
gathered at the United Nations to shape a broad vision to for many more. The data and analysis presented in
fight poverty in its many dimensions. That vision, which this report prove that, with targeted interventions,
was translated into eight Millennium Development Goals sound strategies, adequate resources and political will,
(MDGs), has remained the overarching development even the poorest countries can make dramatic and
framework for the world for the past 15 years. unprecedented progress. The report also acknowledges
uneven achievements and shortfalls in many areas. The
As we reach the end of the MDG period, the world
work is not complete, and it must continue in the new
community has reason to celebrate. Thanks to concerted
development era.
global, regional, national and local efforts, the MDGs

Unprecedented efforts have resulted in profound achievements

GOAL 1: ERADICATE EXTREME POVERTY AND HUNGER

Extreme poverty rate

1990 47% • Extreme poverty has declined significantly over the last two decades. In 1990,
in developing countries nearly half of the population in the developing world lived on less than $1.25 a day;
2015 14% that proportion dropped to 14 per cent in 2015.
1990 47%
• Globally, the number of people living in extreme poverty has declined by more
2015 14% than half, falling from 1.9 billion in 1990 to 836 million in 2015. Most progress has
occurred since 2000.
Global number of extreme
poor • The number of people in the working middle class—living on more than $4 a
day—has almost tripled between 1991 and 2015. This group now makes up half the
workforce in the developing regions, up from just 18 per cent in 1991.
1,926 million1,926 million

1,751 million1,751 million

• The proportion of undernourished people in the developing regions has fallen

by almost half since 1990, from 23.3 per cent in 1990–1992 to 12.9 per cent in
836 million 836 million

2014–2016.

1990 1999 2015

GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATION

1990
2000 out-of-school children 1999 2015 100
Global million • The primary school net enrolment rate in the developing regions has reached 91 per
of2015
primary school age 57 cent in 2015, up from 83 per cent in 2000.
million
2000 100
million • The number of out-of-school children of primary school age worldwide has fallen
2015 57 by almost half, to an estimated 57 million in 2015, down from 100 million in 2000.
million
Primary school net • Sub-Saharan Africa has had the best record of improvement in primary education
enrolment rate of any region since the MDGs were established. The region achieved a
in sub-Saharan Africa 20 percentage point increase in the net enrolment rate from 2000 to 2015,
80% compared to a gain of 8 percentage points between 1990 and 2000.
80%

60%
60% • The literacy rate among youth aged 15 to 24 has increased globally from 83 per
52%
80% cent to 91 per cent between 1990 and 2015. The gap between women and men has
80%
40% narrowed.
60%
60% 52%
20%
40%
0
1990 2000 2015
20%

0
1990 2000 2015
 Overview | 5

GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

Primary school enrolment • Many more girls are now in school compared to 15 years ago. The developing
ratio in Southern Asia regions as a whole have achieved the target to eliminate gender disparity in
primary, secondary and tertiary education.
74 103
74 103

100
• In Southern Asia, only 74 girls were enrolled in primary school for every 100 boys in
100 100
100 1990. Today, 103 girls are enrolled for every 100 boys.
1990 2015
1990 2015
• Women now make up 41 per cent of paid workers outside the agricultural sector, an
increase from 35 per cent in 1990.
90% of countries have more
women in parliament since • Between 1991 and 2015, the proportion of women in vulnerable employment as a
1995 share of total female employment has declined 13 percentage points. In contrast,
vulnerable employment among men fell by 9 percentage points.

• Women have gained ground in parliamentary representation in nearly 90 per cent

of the 174 countries with data over the past 20 years. The average proportion of
women in parliament has nearly doubled during the same period. Yet still only one
in five members are women.

GOAL 4: REDUCE CHILD MORTALITY

Global number of deaths • The global under-five mortality rate has declined by more than half, dropping from
of children under five
1990
12.7 90 to 43 deaths per 1,000 live births between 1990 and 2015.
million

1990
12.7
6 • Despite population growth in the developing regions, the number of deaths of
2015 million
million children under five has declined from 12.7 million in 1990 to almost 6 million in
6 2015 globally.
2015 million
• Since the early 1990s, the rate of reduction of under-five mortality has more than
Global measles vaccine tripled globally.
coverage
100% • In sub-Saharan Africa, the annual rate of reduction of under-five mortality was over
84% five times faster during 2005–2013 than it was during 1990–1995.
80% 73%
100%
60% 84% • Measles vaccination helped prevent nearly 15.6 million deaths between 2000 and
80% 73% 2013. The number of globally reported measles cases declined by 67 per cent for
40%
60% the same period.
20%
40%
• About 84 per cent of children worldwide received at least one dose of measles-
0
20% 2000 2013 containing vaccine in 2013, up from 73 per cent in 2000.
0
2000 2013
6 | The Millennium Development Goals Report 2015

GOAL 5: IMPROVE MATERNAL HEALTH

Global maternal mortality • Since 1990, the maternal mortality ratio has declined by 45 per cent worldwide,
ratio (deaths per 100,000 and most of the reduction has occurred since 2000.
live births)
• In Southern Asia, the maternal mortality ratio declined by 64 per cent between
1990 and 2013, and in sub-Saharan Africa it fell by 49 per cent.

• More than 71 per cent of births were assisted by skilled health personnel globally in
380
330 2014, an increase from 59 per cent in 1990.
380 210
330
• In Northern Africa, the proportion of pregnant women who received four or more
210
antenatal visits increased from 50 per cent to 89 percent between 1990 and 2014.
1990 2000 2013

Global1990
births2000
attended by
2013 • Contraceptive prevalence among women aged 15 to 49, married or in a union,
skilled
80% health personnel increased from 55 per cent in 1990 worldwide to 64 per cent in 2015.
80%
70%
71%
70%
71%
60%
59%
60%
50% 59%
1990 2015
50%
1990 201

GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

Global antiretroviral therapy • New HIV infections fell by approximately 40 per cent between 2000 and 2013,
treatment from an estimated 3.5 million cases to 2.1 million.
13.6
million • By June 2014, 13.6 million people living with HIV were receiving antiretroviral
therapy (ART) globally, an immense increase from just 800,000 in 2003. ART
averted 7.6 million deaths from AIDS between 1995 and 2013.

0.8 13.6
million ART million • Over 6.2 million malaria deaths have been averted between 2000 and 2015,
primarily of children under five years of age in sub-Saharan Africa. The global
ART
malaria incidence rate has fallen by an estimated 37 per cent and the mortality rate
2003 2014 by 58 per cent.
0.8
million
Number of insecticide- ART • More than 900 million insecticide-treated mosquito nets were delivered to
treated mosquito nets
ART malaria-endemic countries in sub-Saharan Africa between 2004 and 2014.
delivered2003
in sub-Saharan
2014
Africa, 2004–2014 • Between 2000 and 2013, tuberculosis prevention, diagnosis and treatment
interventions saved an estimated 37 million lives. The tuberculosis mortality rate
fell by 45 per cent and the prevalence rate by 41 per cent between 1990 and 2013.

900 million

900 million
 Overview | 7

GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

1.9 billion people have gained • Ozone-depleting substances have been virtually eliminated since 1990, and the
access to piped drinking ozone layer is expected to recover by the middle of this century.
water since 1990
• Terrestrial and marine protected areas in many regions have increased substantially
2.3 billion 4.2 billion
since 1990. In Latin America and the Caribbean, coverage of terrestrial protected
areas rose from 8.8 per cent to 23.4 per cent between 1990 and 2014.
2.3 billion 4.2 billion
• In 2015, 91 per cent of the global population is using an improved drinking water
source, compared to 76 per cent in 1990.

1990 2015 • Of the 2.6 billion people who have gained access to improved drinking water since
1990, 1.9 billion gained access to piped drinking water on premises. Over half of the
global population (58 per cent) now enjoys this higher level of service.
98% of ozone-depleting2015
1990
substances eliminated since • Globally, 147 countries have met the drinking water target, 95 countries have met
1990 the sanitation target and 77 countries have met both.

• Worldwide, 2.1 billion people have gained access to improved sanitation. The
proportion of people practicing open defecation has fallen almost by half since
1990.

• The proportion of urban population living in slums in the developing regions fell
from approximately 39.4 per cent in 2000 to 29.7 per cent in 2014.

GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

Official development • Official development assistance from developed countries increased by 66 per cent
assistance in real terms between 2000 and 2014, reaching $135.2 billion.
$135 billion
• In 2014, Denmark, Luxembourg, Norway, Sweden and the United Kingdom
$81 billion $135 billion continued to exceed the United Nations official development assistance target of
$81 billion 0.7 per cent of gross national income.

$ $
$
• In 2014, 79 per cent of imports from developing to developed countries were

$ 0 2014
admitted duty free, up from 65 per cent in 2000.

• The proportion of external debt service to export revenue in developing countries

1990 2014 fell from 12 per cent in 2000 to 3 per cent in 2013.
Global Internet penetration
43%
• As of 2015, 95 per cent of the world’s population is covered by a mobile-cellular
43%
signal.

• The number of mobile-cellular subscriptions has grown almost tenfold in the last 15
6%
years, from 738 million in 2000 to over 7 billion in 2015.
6%

• Internet penetration has grown from just over 6 per cent of the world’s population
2000 2015 in 2000 to 43 per cent in 2015. As a result, 3.2 billion people are linked to a global
2000 2015 network of content and applications.
14 | The Millennium Development Goals Report 2015

TARGET 1.A

Goal 1 Halve, between 1990 and 2015, the proportion of people

whose income is less than $1 a day

Eradicate The extreme poverty rate has dropped

significantly in most developing regions
extreme
Proportion of people living on less than $1.25 a day, 1990, 2011
poverty and and 2015 (percentage)

hunger
Sub-Saharan Africa
57
47 28%
41
Southern Asia
52
23 66%
17
Southern Asia (excluding India)
53
20 73%
14
South-Eastern Asia
46
12 84%
7
Eastern Asia (China only)
61
Key facts 6 94%
4
Latin America and the Caribbean
X More than 1 billion people have 13
been lifted out of extreme 5 66%
4
poverty since 1990.
Caucasus and Central Asia
8
X Despite progress, almost half 4 77%
2
of the world’s employed people
work in vulnerable conditions. Western Asia
5
2 46%
X The proportion of 3
undernourished people in the Northern Africa
5
developing regions has fallen by 2 81%
almost half since 1990. 1
Developing regions (excluding China)
X One in seven children worldwide 41
22 57%
are underweight, down from one 18
in four in 1990. Developing regions
47
X By the end of 2014, conflicts had 18 69%
14
forced almost 60 million people
World
to abandon their homes. 36
15 68%
12

0 10 20 30 40 50 60 70 80 90 100
1990 2011 2015 projection

2015 target Percentage change between 1990 and 2015

Note: Sufficient country data are not available for Oceania.

