Effectiveness of the Public Health Act Cap 281 in emergencies response in Uganda

Abstract

Background: The current Public Health Act Cap 281 was enacted by the colonial government in 1935 to protect and preserve public health. The Act has not been amended in its nearly 80-year history. It draws much of provisions from the 19th Century British laws on insanitary housing, poor ventilation, and drainage. Such laws are obsolete and silent on emerging major public health events including nuclear and radioactive threats, famine, and Noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes. This renders the Act ill-equipped to address 21st century public health needs. This study examines the Public Health Act (PHA) in Uganda to evaluate its effectiveness to the ever-increasing and changing threats posed by emerging public health events. Methods: A cross sectional, mixed-method descriptive study was conducted in 18 districts from 4 major regions. Total sample size was 155 including >95 epidemiologists and other subject experts from diverse public health fields. Respondents’ knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. Quantitative analyses were performed through descriptive analysis (percentages, crosstabulations) and standard deviation using MS Excel and SPSS. Bloom's cutoff of 80 percent was used to determine sufficient knowledge. The scores were classified as high (80.0 percent–100.0 percent), average (60.0 percent–79.0 percent) and low ≤59.0 percent. PHA implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analyzed. Conclusion: The Public Health Act is obsolete and inadequate in many aspects and is not aligned to 21st century public health needs and the WHO IHR. Amendment of the Act has been constrained by the complexity of Uganda’s health system design, top-down approach of the national response to public health events and longstanding health system bottlenecks. Consequently, there is need to review and amend the Public Health Act to improve its capacity and effectiveness in addressing public health emergencies.