Uganda - Social sector strategy (Vol. 1 of 2) : Main report

Report No. 10765-UG Uganda Social Sector Strategy (In Two Volumes) Volume l: The Main Report April 6, 1993 Population and Human Resources Division Easte;n Africa Department FOR OFFICIAL USE ONLY p 0:- t Lo , p< C? ; I 1 L 1- 17' m~ ~ ~ ~~ , pt 9 ,r * t i U 'f l7. . Fri sp ; 4 hor , J LILI: Y 2 o- V -1 i . ; G 2 ' . D .r: f - . Document of the World Bank This document has a restricted distribution and may be used by recipients only in the performrance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.  FOR OFFICIAL USE ONLY UGANDA SOCIAL SECTOR STRATEGY TABLE OF CONTENTS V"olume 1: The Main Renort Page List of Text Tables Executive Summary .......................................... i Preface .... ii Part One, Backoround I. Uganda's Social Indicators in Comparative Perspective . . A. Demographic and Health Indicators .1 B. Children's Health and Nutrition. 3 C. Education Indicators .5 D. Inter-regional Variations in Social Indicators. 6 E. Assessment and Implications. 7 H. Demographic Prospects, and Consequences of High Fertility and Rapid Population Growth .. 9 A. Major Demographic Variables, and .^.lternative Scenarios .. ......... 9 B. Justifications for Fertility Regulation .13 C. Implications of Rapid Population Growth .14 D. Government Policy .18 E. Conclusions .18 IE. Contextual Factors Innluencing the Design of Social Sector Strategy 20 A. Low Income and Lack of Domestic Savings .20 B. Central Government Finance .20 C. Planning and Budgeting of Central Government Expenditure .24 D. Civil Service Reform .26 E. Decentralization .28 F. Relative Roles of Private and Governmental Expenditures and Providers in the Education and Health Sectors .28 Part Two: Delivery of Social Services IV. The Education Sector ..31 A. Primary Education .31 B. Secondary Education .36 C. University Education .38 D. Financing and Management of the Sector as a Whole .40 E. Policy Framework for the Education Sector .42 F. Universal Primary Education: Costs and Prospects .47 G. Investment Program, Expenditure Plan, and Major Donor Activities 50 This report was prepared by a mission which visited Uganda in November/December 1991. The mission consisted of Bruce Jones (Chief), Paul Shaw, Althea Hill (all World Bank staff), and Charles Griffin, Alba D'Souza, Dr. Alex Zinanga, and Yang-ro Yoon (consultants). In addition, Eduard Bos at Headquarters prepared the demographic projections. A draft of this report was discussed with the Government in October 1992. This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Ba.ik authorization.  V. The Health Sector ...................................... 52 A. Health Conditions ..................................... 52 B. Health Care System ................................... 53 C. Health Expenditures and Financing .......................... 61 D. Policy Framework for the Health Sector ....................... 69 Annex: The Major Causes of Morbidity and Mortality in Uganda .......... 71 VI. Family Planning ..73 A. Knowledge, Attitudes, and Practice of Family Planning .73 B. Family Planning Services .76 C. Information, Education, and Communication .................... 80 D. Donor Support for Family Planning Activities ................... 81 E. The Possible Costs of Family Planning ........................ 82 F. Assessment and Future Directions ........................... 83 Part Three: Conclusion VII. Conclusion: Toward An Increased and Better Allocated Social Sector Effort ......................................... 85 Volume IT: Annexes Annex A: Technical Annex on Demographic Data and Projections Annex B: Population Pressure on the Land Annex C: Female Participation in Education Annex D: Selected Figures from Demographic and Health Surveys (DHS) Comparative Studies Annex E: Selected Pages from the 1992 Integrated Survey Questionnaire and the 1992 Community Survey Questionnaire Annex F: Bibliography Annex G: Questionnaire - Statistical Return for Primary Schools, 1990 Statistical Appendix List of Statistical Appendix Tables Fiscal Data Education Sector Data Health Sector Data  LIST OF TEXYT TABLES AND TEXT FIGURES 1/ TEXT TABLES Page No. Chapter I. Uganda's Social Indicators in Comparative Perspective 1.1 Demographic Indicators 2 12 Infant Mortality Rates 3 1.3 Enrollment Ratios 1.4 Inter-regional Variations in Social Indicators 7 Chapter 1I. Demographic Prospects. and Consequences of Population Growth 11.1 Impact of AIDS on Demographic Measures 10 11.2 Alternative Fertility and Population Scenarios 12 11.3 Projected Numbers of MCH Client,; and School-age Children 15 11.4 Employment, Unemployment, and Labor Force, 1990 16 Chapter III. Contextual Factors Influencing the Design of Social Sector Strategy III.1 Central Government Budgetary Operations 21 11.2 Sectoral Distribution of Central Government Expenditure 22 111.3 Resource Envelope for Future Social Sector Spending 23 111.4 Wage and Salary Projection, 1991/92 27 111.5 Private and Government Expenditures in the Education and Health Sectors, 1989/90 29 Chapter IV. The Education Sector IV 1 Primary Enrollment and Enrollment Ratio, by Gender and Grade 32 IV.2 Financing of Primary Education 36 IV.3 Central Government Expenditure in the Education Sector 39 IV.4 Central Government Recurrent Expenditure per Student, by Level 40 IV.5 Unit Costs of Primary Education to the Governwnent 4