24 | The Millennium Development Goals Report 2015

TARGET 2.A

Goal 2 Ensure that, by 2015, children everywhere, boys and

girls alike, will be able to complete a full course of
primary schooling

Achieve
Across the world, tremendous progress
universal has been made since 2000 in enrolling children
primary in primary school

education Adjusted net enrolment rate* in primary education,

1990, 2000 and 2015 (percentage)
Sub-Saharan Africa
52
60
80
Latin America and the Caribbean
87
94
94
South-Eastern Asia
93
93
94
Caucasus and Central Asia
95
95
Key facts Southern Asia
75
80
X The primary school net 95
enrolment rate in the developing Western Asia
regions has reached an estimated 84
86
91 per cent in 2015, up from 83 95
per cent in 2000. Oceania
69
95
X The number of out-of-school
children of primary school age Eastern Asia
97
worldwide has fallen by almost 96
half, to an estimated 57 million in 97
2015, from 100 million in 2000. Northern Africa
80
90
X Between 1990 and 2012, the 99
number of children enrolled in Developed regions
primary school in sub-Saharan 96
97
Africa more than doubled, from 96
62 to 149 million.
Developing regions
80
X In the developing regions, 83
91
children in the poorest
households are four times as 0 20 40 60 80 100
likely to be out of school as those 1990 2000 2015 projection
in the richest households.
* Adjusted net enrolment rate is defined as the number of pupils of the official age
for primary education enrolled either in primary or secondary school, expressed as
X The literacy rate among youth a percentage of the total population in that age group.
aged 15 to 24 has increased
Note: 2000 figure for Oceania is not available.
globally from 83 per cent to 91 1990 figure for Caucasus and Central Asia is not available.
per cent between 1990 and 2015.
28 | The Millennium Development Goals Report 2015

TARGET 3.A

Goal 3 Eliminate gender disparity in primary and secondary

education, preferably by 2005, and in all levels of
education no later than 2015

Promote A majority of regions have reached gender parity

gender in primary education, but disparities persist at
higher levels
equality and
Gender parity index* for gross enrolment ratios in primary,
empower secondary and tertiary education in developing regions,
1990, 2000 and 2015
women 1990
Oceania

2000
2015
Sub-Saharan Africa
1990
2000
2015
Western Asia
1990
2000
2015
Northern Africa
Key facts 1990
2000
2015

X About two thirds of countries Latin America and the Caribbean

1990
in the developing regions have 2000
achieved gender parity in primary 2015
education. Caucasus and Central Asia
1990
2000
X Globally, about three quarters 2015
of working-age men participate Eastern Asia
in the labour force, compared to 1990
half of working-age women. 2000
2015
South-Eastern Asia
X Today, women make up 41 per 1990
cent of paid workers outside of 2000
agriculture, an increase from 35 2015
per cent in 1990. Southern Asia
1990
2000
X The average proportion of 2015
women in parliament has nearly Developing regions
doubled over the past 20 years, 1990
but still only one in five members 2000
2015
are women.
0.4 0.6 0.8 1.0 1.2 1.4
Primary Secondary Tertiary
2015 Target = Gender parity index between 0.97 and 1.03
* The gender parity index is defined as the ratio of the female gross enrolment ratio to
the male gross enrolment ratio for each level of education.
Notes: Data for 2015 are projections. Data for 1990 for the Caucasus and Central Asia
refer to 1993. Projections for 2015 for primary and tertiary education in Oceania are
not available. For primary education, 2012 data are used.
32 | The Millennium Development Goals Report 2015

TARGET 4.A

Goal 4 Reduce by two thirds, between 1990 and 2015,

the under-five mortality rate

Reduce child Substantial progress in reducing child mortality

has been made, but more children can be saved
mortality from death due to preventable causes

Under-five mortality rate, 1990 and 2015

(deaths per 1,000 live births)
Sub-Saharan Africa
179
52%
86
Oceania
74
31%
51

Southern Asia
126
60%
50
Caucasus and Central Asia
73
55%
33
South-Eastern Asia
Key facts 71
62%
27
X The global under-five mortality Northern Africa
rate has declined by more than 73
67%
half, dropping from 90 to 43 24
deaths per 1,000 live births Western Asia
between 1990 and 2015. 65
65%
23
X The rate of reduction in under-
Latin America and the Caribbean
five mortality has more than 54
69%
tripled globally since the early 17
1990s.
Eastern Asia
53
X Measles vaccination helped 78%
11
prevent nearly 15.6 million deaths
Developed regions
between 2000 and 2013.
15
61%
6
X About 84 per cent of children
worldwide received at least one Developing regions
100
dose of measles-containing 53%
47
vaccine in 2013.
World
90
X Every day in 2015, 16,000 53%
43
children under five continue to
die, mostly from preventable
0 50 100 150 200
causes. Child survival must
remain the focus of the post-2015 1990 2015 projection 2015 target
development agenda. Percentage change between 1990 and 2015

Note: Percentage change calculations are based on unrounded numbers.

38 | The Millennium Development Goals Report 2015

TARGET 5.A

Goal 5 Reduce by three quarters, between 1990 and 2015, the

maternal mortality ratio

Improve Southern Asia and Eastern Asia have made the

greatest progress in reducing maternal mortality
maternal
Maternal mortality ratio, 1990, 2000 and 2013
health (maternal deaths per 100,000 live births, women aged 15¬49)
Sub-Saharan Africa
990
830 49%
510
Southern Asia
530
360 64%
190
Oceania
390
290 51%
190
Caribbean
300
230 36%
190
South-Eastern Asia
320
Key facts 220 57%
140
Latin America
X Since 1990, the maternal 130
98 40%
mortality ratio has been cut 77
nearly in half, and most of the Western Asia
reduction has occurred since 130
2000. 97 43%
74
Northern Africa
X More than 71 per cent of births 160
were assisted by skilled health 110 57%
personnel globally in 2014, an 69

increase from 59 per cent in Caucasus and Central Asia

70
1990. 65 44%
39
X In the developing regions, only Eastern Asia
95
56 per cent of births in rural
63 65%
areas are attended by skilled 33
health personnel, compared with Developed regions
87 per cent in urban areas. 26
17 37%
16
X Only half of pregnant women in
Developing regions
the developing regions receive 430
the recommended minimum of 370 46%
230
four antenatal care visits.
World
380
X Just 51 per cent of countries have 330 45%
data on maternal cause of death. 210

0 200 400 600 800 1000

1990 2000 2013 2015 target

Percentage change between 1990 and 2013 (based on unrounded numbers)

44 | The Millennium Development Goals Report 2015

TARGET 6.A

Goal 6 Have halted by 2015 and begun to reverse the spread of

HIV/AIDS

Combat The number of people newly infected with HIV

continues to decline in many regions of the world
HIV/AIDS,
Estimated number of new HIV infections, 2000 and 2013
malaria and (thousands)

other diseases
Southern Africa*
1,370
700
Eastern Africa*
650
400
West Africa*
550
290
Central Africa*
140
74
North Africa*
8
13
Key facts Southern Asia
310
160
X New HIV infections fell by
South-Eastern Asia and Oceania
approximately 40 per cent 120
between 2000 and 2013, from 120
an estimated 3.5 million cases to Latin America
2.1 million. 96
94
X By June 2014, 13.6 million people Eastern Asia
living with HIV were receiving 63
antiretroviral therapy globally, an 70
increase from just 800,000 in Caribbean
2003. 27
12
X In sub-Saharan Africa still less Caucasus and Central Asia
10
than 40 per cent of youth aged 15
8.3
to 24 years had comprehensive
correct knowledge of HIV in 2014. Western Asia
0.9
1.9
X Thanks to the expansion of anti-
Developed regions
malaria interventions, over 6.2 170
million malaria deaths have been 190
averted between 2000 and 2015, Developing regions
primarily of children under five 3,340
years of age in sub-Saharan Africa. 1,940

X Tuberculosis prevention, diagnosis 0 1000 2000 3000 4000

and treatment saved an estimated
37 million lives from 2000 to 2013. 2000 2013

* The composition of the subregions of Africa is shown on page 71.

52 | The Millennium Development Goals Report 2015

TARGET 7.A

Goal 7 Integrate the principles of sustainable development into

country policies and programmes and reverse the loss
of environmental resources

Ensure Deforestation has slowed, but it continues

environmental to jeopardize species and the livelihoods
of millions of people
sustainability
About 30 per cent of the land area on the planet is covered by
forests. At least 1.6 billion people depend directly on forests for their
livelihoods, and they provide additional benefits that are enjoyed
by all, such as clean air and water. In addition, forests provide a
home to millions of animals and plants as well as catchment for
three-fourths of fresh water. They also play an important role in
adaptation to and mitigation of climate change. However, forests are
under threat from deforestation around the world.

In recent years, the net loss of forest area has slowed, due to both
a slight decrease in deforestation and an increase in afforestation,
as well as the natural expansion of forests in some countries and
regions. Net loss in forest area declined from 8.3 million hectares
annually in the 1990s to an estimated 5.2 million hectares (an area
Key facts about the size of Costa Rica) each year from 2000 to 2010. In
spite of this improvement, deforestation remains alarmingly high
X Ozone-depleting substances in many countries.
have been virtually eliminated,
and the ozone layer is expected South America and Africa experienced the largest net losses of
to recover by the middle of this forest area in the first decade of the new millennium. Oceania
century. also reported a net loss, largely due to severe drought and forest
fires in Australia. Asia, on the other hand, registered a net gain
X Global emissions of carbon of around 2.2 million hectares annually between 2000 and 2010
dioxide have increased by over following a net loss in the 1990s. This gain, mostly due to large-
50 per cent since 1990. scale afforestation programmes in China, offsets continued high
rates of net loss in many countries in Southern and South-Eastern
X In 2015, 91 per cent of the global Asia.
population uses an improved
drinking water source, compared Deforestation, forest degradation and poor forest management
to 76 per cent in 1990. release carbon into the atmosphere, contributing to climate
change. Since 1990, global forests have lost carbon stored in their
X Since 1990, 2.1 billion people biomass in almost all regions, adding to global carbon emissions.
have gained access to improved The total carbon stock held in forest biomass fell by an estimated
sanitation, and the proportion 0.5 gigatonnes annually from 2005 to 2010, primarily due to a
of people practising open reduction in global forest area. Stemming these damaging releases
defecation globally has fallen of carbon requires sustainable forest management worldwide to
almost by half. limit deforestation and allow forests to maintain their crucial role
in ecosystem health.
X The proportion of urban
population living in slums in the
developing regions fell from
39.4 per cent to 29.7 per cent
between 2000 and 2014.
62 | The Millennium Development Goals Report 2015

Official development assistance has plateaued in

Goal 8 recent years, after increasing significantly in the

first decade of the new millennium

Develop Official development assistance (ODA) from OECD-DAC countries,

2000¬2014 (constant 2013 US$ billions)

a global 150

partnership for 120

development
90

60

30

0
2000 2002 2004 2006 2008 2010 2012 2014
Key facts (preliminary)
Net debt relief grants Multilateral ODA
X Official development assistance Humanitarian aid Bilateral development projects,
from developed countries programmes and technical cooperation
increased by 66 per cent in real
terms between 2000 and 2014. A decline in aid flows during the last years of the 20th century
reversed early in the new millennium. Net official development
X In 2014, 79 per cent of imports assistance (ODA) from member countries of the Development
from developing to developed Assistance Committee (DAC) of the Organisation for Economic
countries were admitted duty Co-operation and Development (OECD) increased by 66 per cent
free. between 2000 and 2014. However, after reaching an all-time high
in 2013, net ODA flows from DAC members totalled $135.2 billion
X The proportion of external debt in 2014, marking a slight decline, of 0.5 per cent, in real terms.
service to export revenue in
developing countries fell from 12 ODA in the form of net aid for core bilateral projects and
per cent in 2000 to 3 per cent in programmes, which represents about 60 per cent of the total,
2013. remained virtually unchanged between 2013 and 2014. In contrast,
debt relief grants fell by 87 per cent in real terms, from $3.6 billion
X As of 2015, 95 per cent of the to $476 million. Humanitarian aid rose by 22 per cent in real terms,
world’s population is covered by from $11 billion to $13 billion.
a mobile-cellular signal.
Total ODA from DAC member countries represented 0.29 per cent
X Only one third of the population of their gross national income (GNI) in 2014. The top five donor
in the developing regions use the countries by volume were the United States, the United Kingdom,
Internet, compared to 82 per cent Germany, France and Japan. Denmark, Luxembourg, Norway,
in the developed regions. Sweden and the United Kingdom continued to exceed the United
Nations’ ODA target of 0.7 per cent of GNI. In 2014, the Group of
7 industrialized countries provided 71 per cent of all the net ODA
from DAC members, while European Union countries provided 55
per cent.
MILLENNIUM
DEVELOPMENT GOALS
REPORT FOR UGANDA 2015
SPECIAL THEME:
RESULTS, REFLECTIONS AND THE WAY FORWARD

With support from

 Millenium Development Goals
Report for Uganda 2015 iii

Uganda’s MDG Results at a Glance

Goal 1: Eradicate extreme poverty and hunger

Target 1.A: Halve, between 1990 and 2015, the proportion of people whose
income is less than one dollar a day ACHIEVED

Target 1.B: Achieve full and productive employment and decent work for all,
including women and young people NO TARGET

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer MISSED
from hunger NARROWLY

Goal 2: Achieve universal primary education

Target 2.A: Ensure that, by 2015, children everywhere, boys and girls alike, will be
able to complete a full course of primary schooling NOT ACHIEVED

Goal 3: Promote gender equality and empower women

Target 3.A: Eliminate gender disparity in primary and secondary education,

preferably by 2005, and in all levels of education no later than 2015 NOT ACHIEVED

Goal 4: Reduce child mortality NO TARGET OR INSUFFIECIENT

EVIDENCE 3
Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five MISSED
mortality rate NARROWLY
ACHIEVED 6
Goal 5: Improve maternal health

Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio NOT ACHIEVED

Target 5.B: Achieve, by 2015, universal access to reproductive health NO TARGET

Goal 6: Combat HIV/AIDS, malaria and other diseases

Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS NOT ACHIEVED

Target 6.B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all
those who need it ACHIEVED

Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria
and other major diseases ACHIEVED
MISSED NARROWLY 3
Goal 7: Ensure environmental sustainability
Target 7.B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in INSUFFICIENT NOT ACHIEVED 5
the rate of loss EVIDENCE

Target 7.C: Halve, by 2015, the proportion of people without sustainable access MISSED
to safe drinking water and basic sanitation NARROWLY

Target 7.D: By 2020, to have achieved a significant improvement in the lives of at

NO TARGET
least 100 million slum dwellers
Goal 8: Develop a global partnership for development

Target 8.B: Address the special needs of the least developed countries NOT ACHIEVED

Target 8.D: Deal comprehensively with the debt problems of developing

countries through national and international measures in order to make debt ACHIEVED
sustainable in the long term

Target 8.E: In cooperation with pharmaceutical companies, provide access to

affordable essential drugs in developing countries ACHIEVED

Target 8.F: In cooperation with the private sector, make available the benefits of
new technologies, especially information and communications ACHIEVED

Note: MDG outcomes are projected based on the most up-to-date evidence available in September 2015.
 Millenium Development Goals
Report for Uganda 2015 13

3. UGANDA’S MILLENNIUM DEVELOPMENT

GOALS RESULTS
This chapter presents Uganda’s MDGs performance and gap ratio — an indicator that estimates the depth of
discusses the progress made and challenges faced during poverty by establishing how far individuals are below
their implementation period (2000 to 2015). Government the poverty line – declined by three quarters from 20.3
interventions and policy reforms that have contributed in 1992/93 to 5.2 in 2012/13 (Table 3.1). The poverty
to the observed trends are highlighted, recognising that gap measures both the breadth and depth of poverty,
Uganda implemented the MDGs under two different so the more rapid decline in the poverty gap relative to
but related national development frameworks — the the poverty headcount indicates the average depth of
Poverty Eradication Action Plan (1997 – 2010) and the poverty has declined.
National Development Plan (2010 to date). The gaps and
unfinished MDG business are identified and returned to Inequality is an important policy challenge, but
for deeper analysis in Chapter 4. income inequality has not changed significantly over
the MDG period. The share of the poorest quintile
The nationally representative data used to track (20%) in total household consumption has remained
progress in previous MDG reports is combined with stable, showing that the benefits of growth have been
the latest available comparable official data (both enjoyed by households across the income distribution.
administrative and from household surveys) to report Most successful developing countries show a natural
progress on a goal-by-goal and indicator-by-indicator tendency towards increasing inequality, as emerging
basis for the entire 15 years. Where there are gaps in this economic opportunities tend to be concentrated in
evidence, other data sources (which may not be directly certain locations or industries. In Uganda these forces
comparable or nationally representative) are discussed, have been counteracted by Government interventions
while acknowledging the limitations of this evidence. put in place to address inequality and vulnerability, such
Based on all the available evidence, one of four projected as the Youth Livelihood Programme and the Northern
outcomes is assigned to each target: “Achieved”, “Missed Uganda Social Action Fund (NUSAF) among others.
Narrowly”, “Not Achieved”, or “Insufficient Evidence”.
The narrowly missed category allows for recognition of Whereas the incidence and intensity of poverty have
significant progress made that is nonetheless likely to declined, a large section of the population remains
fall short of the (often very ambitious) targets sets. vulnerable to poverty. According to the Chronic
Poverty Report 2014-2015, around 10% of households
in Uganda escaping poverty saw their consumption
3.1. Goal 1: Eradicate extreme increase to a level less than 10% above the poverty line,
poverty and hunger meaning they are vulnerable to living in poverty again
in the future.18 On the other hand, the rapid reduction
Uganda has made important progress towards reducing in poverty is also reflected in the expansion of the
income poverty, having already halved the proportion middle class, which enjoys more secure livelihoods.
of people whose consumption is less than the national The proportion of the population in the middle class
poverty line in 2009/10, well ahead of the 2015 deadline. grew from 32.6% to 37.0% in just three years between
The national poverty headcount declined from 56.4% in 2009/10 and 2012/13.19
1992/93 to 24.5% in 2009/10 and further to 19.7% in
2012/13 (Table 1). Rural poverty declined from 60.4%
to 22.8% over the same period, while the poverty rate
18 Chronic Poverty Advisory Network (2014).
in urban areas fell from 28.8% to 9.3%. The poverty 19 Ministry of Finance, Planning and Economic Development (2014c).
 Millenium Development Goals
14 Report for Uganda 2015

TARGET 1.A HALVE, BETWEEN 1990 AND 2015, THE PROPORTION OF PEOPLE WHOSE
TABLE 3.1
INCOME IS LESS THAN ONE DOLLAR A DAY

PROJECTED OUTCOME: ACHIEVED

Indicator 1992/93 1999/2000* 2002/3 2005/6 2009/10 2012/13 2015 target

1.1 Proportion of population 56.4% 33.8% 39.0% 31.0% 24.5% 19.7% 25.0%
below national poverty line
1.2 Poverty gap ratio 20.3 10.0 11.9 8.8 6.8 5.2
1.3 Share of poorest quintile in 6.9% 6.7% 6.3% 6.4% 6.2% 6.4%
total household consumption
Source: UNHS 1992/1993, 1999/2000, 2002/2003, 2005/2006, 2009/10, 2012/13. Note: * Estimates exclude the districts of Bundibugyo, Kitgum, Gulu, Pader and Kasese, which
were not covered in the 1999/2000 survey due to instability.

Figure 3.1 shows the trends in poverty reduction since The focus of the NDP on addressing Uganda’s physical
1992/93. If the current trend is sustained, the country infrastructure deficit and investing in other productive
is on track to reduce poverty to 5% or less as targeted sectors has benefited many poor and vulnerable
in Vision 2040. Uganda’s strong performance on income households. Investments to support high-value sectors
poverty is mainly attributed to high and sustained decreases poverty directly by generating jobs to employ
economic growth rates, averaging close to 7% over the poor individuals and indirectly through important inter-
last two decades, and an increase in more secure and sectoral linkages that benefit the poor.21 To maximise
productive forms of employment. Recent evidence from the impact of infrastructure investment on poverty,
the 2014 Poverty Status Report identifies growth of emphasis should be on feeder roads, especially in rural
nonfarm household enterprises as one of the key factors areas. Economic returns to investment in rural feeder
behind the rapid fall in rural poverty. 20
Between 2005/6 roads have been found to be approximately twice as
and 2012/13, the share of households depending on large as for national roads. An estimated 3,156 rural
non-agricultural enterprises as their main source of poor people are lifted out of poverty for every billion
income increased from 19% to 21%. This partly reflected Uganda shillings invested in feeder roads, compared
the growth of the telecommunications sector, which has to 386 people when the same amount of resources is
fuelled access to business and market information in invested in national roads.22
rural areas.
Government has a number of measures to support the
FIGURE PROPORTION OF THE POPULATION 6.7 million Ugandans who are still in absolute poverty,
3.1 BELOW THE NATIONAL POVERTY LINE and the further 14.7 million who are estimated to remain
vulnerable. These programmes include the National
Agricultural Advisory Services (NAADS), which has
been restructured recently to improve effectiveness.
Other initiatives include the Social Assistance Grant
for Empowerment (SAGE), which provides a monthly
payment of about 25,000 shillings to the elderly and
other vulnerable individuals in 15 districts. Government
has built productive capabilities through interventions
such as the Youth Opportunities Programme under
NUSAF, which disbursed conditional cash transfers to
groups of youth for technical or vocational training; and
the Rural Financial Services Strategy which helps people
Source: UNHS 1992/3, 1999/2000, 2002/03, 2005/6, 2009/10 and 2012/13. to start new businesses.

21 Ministry of Finance, Planning and Economic Development (2014c).

20 Ministry of Finance, Planning and Economic Development (2014c). 22 Mwanje (2014).
 Millenium Development Goals
Report for Uganda 2015 15

Employment creation is crucial for improving household number of wage jobs in registered firms increased from
welfare. As in most African countries, employment 544,723 in 2002 to 849,461 in 2011. This represents an
remains overwhelmingly informal due to insufficient average growth rate of 5.1%, which is high compared
labour demand in the formal sector. Almost four in to most other countries but still not significantly higher
five working Ugandans are employed by themselves or than Uganda’s labour force growth. Underemployment
their families. These jobs are often in low-productivity remains a greater challenge than unemployment. In
sectors, characterised by lower and less secure income 2012/13, 8.9% of the labour force was classified as
and worse working conditions compared to wage and time-related underemployed – those who worked fewer
salaried jobs. The proportion of the labour force in than 40 hours a week and reported that they would like
this type of employment has fallen over the last 20 to work more. However, 67% of the labour force was
years, reflecting strong growth in wage employment, working less than 40 hours a week.
but may have stagnated more recently (Table 3.2). The

TARGET 1.B ACHIEVE FULL AND PRODUCTIVE EMPLOYMENT AND DECENT WORK FOR
TABLE 3.2
ALL, INCLUDING WOMEN AND CHILDREN.

NO TARGET

Indicator 1992/3 2002/03 2005/06 2009/10 2012/13 2012/13

1.4 Growth rate of GDP per person employed NA NA NA NA NA 19.7%
1.5 Employment-to-population ratio 84.7% 77.5% 70.3% 75.4% 83.4% 5.2
1.6 Proportion of employed people living below NA NA NA NA NA 6.4%
national poverty line
1.7 Proportion of own-account and contributing 87.3% 85.3% 80.6% 74.4% 78.9%
family workers to total employment

Source: UNHS 1992/1993, 2002/2003, 2005/2006, 2009/10, 2012/13. Note: Includes population of working age that is employed and not attending formal education. For
comparability over time, employment is defined to include agricultural contributing family workers and may therefore differ from recent estimates published by UBOS.

Government is increasing attention and resources The detrimental effects of poor nutrition during
to raise labour force productivity and boost the childhood can persist well into adulthood and cannot
employability of the country’s workforce, especially the be easily remedied. High rates of malnutrition therefore
youth. A good example is the Skilling Uganda programme jeopardise future economic growth by reducing the
which was launched in October 2012 with emphasis on intellectual and physical potential of the population.
the provision of hands-on technical skills, business skills Malnutrition remains widespread in Uganda, despite
development and entrepreneurship. Entrepreneurship significant progress over recent years. Weight-for-age
training is also provided through the Enterprise Uganda takes into account both chronic and acute malnutrition,
programme. Other Government interventions include and is the MDG indicator used to assess the population’s
technical and vocational training; development of overall nutritional health. The share of underweight
serviced industrial parks; capital venture funds for children under five years of age declined from 26% in
young entrepreneurs; and special programmes with 1995 to 14% in 2011 (Table 3.3). Based on this progress,
a regional focus such as the Karamoja Livelihood Uganda is close to achieving this MDG. However there has
Programme (KALIP), and Northern Uganda Social been no national survey to measure child nutrition since
Action Fund (NUSAF) among others. With the majority 2011, and more recent hospital records do not indicate
of the labour force still reliant on small-scale farming, a significant decline in the prevalence of conditions
interventions to support agricultural commercialisation related to malnutrition – such as anaemia, kwashiorkor
and agro-processing activities are critical, including and marasmus.23 Based on this evidence, Uganda is
the provision of extension and advisory services, and projected to narrowly miss the hunger-reduction target
support for contract farming arrangements that benefit (Figure 3.2).
smallholders, such as the oil palm project in Kalangala
district. 23 Ministry of Health (2014).
 Millenium Development Goals
16 Report for Uganda 2015

TARGET 1.C HALVE, BETWEEN 1990 AND 2015, THE PROPORTION OF PEOPLE WHO
TABLE 3.3
SUFFER FROM HUNGER

PROJECTED OUTCOME: MISSED NARROWLY

Indicator 1995 2001 2006 2011 2015 target

1.8 Prevalence of underweight children under 25.5% 22.8% 15.9% 13.8% 10%
five years of age
1.9 Proportion of population below minimum NA NA NA NA
level of dietary energy consumption
Source: UDHS. Notes: Indicator 1.8 refers to the share of children below two standard deviations of the mean weight for age.

FIGURE PREVALENCE OF UNDERWEIGHT 3.2. Goal 2: Achieve universal

3.2 CHILDREN UNDER FIVE YEARS OF AGE
primary education
Education is crucial for building human empowerment
as an end and as a means to deliver economic progress.
In order to improve access to education, Government
introduced Universal Primary Education (UPE) in 1997.
This has contributed to a more than threefold increase in
total primary school enrolment from 2.7 million in 1996
to 8.5 million in 2013.

Rapid enrolment growth necessitated an increase in

the number of schools and classrooms — in 1996 there
were 7,351 primary schools, and it is now stands at over
Source: UDHS 1995, 2001, 2006, 2011. Notes: Refers to the share of children below
two standard deviations of the mean weight for age. 22,600; the number of classrooms increased from 40,000
to 149,000 over the same period.25 This resulted from a
Although the MDG target is likely to be missed, coherent and targeted Government strategy to invest
Government interventions to improve nutrition through in UPE schools. For example, education interventions
the Uganda Nutrition Action Plan (UNAP) for 2011 to under the Peace, Recovery and Development Programme
2016 have yielded some positive results. UNAP targets a (PRDP) have boosted education outcomes in the Northern
number of simple and cost effective measures to improve region. Over four years from 2009 to 2013, 2,808
maternal nutrition and care, including promoting classrooms were constructed, and 253 rehabilitated. At
exclusive breastfeeding for the first six months of life; the same time 2,634 teachers’ houses were constructed
timely, adequate, safe and appropriate complementary and 43,050 desks purchased. As a result, there has
feeding and micronutrient intake between 6 and 24 been an improvement in the teacher-to-classroom ratio
months; and the fortification of common staple foods. from 90 in 2009 to 68 in 2013, which is in line with the
Statistics from UDHS 2011 indicate that more than national average for Government schools. Nonetheless,
six in ten children (63%) younger than 6 months are with the region experiencing rapid enrolment growth,
exclusively breastfed. Complementary foods are not recruiting and retaining a sufficient number of teachers
introduced in a timely fashion for all children – fewer remains a challenge.
than seven in ten at 6-to-9-month old children (68%)
receive complementary foods.24 Malnutrition remains The net school enrolment ratio (NER) — a major MDG
an important challenge, and its relationship to parent’s indicator – measures the share of children of school-
education and household wealth necessitates a holistic going age who are attending school. The primary school
policy response. NER increased from 53% in 1990 to 57% by 1996 and
then to 87% with the introduction of UPE in 1997.
24 UNICEF and WHO recommend that children be exclusively breastfed during the
first 6 months of life and that children be given solid or semi-solid complementary
food in addition to continued breastfeeding from age 6 months until 24 months or
more, when the child is fully weaned 25 Namukwaya and Kibirige (2014) and Ministry of Education and Sports (2014).
 Millenium Development Goals
Report for Uganda 2015 17

The NER has remained above 80% ever since, but and uniforms. Socioeconomic status, sometimes long
has not increased further (Table 3.4). The MDG target distances to school, and obligations towards the family
of 100% net enrolment is therefore expected to be business or farm are major factors explaining primary
missed. Studies suggest that financial constraints school dropout rates.2 Gross primary school enrolment
remain the most prominent factor explaining both remains above 120%, implying that there are more
non-enrolment and high dropout rates.1 This reflects primary school pupils than there are children of official
high out-of-pocket household expenses on scholastic school-going age. This highlights challenges such as late
and non-scholastic materials such stationary, meals entry, re-entry and grade repetition.

1 Mbabazi et al (2014). 2 Tamusuza (2011).

TARGET 2.A ENSURE THAT, BY 2015, CHILDREN EVERYWHERE, BOYS AND GIRLS ALIKE,
TABLE 3.4
WILL BE ABLE TO COMPLETE A FULL COURSE OF PRIMARY SCHOOLING

PROJECTED OUTCOME: NOT ACHIEVED

2002 2006 2010 2013 2015 target

Gross primary school enrolment rate1 126% 126% 120% 129% 100%
Boys 129% 128% 121% 132% 100%
Girls 123% 124% 120% 126% 100%
Net enrolment ratio in primary education2 86% 84% 83% 82% 100%
Boys 85% 84% 82% 81% 100%
Girls 86% 85% 83% 8% 100%
Gross primary completion rate3 49% 48% 54% 67% 100%
Boys 59% 55% 56% 67% 100%
Girls 41% 42% 51% 67% 100%
Net completion rate 4
NA 6% 5% 9%
Boys NA 5% 3% 10%
Girls NA 7% 7% 7%
Literacy rate of 15-24 year-olds 5
59% 60% 76% NA
Men 65% 70% 77% NA
Women 53% 58% 75% NA
Sources: 1,2,4UNHS 2002/03, 2005/6, 2009/10, 2012/13; 3Ministry of Education and Sports (2013) and (2015); 5UDHS 2001/2, 2006, 2010/11. Notes: 1,2,4,5 data for the fiscal year in
which the survey was conducted, see sources; 1refers to the total number of pupils attending primary school as a percentage of the total population aged 6-12; 2refers to the number
of children aged 6-12 attending in primary education as a percentage of the total population aged 6-12; 3refers to the number of candidates in the primary-school leaving exam
as a percentage of the total number of 12 year olds; 4refers to the proportion of 13 year olds who have at least completed P7; 5Refers to those who can read a complete sentence or
have attended secondary school. The UNHS 2012/13 indicates literacy rates may have improved but these estimates may not be directly comparable to the DHS estimates due to
differences in methodology and are therefore not reported.

The focus of UPE is not only on enrolment but to enable factors both on the supply-side (the quality of schools)
children, especially girls, to start school on time, and the demand-side (such as economic obligations,
complete a full cycle of quality primary schooling and parental attitudes to education and early marriages).
achieve the required proficiency levels. Uganda has Learning outcomes have improved – the basic literacy
made considerable progress improving progression rates rate among young adults increased from 59% in 2002
through primary school. The gross primary completion to 74% in 2011 (Table 3.4). Nonetheless, concerns
rate – the number of pupils in the final year of primary regarding education quality have persisted, with
school as a percentage of all 12 year-olds – increased primary school test results suggesting the improvement
from 49% in 2002 to 72% in 2014/15. Furthermore, in education standards may have slowed over the last
the previously large gap in completion rates between five years (Figure 3.5 and Figure 3.6). This is attributed
girls and boys has been eliminated. Nonetheless, the to insufficient infrastructure and learning materials, but
progress made is insufficient to meet the MDG target more importantly low motivation among teachers and
of 100% primary school completion by 2015 (Figure school managers and weak compliance with set service
3.3 and Figure 3.4). This reflects persistently high class delivery standards.
repetition and drop-out rates, which can be attributed to
 Millenium Development Goals
18 Report for Uganda 2015

FIGURE FIGURE
GROSS PRIMARY COMPLETION RATE, BOYS GROSS PRIMARY COMPLETION RATE, GIRLS
3.3 3.4

Sources: Ministry of Education and Sports (2014) and Ministry of Education (2015). Notes: Gross primary completion refers to the number of candidates in the primary-school
leaving exam as a percentage of the total number of 12 year olds.

FIGURE FIGURE
LEARNING OUTCOMES (PRIMARY 3 PUPILS) LEARNING OUTCOMES (PRIMARY 6 PUPILS)
3.5 3.6

Source: Ministry of Education and Sports (2014). Notes: Shows the proportion of pupils reaching the defined level of competency in literacy and numeracy.

Government remains committed to enhancing education school inspection remains a challenge. Over the next
access and quality. The Capitation and School Facilities five years, Government plans to invest significantly in
Grants were recently increased to ensure better the human resources, facilitation and autonomy of the
effectiveness of the UPE and USE/UPOLET programmes, inspection function.1
and an additional 293 primary schools are under
construction across the country. NDP II recognises that
1 National Planning Authority (2015).
 Millenium Development Goals
Report for Uganda 2015 19

3.3. Goal 3: Promote gender continuous efforts to improve access to education. The
ratio of girls to boys in primary school now stands at
equality and empower women 100%, up from 93.2% in 2000 (Table 3.5). Significant
progress has also been achieved at the secondary and
Uganda has made significant progress in promoting
tertiary levels, with the ratio of girls to boys now close
gender equality and empowering women. The target
to 90% and 80% respectively. However, the target of
of having the same number of girls as boys in primary
closing these gender gaps completely by 2015 will not
school has been achieved, reflecting Government’s
be met (Figure 3.7 and Figure 3.8).

TARGET 3.A ELIMINATE GENDER DISPARITY IN PRIMARY AND SECONDARY EDUCATION,

TABLE 3.5
PREFERABLY BY 2005, AND IN ALL LEVELS OF EDUCATION NO LATER THAN 2015.

PROJECTED OUTCOME: NOT ACHIEVED

Indicators 2000 2003 2006 2009 2012 2014 2015

target
3.1 Ratio of girls to boys1
in primary education 93.2% 97.1% 99.4% 99.9% 99.9% 100.0% 100%
in secondary education 78.8% 82.4% 83.5% 84.2% 85.2% 88.3% 100%
in tertiary education 58.0% 64.7% 72.7% 77.6% 78.6% 79.1% 100%
3.2 Share of non-agricultural wage workers NA NA 28.1% 33.4% 30.2% NA
who are women2
3.3 Proportion of seats held by women in 17.9% 24.7% 23.9% 30.7% 35.0% 35.0%
Parliament 3

Sources: 1Ministry of Education and Sports (2012) and (2015); 2UNHS 2005/06, 2009/10 and 2012/12; 3UNSTATS. Notes: 2Year corresponds to fiscal year of survey, see sources.
Based on main employment over the 12 months before the survey among the population of working age that is not attending formal education.

The continued gender disparity in access to secondary school, but gender biases persist at the secondary and
and tertiary education is explained by a number of tertiary education – households sometimes choose to
factors. Although learning opportunities are available educate boys at the expense of girls, particularly in the
to both genders, socioeconomic factors and cultural and relatively poor northern region.30 Gender inequality
religious practices still have important impacts on girls’ is still highest within tertiary education. Although
enrolment, as well as school-specific factors such as there is positive discrimination for women applying
sanitary facilities and effective counselling services.29 for Government sponsorship in public universities,
Public policy has helped to raise the aspirations of affirmative action has not gone far enough to counteract
parents for their daughters to at least complete primary gender biases entirely.

29 Ogawa and Wokadala (2013). 30 Ssewanyana and Kasirye (2010).

 Millenium Development Goals
20 Report for Uganda 2015

FIGURE RATIO OF GIRLS TO BOYS IN SECONDARY FIGURE RATIO OF WOMEN TO MEN IN TERTIARY
3.7 SCHOOL 3.8 EDUCATION

Source: Ministry of Education and Sports (2012) and (2015).

Uganda is one of only eight countries in the world to have

more than 30% of the seats in the national parliament
3.4. Goal 4: Reduce child
held by women. More than one in every three members mortality
of parliament (35%) is a woman. This is largely attributed
There has been significant progress in the reduction of
to the quota system that requires every district to have a
both under-five and infant mortality rates in Uganda.
woman MP – 112 women representatives out of the 130
The under-five mortality rate declined by 42% from 156
women MPs are elected in this manner. Women occupy
per 1,000 live births in 1995 to 90 per 1,000 live births
24% of cabinet positions, including senior ministerial
in 2011 (Table 3.6). The infant mortality rate declined
portfolios such as Security, Energy and Minerals,
37% from 86 to 54 per 1,000 live births over the same
Education, Trade and Industry, and Tourism. The National
period. The fall in both indicators has accelerated since
Gender Policy introduced in 1997 has been successful
2006, showing that intensified Government efforts to
in raising awareness of gender inequalities at all levels
improve child survival are paying off. Government’s
of Government and within society. Nevertheless,
Child Survival Strategy aims for universal access to
gender inequality persists and women continue to
a number of high-impact interventions including
face discrimination, particularly in access to economic
micronutrient supplementation, malaria prevention
opportunities and ownership of assets.
and treatment, immunisation, prevention of mother-
to-child transmission of HIV, and improved water and
sanitation. Training programmes for birth attendants and
other health workers launched by the Ministry of Health
have also helped to raise new-born care standards and
the diagnosis and management of common childhood
illnesses.
 Millenium Development Goals
Report for Uganda 2015 21

TARGET 4.A REDUCE BY TWO-THIRDS, BETWEEN 1990 AND 2015, THE UNDER-FIVE
TABLE 3.6
MORTALITY RATE

PROJECTED OUTCOME: MISSED NARROWLY

Indicator 1995 2001/02 2006 2011 2015 target

4.1 Under-five mortality rate (per 1,000 live births) 156 152 137 90 56
4.2 Infant mortality rate (per 1,000 live births) 86 88 76 54 31
4.3 Proportion of 1-year-old children immunised 59.6% 56.8% 68.1% 75.8%
against measles1
Source: UDHS 1995, 2001/2, 2006, 2011. Notes: 1refers to the percentage of children between 12 and 23 months who had received at least one dose of the measles vaccine at any
time prior to the date of survey, according to either a vaccination card or mother’s report. It is generally recommended for children to be immunised against measles at the age of 9
months.

Data constraints makes it difficult to monitor child mortality and assess the outcome of MDG 4. As the registration of
births and deaths is often not comprehensive, under-five and infant mortality are measured through national surveys
that ask women to recall their birth histories, in particular the Demographic and Health Survey (DHS) conducted every
five years. The last DHS was in 2011 and there is limited evidence for the period since then. Significant progress has
been made in the fight against malaria, the leading cause of child mortality (see Goal 6). However this is unlikely to be
sufficient to meet the MDG 4 target by 2015. To address the child mortality data constraints in many countries, the UN
uses a statistical model to generate a smooth curve averaging over estimates from different data sources and extending
the trend forward to a target year.31 Projecting the UN-estimated trend forward to 2015, Uganda is expected to narrowly
miss the under-five and infant mortality targets (Figure 3.9 and Figure 3.10).

FIGURE 3.9 UNDER-5 MORTALITY RATE FIGURE 3.10 INFANT MORTALITY RATE

Source: UDHS 1995, 2001/2, 2006, 2011; and UN Inter-agency Group for Child Mortality Estimation (2014). Note: The mortality rate is expresses as the number of deaths per 1,000
live births.

According to the reports made by health facilities, malaria remains the leading cause of death among infants and the
under-fives. In 2013/14, the disease was responsible for 20% of hospital-based under-five deaths, and 28% of under-
five deaths in all inpatient facilities. But an important trend over recent years has been a decline in the proportion of
deaths attributed to malaria (Figure 3.11), reflecting significant progress in the fight against the disease (see Goal 6).
According to hospital records in 2013/14, the other leading causes of child fatalities are pneumonia (12.4%), anaemia
(12.2%) and perinatal conditions in new-borns (9.7%).

31 For instance, estimates of child mortality based on Uganda’s 2009 Malaria Indicator Survey are lower than estimates based on the DHS, the data source used in this report to track
MDG 4. For details on how UN IGME reconciles alternative estimates such as this, see Alkema and New (2014).
 Millenium Development Goals
22 Report for Uganda 2015

FIGURE 3.11 CAUSES OF UNDER-FIVE MORTALITY

a. 2010/11 b. 2013/14

Perinatal condition Perinatal condition

7.8% 9.7%

Pneumonia Anaemia
11.4% 12.2%
Other Other
41.6% 45.8%
Anaemia
12.1% Pneumonia
12.4%
Malaria Malaria
27.2% 19.9%

Sources: Ministry of Health (2011) and Ministry of Health (2014). Note: Shows only hospital-based deaths. In 2010/11 there were 5,331 under-five deaths recorded in hospitals,
compared to 10,210 in 2013/14. This is only a small proportion (around 5 to 15%) of the total number of child deaths estimated using household surveys.

Measles control through vaccination

important strategy for the reduction of childhood
remains an
3.5. Goal 5: Improve maternal
morbidity and mortality. According to DHS estimates, health
measles immunisation coverage for one-year olds
The MDG 5 target is to reduce by three quarters,
increased from 57% in 2001/02 to 76% in 2011 (Table
between 1990 and 2015, the maternal mortality ratio
3.6). This progress reflects two integrated Measles
(MMR). Uganda’s MMR fell from 506 per 100,000 live
Supplemental Immunisation Activities conducted
births in 1995 to 438 in 2011 (Table 3.7). No national
in 2006 and 2009, which significantly increased the
survey to measure maternal mortality directly has been
proportion of the population protected against measles
conducted since 2011. The World Health Organisation,
and reduced the burden of the disease. Recent estimates
other UN agencies and the World Bank have used a
based on health facility and district reports gathered
regression model and information on fertility, birth
through the Health Management Information System
attendants and GDP to predict Uganda’s maternal
(HMIS) suggest higher coverage, with the estimated
mortality in 2013, estimating a rate of 360 per 100,000
immunisation rate increasing from 85% in 2010/11
births.33 This suggests a significant reduction in
to 87% in 2013/14.32 Uganda is therefore close to
Uganda’s maternal mortality over the last few years,
achieving the national immunisation target of 90%,
which is corroborated by reports from health facilities –
which should be sufficient to stop measles transmission
there was a 25% reduction in the institutional maternal
and eliminate the disease.
death rate between 2010/11 and 2013/14.34 But given
the methodologies used the margin for error is high and
extending the WHO-estimated trend to 2015 suggests
Uganda has made insufficient progress to meet the MDG
target of 131 maternal deaths per 100,000 live births
(Figure 3.12).

32 Caution is required when comparing the trends over time given methodological 33 World Health Organisation (2014a).
difference between the DHS and HMIS. 34 Ministry of Health (2014).
 Millenium Development Goals
Report for Uganda 2015 23

TARGET 5.A REDUCE BY THREE QUARTERS, BETWEEN 1990 AND 2015, THE MATERNAL
TABLE 3.7
MORTALITY RATIO

PROJECTED OUTCOME: NOT ACHIEVED

Indicator 1995* 2001/02* 2006* 2011* 2013** 2015 target

5.1 Maternal mortality ratio1 506 505 435 438 360 131
5.2 Proportion of births attended by skilled 37.8% 39.0% 42.1% 58.0% NA 100%
health personnel 2
Sources: *UDHS; **World Health Organisation (2014a). Notes: 1Maternal deaths per 100,000 live births in the seven-year period preceding the survey, except for 1995 where the
estimate refers to period from 1986 to 1995, and 2013 where estimates are from a regression model. Some previously published estimates for 2001/02 and 2006 refer to the
10-year-period prior to these surveys. To compare across time these estimates were recalculated for the seven-year period preceding the surveys. 2Among births in the five years
preceding the survey. Skilled provider includes a physician, nurse, midwife, clinical officer, or medical assistant. The coding “NA” refers to data not available for this study.

BIRTHS ATTENDED BY A SKILLED

FIGURE 3.12 MATERNAL MORTALITY RATIO FIGURE 3.13
HEALTH WORKER

Observed Observed

Source: UDHS 1995, 2001/2, 2006, 2011, and World Health Organisation (2014a). Note: Figure 3.6 includes the two-standard-deviation confidence limits. The maternal mortality
ratio is expressed per 100,000 live births.

Although the overall fall in maternal mortality has fallen the distribution of Emergency Obstetric and New-born
short of the MDG target, Uganda has made impressive Care (EmONC) equipment to health facilities across the
gains in reducing maternal deaths occurring within country. Improved antenatal care has led to a large fall in
health facilities. The institutional maternal mortality cases of antepartum haemorrhage, which until recently
ratio fell by a quarter in just three years, from 194 per was the leading direct cause of maternal mortality
100,000 live births in 2010/11 to 146 in 2013/14. (Figure 3.8). In 2013/14, the main causes of maternal
This reflects a number of successful Government death occurring in health facilities were postpartum
interventions, including the recruitment of additional haemorrhage (26%), hypertension (15%), sepsis (14%),
midwifes and other health workers to offer maternal urine rapture (11%) and abortion-related deaths (10%).
care services, particularly in hard-to-reach areas; and
 Millenium Development Goals
24 Report for Uganda 2015

FIGURE 3.14 CAUSES OF MATERNAL MORTALITY

a. 2009 – 2011 b. 2013/14

Other
7% Antepartum hemorrhage
10%
Malaria 3%
Other HIV/AIDS related
14% Antepartum
Malaria 4% 4%
hemorrhage
20%
HIV/AIDS related
4% Sepsis 14% Postpartum
Postpartum hemorrhage
Sepsis 8% 26%
hemorrhage
19%

Abortion
Urine rupture 13% Urine rupture
8%
11%
Abortion
Hypertensive disorders
Hypertensive disorders 10%
10%
15%

Sources: Ministry of Health (2014). Note: Shows only health facility-based deaths.

The institutional MMR (146 per 100,000 live births in postpartum haemorrhage, hypertension and sepsis
2013/14) is much lower than the overall estimate based as causes of maternal death illustrate the need to
on a household survey (438 per 100,000 live births in improve postnatal care. To accelerate reduction in the
2011). This helps to explain Uganda’s slow progress in MMR, Government has instituted routine home visits by
reducing the overall MMR despite the rapid improvement Village Health Teams in the first week after delivery, and
seen in hospital records. A significant share of births are continues to improve transportation systems for new
delivered outside health facilities, but perhaps more mothers to access emergency care.
importantly a large share of maternal deaths occur
sometime after the birth. Over 60% of maternal deaths Use of contraceptive methods is one of the indicators
in developing countries are estimated to occur more than most frequently used to assess the impact of family
a day after delivery. 35
This is corroborated by the high planning activities. The proportion of women between
and rising share of maternal deaths in Uganda that are the age of 15 and 49, married or in union, who were
attributed to postpartum haemorrhage, hypertensive using any method of contraception, increased from 23%
disorders and sepsis (Figure 3.14), all of which typically in 2000/01 to 30% in 2011. This illustrates improved
occur more than 24 hours after the birth. access to safe, affordable and effective methods of
contraception, however this has been outpaced by rising
The proportion of deliveries attended by skilled demand – with more women wanting to space or limit
personnel has improved significantly, particularly since their number of children, the unmet demand for family
2006, although this is still likely to fall short of the 100% planning services rose from 24% to 34% over the same
target by 2015 (Figure 3.13). Government has prioritised period. The adolescent birth rate in Uganda was last
access to skilled birth attendants, increasing health measured in 2011, with an estimated 135 births per
worker recruitment to detect and manage complications 1,000 women aged 15 to 19 years. The high adolescent
during pregnancy. This has contributed to a large fall birth rate reflects the low rate of contraceptive use and
in cases of life-threatening complications such as high incidence of early marriages in many Ugandan
antepartum haemorrhage. The growing importance of communities.

35 World Bank (2009).

 Millenium Development Goals
Report for Uganda 2015 25

TABLE 3.8 TARGET 5.B ACHIEVE, BY 2015, UNIVERSAL ACCESS TO REPRODUCTIVE HEALTH

PROJECTED OUTCOME: NOT ACHIEVED

Indicator 1995 2000/01 2006 2011

5.3 Contraceptive prevalence rate 1
14.8% 22.8% 23.7% 30.0%
5.4 Adolescent birth rate2 204 178 152 135
5.5 Antenatal care coverage3
at least one visit by skilled provider 91.3% 92.4% 93.5% 94.9%
at least four visits by any provider 47.2% 41.9% 47.2% 47.6%
5.6 Unmet need for family planning4 21.9% 24.4% 40.6% 34.3%
Source: UDHS. Notes: 1Percentage of currently married or in-union women age 15-49 using any method of contraception. 2Number of births per 1,000 women aged 15-19 in the
three-year period preceding the survey (estimates published elsewhere may refer to a longer period prior to the survey). 3As reported by the women surveyed in the DHS. A different
methodology is used to monitor antenatal care coverage in the HMIS, leading to different estimates that may not be comparable. 4Share of currently married women aged 15-49 who
indicate that they either want no more children or want to wait for two or more years before having another child, but are not using contraception.

3.6. Goal 6: Combat HIV/AIDS, malaria and other diseases

MDG 6 is to halt and begin to reverse the spread of HIV by to 7.3%. The most recent estimates by UNAIDS – which
2015 (Target 6A); achieve universal access to treatment are based on an epidemiological model rather than
for HIV and AIDS for all those who need it by 2010 measured from a survey directly – suggest the adult
(Target 6B); and halt and begin to reverse the incidence prevalence rate increased marginally to 7.4% in 2013.
of malaria and tuberculosis by 2015 (Target 6C). Higher prevalence can be partly attributed to improved
survival rates as more people living with HIV/AIDS now
Uganda has experienced a generalised HIV epidemic
have access to antiretroviral therapy (ART). However
for more than two decades. The country had impressive
it also driven by a rise in new infections, and this is
success controlling HIV during the 1990s, bringing
reflected in the MDG indicator – which focuses on HIV
down HIV prevalence among adults aged 15 to 49
prevalence among the youth. The proportion of 15 to 24
years from a national average of 18.5% in 1992 to
year-olds living with HIV increased from 2.9% in 2004/5
6.4% in 2004/2005. However the 2011 Aids Indicator
to 3.7% in 2011 (Table 3.9). The increase in prevalence
Survey (AIS) revealed this trend had reversed, with the
occurred in both the male and female youth, with young
prevalence rate among 15 to 49 year-olds increasing
women remaining at higher risk of infection.

TABLE 3.9 TARGET 6.A HAVE HALTED BY 2015 AND BEGUN TO REVERSE THE SPREAD OF HIV/AIDS

PROJECTED OUTCOME: NOT ACHIEVED

Indicator 2000/2001 2004/2005 2006 2011

6.1 HIV prevalence among population aged 15-24 years1 NA 2.9% NA 3.7%
15-19 years, female NA 2.6% NA 3.0%
15-19 years, male NA 0.3% NA 1.7%
20-24 years, female NA 6.3% NA 7.1%
20-24 years, male NA 2.4% NA 2.8%
6.2 Condom use at last high-risk sex, 15-24 year-olds2* 53.1% 54.0% 46.5% 56.1%
female 44.2% 52.9% 38.4% 51.0%
male 62.0% 55.1% 54.5% 61.1%
6.3 Proportion of population aged 15-24 years with comprehensive correct knowledge 34.5% 32.4% 35.1% 38.8%
of HIV/AIDS3*
female 28.5% 29.5% 31.9% 38.1%
male 40.4% 35.3% 38.2% 39.5%
6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged NA NA 96% 87%
10-14 years 4
 Millenium Development Goals
26 Report for Uganda 2015

Sources: 1UHSBS 2004/05 and UAIS 2011; 2,3UDHS 2001/2, UHSBS 2004/05, UDHS 2006, 2011; 4UDHS 2006, 2011. Notes: 2higher-risk sex refers to sexual intercourse with a
non-marital, non-cohabitating partner, expressed as a percentage of men and women age 15-24 who had higher-risk sex in the past 12 months. 3Comprehensive knowledge means
knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a
healthy-looking person can have the AIDS virus, and rejecting that AIDS can be transmitted through mosquito bites and that a person can become infected with the AIDS virus by
eating from the same plate as someone who is infected. *The total is calculated as the simple arithmetic mean of the percentages in the rows for male and females.

Other HIV indicators show significant progress. Although not captured under MDG 6, recent years have seen great
success in reducing the transmission of HIV from mother to child, with the number of such infections falling from 27,660
in 2011 to 9,629 in 2013. This can mainly be attributed to the rollout of the elimination of Mother-to-Child Transmission
(eMTCT) Option B+ approach across the country.36 Equitable access to HIV/AIDS treatment has also improved greatly.
The share of the population with advanced HIV receiving Anti-Retroviral Therapy ART increased from 44% in 2008 to
69% in 2013 (Table 3.10). This progress has prompted the Ministry of Health to progressively expand ART eligibility.
Adults with a CD4 count below 500 can now initiate treatment – the threshold was raised from 350 in 2013 and from
250 in 2011.37 Even under the revised guidelines, Uganda remains on course to achieve the national target of providing
antiretroviral drugs to 80% to the eligible population by 2015 (Figure 3.15). The estimated number of AIDS-related
deaths fell from 67,000 in 2010 to 31,000 in 2014.38

TARGET 6.B ACHIEVE, BY 2010, UNIVERSAL ACCESS TO TREATMENT FOR HIV/AIDS FOR
TABLE 3.10
ALL THOSE WHO NEED IT

PROJECTED OUTCOME: ACHIEVED

Indicator 2008 2009 2010 2012 2013 2015 target

6.5 Proportion of population with advanced HIV 44% 54% 50% 62% 69% 80%
infection with access to antiretroviral drugs

Source: Uganda AIDS Commission. Note: the 2015 target refers to the target set in Uganda’s National Strategic Plan for HIV&AIDS, 2011/12 – 2014/15.

To ensure further improvements, Government will work to achieve an appropriate balance of strategies to prevent
and treat HIV/AIDS. The indicators that lag behind – such as condom use for higher-risk sexual activity – show that
Government must renew its investment in the prevention strategies responsible for the substantial progress made in
the 1990s. The National HIV Prevention Strategy launched in 2011 prioritises behaviour change to reduce high-risk
sexual activity through HIV counselling, and education and information campaigns.

FIGURE 3.15 ACCESS TO ART FIGURE 3.16 MALARIA AMONG CHILDREN

Sources: Uganda AIDS Commission; UMIS 2009 and 2014/15; UDHS 2006 and 2011. Note: Figure 3.9 shows the proportion of population with advanced HIV infection with access
to antiretroviral therapy (ART). The national target is from Uganda’s National Strategic Plan for HIV&AIDS, 2011/12 – 2014/15. Figure 3.10 shows the percentage of children under
5 testing positive for malaria according to microscopy; the proportion of children under 5 sleeping under insecticide-treated bed nets; and the percentage of children under five who
were ill with a fever in the two weeks preceding the survey that received any anti-malarial drug.

36 Uganda AIDS Commission (2014).

37 Uganda Aids Commission (2015) and Uganda Aids Commission (2012).
38 Uganda Aids Commission (2015).
 Millenium Development Goals
Report for Uganda 2015 27

Malaria is Uganda’s largest public health concern and This is a clear indication that Uganda has begun to reverse
a leading cause of child mortality, poverty and low the incidence of malaria as targeted under MDG 6. This
productivity. Government has scaled up a number of achievement is in-part due to Government’s campaign for
interventions to reduce the burden of malaria, backed universal coverage of Long-Lasting Insecticide-Treated
up by enhanced political commitment and increased Nets, which involved the distribution of 19.5 million
funding for malaria control. The 2014/15 Malaria nets across 106 districts. As a result, the proportion of
Indicator Survey (MIS) showed that these efforts are children under five sleeping under insecticide-treated
paying off. The prevalence of malaria among children bed nets increased from just 9.7% in 2006 to 74.4% in
under five more than halved from 42.8% in 2009 to 2014. There was a similarly impressive improvement in
19.0% in 2014 (Table 3.11 and Figure 3.16). This has had the proportion of children under five with fever treated
a direct impact reducing child mortality – the proportion with appropriate antimalarial drugs. This indicator rose
of hospital-based under-five deaths attributed to malaria from 64.5% in 2011 to 86.7% in 2014, in part due to
fell from 27.2% in 2010/11 to 19.9% in 2013/14.39 the provision of rapid diagnostic tests and first line
anti-malarials through the Integrated Community Case
Management programme launched in 2010.
39 Ministry of Health (2014).

TARGET 6.C HAVE HALTED BY 2015 AND BEGUN TO REVERSE THE INCIDENCE OF
TABLE 3.11
MALARIA AND OTHER MAJOR DISEASES

PROJECTED OUTCOME: ACHIEVED

Indicator 2001 2006 2009 2011 2014 2015

target
6.6 Incidence and death rates associated with malaria NA 2.9% NA 3.7%
Reported cases of malaria per 100,000 1
22,593 57,407 32,003 37,142 NA
Prevalence of malaria among children2 NA NA 42.4% NA 19.0%
6.7 Proportion of children under 5 sleeping under insecticide- NA 9.7% 32.8% 42.8% 74.4%
treated bed nets3
6.8 Proportion of children under 5 with fever treated with NA 61.3% NA 64.5% 86.7%
appropriate anti-malarial drugs 4
6.9 Incidence, prevalence and death rates associated with 53.1% 54.0% 46.5% 56.1%
tuberculosis5
Incidence rate per 100,000 population6 400 283 226 193 166*
Prevalence rate per 100,000 population7 410 288 215 183 154* 103
Death rate per 100,000 per population8 40 26 18 14 NA 35
6.10 Proportion of tuberculosis cases detected and cured under 28.5% 29.5% 31.9% 38.1%
directly observed treatment short course
Case detection rate9 37% 49% 57% 68% 73%* 70%
Treatment success rate 10
56% 70% 67% 73% 77%** 85%
Sources: 1HMIS; 2UMIS 2009 and 2014/15; 3UDHS 2006, UMIS 2009, UDHS 2011, UMIS 2014/15; 4UDHS 2006, UDHS2011, UMIS 2014/15; 5,9,10 WHO, Global TB Database. Notes:
2
Percentage of children aged 0-59 months testing positive for malaria according to microscopy. 4Percentage of children aged 0-59 months who were ill with a fever in the two weeks
preceding the survey that received any anti-malarial drug. 5Refers to pulmonary, smear positive, and extra-pulmonary tuberculosis cases, including patients with HIV. 6New cases of
tuberculosis per 100,000 people. 7Total number of tuberculosis cases per 100,000 people. 8Excluding patients who are HIV+. 9The percentage of newly notified tuberculosis cases
(including relapses) to estimated incident cases. 10The percentage of new, registered smear-positive (infectious) cases that were cured or in which a full course of treatment was
completed. *Year is 2013. ** Year is 2012. The coding “NA” refers to data not available for this study.

Uganda has also made important progress in the fight treatment short course (DOTS) and STOP TB strategies.
against tuberculosis (TB). The country has already The case detection rate was 73% in 2013, exceeding the
met the MDG targets to reduce the TB prevalence and 2015 target of 70%. Government is working to maintain
mortality rates by 50%. 40 This success was driven by and improve on these achievements by empowering
improved case detection under the directly observed communities, support groups and social networks to
prevent TB transmission, and support case detection and
40 World Health Organisation (2014b). treatment of TB patients.
 Millenium Development Goals
28 Report for Uganda 2015

3.7. Goal 7: Ensure environmental sustainability

Goal 7 is to ensure environmental sustainability, with eliminating consumption of ozone-depleting substances
indicators focusing on biodiversity loss, safe water (Table 3.12). The country still struggles with the loss of
and sanitation and the lives of slum dwellers. Uganda’s biodiversity however. Satellite imaging data released by
growth must reduce poverty and build a shared FAO indicate that the proportion of Uganda’s land area
prosperity for people today and for future generations. covered by forest had fallen to 15% in 2010, from 18% in
Government recognises that ecosystem services are 2005 and 25% in 1990 (Table 3.12). Uganda’s wetlands,
critical determinants of economic productivity and fish stocks and rangelands have also been depleted,
human wellbeing, and has placed natural resource although reliable data on these areas is sparse. The main
management at the core of Uganda’s strategy to drivers of environmental change include poverty, rapid
transform from a peasant society to a modern and population growth, urbanisation, agricultural expansion,
prosperous country by 2040. informal settlement development, industrialisation
and the impacts of climate variability among others. 42
Uganda is not a significant contributor to the global Reduced vegetation cover has contributed to the
environmental crisis. Uganda’s carbon dioxide emissions erosion of fertile topsoils, and depleted soil organic
have increased slightly over recent years, but remain matter has become a major impediment to agricultural
extremely low – according to the Carbon Dioxide productivity in many parts of the country. Potentially
Information Analysis Center, Uganda is ranked 205 out lucrative economic activities such as ecotourism are
of 216 countries in terms of fossil-fuel carbon emissions also threatened.
per person. 41 Uganda has also been successful in nearly

41 Boden and Andres (2012). 42 FAO (2010).

TARGET 7.B REDUCE BIODIVERSITY LOSS, ACHIEVING, BY 2010, A SIGNIFICANT

TABLE 3.12
REDUCTION IN THE RATE OF LOSS

PROJECTED OUTCOME: ACHIEVED

Indicator 1990 2000 2004 2006 2010 2012

7.1 Proportion of land area covered by forest1 25% 21% 18% 18% 15% 14%
7.2 CO2 emissions, per person (in metric tons) 0.08 0.08 0.08 0.09 0.11 0.11
7.3 Consumption of ozone-depleting substances NA NA 42.4% NA 19.0%
(in metric tons) 15.8* 30.6 24.3 6.5** 0.3 0.05
7.4 Proportion of fish stocks within safe biological limits NA NA NA NA NA NA
7.5 Proportion of total water resources used NA NA 0.5% NA NA NA
7.6 Proportion of terrestrial and marine areas protected 13%* 15%*** 15% 15% 15% 11%
7.7 Proportion of species threatened with extinction NA NA NA 2% NA NA

Sources: NEMA, State of the Environment Reports (2006/2007 and 2008/2009); FAO, Global Forest Resources Assessment 2010; Carbon Dioxide Information Analysis Center; UNEP
Ozone Secretariat. Notes: 1Data up to 2010 are based on satellite imagery, figure for 2012 is a FAO estimate. *Year is 1992; ** Year is 2005; *** Year is 2002.

Government has put in place appropriate laws, policies and regulations to protect natural ecosystems, but low levels of
compliance continue to result in environmental degradation. Even within protected areas, deforestation is occurring at
an estimated rate of 1.9% each year, driven by the demand for agricultural and grazing land, timber and fuel wood. 43
In
response, Government has created the environment police protection unit to enforce environmental laws and regulations,
and stepped up strategies to reduce forest depletion and increase reforestation efforts – instituting a ban on tree
cutting in 2012 and strengthening the regulation of log harvesting, charcoal burning and other forestry activities. The
coverage and quality of data on the state of Uganda’s natural ecosystems is not sufficient to assess whether such efforts

43 National Forestry Authority (2009).

 Millenium Development Goals
Report for Uganda 2015 29

have reduced the rate of biodiversity loss as targeted Uganda has made significant improvements in the
under MDG 7. Natural resources and ecosystems have provision of safe drinking water. The proportion of the
immense economic, social and cultural value, but this population using an improved drinking water source
has been poorly quantified and monitored, increasing increased from 52% in 2001/2 to 72% in 2012/13 (Table
the danger that economic growth could erode these 3.13). The MDG target for rural areas is projected to be
resources and undermine the country’s sustainable achieved due to Government’s significant investment in
development. An important element of Uganda’s post- rural water supply over the last 15 years. This achievement
2015 development agenda will be to better measure the has helped to prevent the spread waterborne diseases,
value of natural capital and ecosystem services in order with significant impacts on healthcare costs, economic
to guide strategic planning processes. productivity and human welfare.

TARGET 7.C HALVE, BY 2015, THE PROPORTION OF PEOPLE WITHOUT SUSTAINABLE

TABLE 3.13
ACCESS TO SAFE DRINKING WATER AND BASIC SANITATION

PROJECTED OUTCOME: MISSED NARROWLY

Indicator 2001/02 2006 2011 2012/13 2015 target

7.8 Proportion of population using an improved drinking water 52.0% 67.1% 70.0% 72.2%
source
Urban 89.0% 89.7% 89.6% 87.3% 100%
Rural 46.4% 63.8% 66.6% 67.7% 70%
7.9 Proportion of population using an improved sanitation NA 72.7% 75.7% 74.3%
facility
Urban NA 93.6% 92.6% 88.0% 100%
Rural NA 69.6% 72.8% 70.3% 77%
7.6 Proportion of terrestrial and marine areas protected 13%* 15%*** 15% 15% 15%
7.7 Proportion of species threatened with extinction NA NA NA 2% NA
Source: UDHS 2001/02, 2006, 2011; UNHS 2012/13. Notes: Improved drinking water sources are defined to include a household connection (piped), private and public taps,
boreholes, a protected/dug well or spring, rain and bottled water. Improved sanitation facilities are defined to include flush toilets, ventilated improved pit latrines, pit latrines with a
slab/cover, composting toilets, and Ecosans, whether or not share this facility is shared with other households.

The other water and sanitation indicators are a source generally. Although data is limited, 45 the available
of concern however. Access to safe water is much higher evidence suggests limited improvements in access
in urban areas but there has been limited improvement to basic sanitation. The proportion of the population
over the MDG period. In fact the most recent national with no or an uncovered latrine remained almost
household survey conducted in 2012/13 suggested a constant between 2006 and 2012/13 (Table 3.13),
reversal, with access in urban areas falling from 90% to and the sanitation targets are therefore unlikely to be
87%. This may in part reflect methodological issues, 44 achieved in either rural or urban areas (Figure 3.18). This
but water services have also been strained by rapid is particularly worrying as sanitation practices tend to
urban growth. More concentrated settlement patterns have a larger impact on health outcomes than access to
should enable more efficient service delivery, but the safe water alone. 46
lack of progress in urban areas reflects weak water-
network management and poor urban planning more

45 A number of household surveys have attempted to measure household sanitation

practices, but methodological issues limit data comparability over time. For instance
44 For instance the gazetting of new urban centres means some areas previously the Uganda National Household Survey did not distinguish between covered and
classified as rural are now considered urban, so the estimate for 2012/13 may not not uncovered pit latrines until 2012/13.
directly comparable with the data from earlier surveys. 46 Günther and Fink (2010).
 Millenium Development Goals
30 Report for Uganda 2015

FIGURE 3.17 ACCESS TO SAFE WATER FIGURE 3.18 ACCESS TO SANITATION

Sources: UDHS 2001/02, 2006, 2011; UNHS 2012/13. Note: Figure 3.17 shows the proportion of the population using an improved drinking water source, defined as a household
connection (piped), private and public tap, borehole, a protected/dug well or spring, rain or bottled water. Figure 3.18 shows the proportion of the population using an improved
sanitation facility, defined as a flush toilet, ventilated improved pit latrine, pit latrine with a slab/cover, composting toilet or Ecosans, whether or not share this facility is shared with
other households. Solid lines show observed trend; dotted lines show projection or target.

The relatively slow progress in access to water and particularly for affordable homes. The construction
sanitation in Uganda’s towns and cities is reflected in sector has been unable to meet rising demand for a
urban living conditions more generally. The share of number of reasons, including high transport costs,
the urban population living in slum-like conditions inadequate skills, inappropriate building regulations,
rose from 34% in 2002/03 to 43% in 2012/13 (Table and limited access to land and finance. Addressing these
3.14). The size of Uganda’s urban population more than constraints has become a priority for Government. The
doubled from 2.9 million in 2002 to 6.4 million in 2014. construction of affordable formal housing on a large
This rapid growth has overwhelmed the capacity of scale, particularly if driven by small construction firms
urban authorities and the private construction sector, using labour-intensive techniques, has huge potential
leading to growing problems of poor housing conditions, to expand employment opportunities, improve living
congestion and the unrestricted sprawling of major conditions and contribute to Uganda’s sustainable
towns. There is a large and growing housing deficit, development.

TARGET 7.D BY 2020, TO HAVE ACHIEVED A SIGNIFICANT IMPROVEMENT IN THE LIVES OF

TABLE 3.14
AT LEAST 100 MILLION SLUM DWELLERS

NO TARGET

Indicator 2002/03 2005/06 2008 2009/10 2011 2012/13

7.10 Proportion of urban population living in slums 34% 34% 27% 29% 28% 43%
Source: UNHS 2002/03, 2005/6, 2009/10, 2012/13; USDS 2008; UDHS 2011. Note: proxied by share of urban population living in houses with either walls or floors made of
temporary materials, or with no or an uncovered pit latrine.
 Millenium Development Goals
Report for Uganda 2015 31

3.8. Goal 8: Develop a global partnership for development

MDG 8 is to develop close partnerships between towards end of the last decade significantly weakened
developing and industrialised countries, including more the outlook for ODA. Globally, ODA flows to developing
generous development assistance. The International countries remain below 0.7% of GNI, averaging 0.3
Conference on Financing for Development held in per cent of GNI in 2013, with only five of the DAC’s 28
Monterrey, Mexico in 2002 agreed that a substantial member countries meeting the longstanding UN agreed
increase in Official Development Assistance (ODA) target. In particular, ODA to Sub-Saharan Africa dropped
would be required to achieve the MDGs. Rather than for two years in a row: down by 8% in 2012 and by 4%
monitoring Uganda’s progress towards MDG 8, this in 2013, even when there was a rebound in aid to other
section assesses how changes in the global partnership developing countries in 2013.
for development over the last 15 years have affected
Uganda. Some indicators under MDG 8 are re-interpreted Uganda has been affected by the contraction in
in the Ugandan context to facilitate this assessment, but development finance. The country’s total donor
where this is not possible no data is reported. assistance fell from 11.3% of GDP in 2003/4 to 2.7% of
GDP in 2013/14 (Table 3.15). Donors froze almost USD
The MDG global partnership agreements helped to 300 million in general budget support in 2012/13, citing
increase the political momentum for aid globally, fiduciary concerns. Uncertainties in ODA disbursements
following a substantial weakening during the 1990s. coupled with weak implementation frameworks
ODA jumped by around 70% in real terms between 2000 reduce the effectiveness of development assistance
and 2005. However, the effectiveness of this partnership in delivering public services, and there is need for
has been deteriorating, especially in recent years. alternative financing sources to minimise the economic
The global financial and economic crisis experienced impact of such exogenous shocks.

TABLE 3.15 TARGET 8.B ADDRESS THE SPECIAL NEEDS OF THE LEAST DEVELOPED COUNTRIES*

PROJECTED OUTCOME: NOT ACHIEVED

Indicator 1999/00 2003/4 2008/9 2013/14 2015 target

8.1 Net ODA (in US$ million)1 568 815 825 721
8.2 Proportion of total bilateral, sector-allocable ODA of OECD/ NA 38.7% 16.5% 13.2% 100%
DAC donors to basic social services2
8.4 ODA received in landlocked developing countries as a 9.2% 11.3% 4.1% 2.7% 70%
proportion of their gross national incomes3
Source: Ministry of Finance, Planning and Economic Development, Annual Budgetary Central Government Finance Statistics. Notes: 1Total value of loan and grants including debt
relief disbursed to Uganda during the financial year; 2Estimated donor-funded expenditure on education, health, and water supply relative to total donor-funded expenditure; 3Total
donor assistance/GDP in Uganda. *Includes tariff and quota free access for the least developed countries’ exports; enhanced programme of debt relief for heavily indebted poor
countries (HIPC) and cancellation of official bilateral debt; and more generous ODA for countries committed to poverty reduction.

There has been a marked fall in the proportion of Uganda’s of the MDGs. There has been a corresponding rise in the
donor support to basic social services. In 2003/4, 39% share of development assistance invested in physical
of sector-allocable development assistance was spent infrastructure and other productive sectors, although
in the education, health and water sectors, but this the available concessional financing is insufficient to
fell to just 13% in 2013/14. This is partly explained by meet the country’s growing investment needs.
increased domestic spending over the last 15 years that
has filled the gaps in basic social service delivery and Until recently, ODA was the main source of Uganda’s
reduced the need for donor assistance in these areas. development financing. The emergence several large
Uganda also faces high transportation and energy costs, developing and transition countries – most notably
and relative isolation from world markets, and addressing the BRICS (Brazil, Russia, India, China and South Africa)
these needs has grown in importance since the adoption – has transformed the global economy and provided
 Millenium Development Goals
32 Report for Uganda 2015

new development finance possibilities. The Fifth BRICS 3.16). This has freed up fiscal space for priorities such
Summit held in South Africa in March 2013 agreed to as infrastructure investment and service delivery. To
establish a new Development Bank. They also agreed ensure public debt remains sustainable, Government
to establish the BRICS Multilateral Infrastructure Co- undertakes a Debt Sustainability Analysis (DSA) annually
Financing Agreement for Africa, which paves the way to assess the country’s level of indebtedness (solvency)
for the establishment of co-financing arrangements for and its ability to service its debt, now and in the future
infrastructure projects across the African continent. (liquidity) based on the performance of the economy.
Moving forward there will be a large array of alternative The latest DSA revealed that Uganda’s debt is highly
financing options available to Uganda, including sustainable over both the medium and long term and
domestic public and private public finance, international is under no debt distress when subjected to stress
public and private finance, and blended financing tests. 47 This is attributed to Government’s prudent debt
mechanisms. management policy to maximise financing on highly
concessional terms, and borrowing on non-concessional
Debt relief granted by Uganda’s multilateral creditors but favourable terms only for high-return projects that
under the HIPC and MDRI initiatives has helped to cannot be financed by traditional concessional means.
significantly bring down the country’s external debt
service requirements, from 23% of export earnings
in 1999/2000 to 5.2% of exports in 2013/14 (Table 47 Ministry of Finance, Planning and Economic Development (2014d).

TARGET 8.D DEAL COMPREHENSIVELY WITH THE DEBT PROBLEMS OF DEVELOPING

TABLE 3.16 COUNTRIES THROUGH NATIONAL AND INTERNATIONAL MEASURES IN ORDER TO MAKE
DEBT SUSTAINABLE IN THE LONG TERM

ACHIEVED

Indicator 1999/00 2003/4 2008/9 2013/14

8.11 Debt relief committed under HIPC and MDRI Initiatives (in US$ million) NA NA 44.3 51.4
8.12 Debt service (% of exports) 23.3% 15.2% 4.6% 5.2%
Source: Ministry of Finance, Planning and Economic Development and Bank of Uganda.

Uganda’s first National Development Plan (2010/11 – monitors drug availability using six tracer medicines
2014/15) was financed using traditional sources, largely – first line antimalarials, depo-provera, sulfadoxine/
through foreign concessional borrowing and domestic pyrimethamine, measles vaccine, ORS sachets and
resources. However, NDP II seeks to explore alternative cotrimoxazole. There has been a significant improvement
financing options, while ensuring the expansion of public over recent years, with the proportion of health facilities
debt fits within a sustainable macroeconomic policy stocking all six tracer medicines increasing from just
framework. To minimise the costs and risks of contracting 21% in 2009/10 to 57% in 2013/14, on track to meet
new forms of debt, Government has developed a new the 60% target set for 2015. A recently conducted client
Public Debt Policy Framework laying out the overall satisfaction survey found that 79% of public health
policy, legal and institutional frameworks within which facility users were satisfied with the availability of these
debt will be incurred, used and managed. Government’s drugs. 48 This remarkable improvement reflects improved
evolving financing strategy will be published every supply chain management by the Ministry of Health and
year in the Medium-Term Debt Management Strategy, the National Medical Stores, including more frequent
ensuring Government‘s financing needs are met without drug deliveries and constant monitoring of uptake to
compromising macroeconomic stability or long-term respond to local disease profiles. Further interventions
debt sustainability. under NDP II aim to build on this success to achieve zero
stock-outs across all public health facilities.
A key component of MDG 8 concerns global
collaboration for access to essential medicines. 48 Ministry of Health (2014). The study was conducted by the Medicines
Transparency Alliance and Uganda National Health User’/Consumers’ Organization
Uganda’s Health Management Information System in 2014, covering 202 health facilities across 10 districts.
 Millenium Development Goals
Report for Uganda 2015 33

TARGET 8.E IN COOPERATION WITH PHARMACEUTICAL COMPANIES, PROVIDE ACCESS TO

TABLE 3.17
AFFORDABLE ESSENTIAL DRUGS IN DEVELOPING COUNTRIES

PROJECTED OUTCOME: ACHIEVED

Indicator 2007/8 2009/10 2011/12 2013/14 2015

target**
8.12 Proportion of population with access to affordable 28% 21% 49% 57% 60%
essential drugs on a sustainable basis*
Source: Ministry of Health (2012) and (2014). Note: *measured as the percentage of health facilities without stock outs of any 6 tracer medicines (first line antimalarials, depo-
provera, sulfadoxine/pyrimethamine, measles vaccine, ORS sachets, and cotrimoxazole) in the previous 6 months. ** National target set in the Health Sector Strategic Plan (Ministry
of Health, 2010).

The final indicator under MDG 8 measures the usage inhabitants in 2004 to 22 per 100 inhabitants in 2013,
of new information and communication technologies. with the vast majority (95%) accessing the internet
Uganda’s communication’s sector is one of the fastest- via mobile devices. The penetration of mobile phones,
growing in Africa, largely driven by the rapid expansion mobile internet and money transfer services even into
of mobile telephony. The number of mobile-cellular remote rural areas has already brought large benefits,
subscriptions per 100 inhabitants increased from 4.5 and has even greater potential as a platform for many
in 2004 to 52 in 2013 (Table 3.18 and Figure 3.19). The innovative new services.
number of internet users increased from just 1 per 100

TARGET 8.F IN COOPERATION WITH THE PRIVATE SECTOR, MAKE AVAILABLE THE
TABLE 3.18
BENEFITS OF NEW TECHNOLOGIES, ESPECIALLY INFORMATION AND COMMUNICATIONS

ACHIEVED

Indicator 2004 2006 2008 2010 2012 2013

8.13 Telephone lines per 100 population 0.3 0.5 0.6 1.0 0.9 NA
8.14 Cellular subscribers per 100 population 4.5 9.8 28.9 40.4 48.8 51.9
8.15 Internet users per 100 population 1.1 5.8 8.4 12.6 18.5 21.6
Source: UBOS, Statistical Abstract, various years. Note: data refer to end of year estimates.

The launch of the Lower Indian Ocean Network (LION NUMBER OF MOBILE PHONE
FIGURE
2) under-sea cable in 2012 has helped to increase 3.19 SUBSCRIBERS AND INTERNET USERS
internet speeds and access within the country, with 4G
technologies recently rolled out in many areas. Improved
ICT infrastructure has enabled significant enhancements
in public service delivery, with around 65% of
Government institutions providing online services
such as e-tax registration and payments. The National
Backbone Infrastructure has been extended to a number
of districts, reducing internet costs and enabling the
uptake of e-Government services and applications. To
improve the accessibility and affordability of internet
services, Government plans to further extend the
National Backbone Infrastructure and construct a
number of ICT incubation centres and business parks.

Source: UBOS, Statistical Abstract, various years. Note: shows number of subscribers/
users per 100 population.