Transformations in the Marriage Process among the

Mawazo The Journal of The Faculties of Arts and Social Sciences Makerere University

Vol. 8 No. 2 December 2007 • Transformations in the Marriage Process Among the Bakiga of South-western Uganda ......................

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• Banyankore: An Ethnically Dichotomised Uganda Society With Features of Castes ............................. 16 • When Traditional Medicine Provides a Choice for Primary Health Care: A Study of Underserved Communities in Busia District, Uganda .................. 23 • Customs, Rituals, and Practices Associated with Pregnancy and Childbirth: Implications for Safe Motherhood in Rural Areas ...................................... 31 • Guardian Needs and Capacity to Care for Aids Affected Children ......................................................

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• Decentralisation of Malaria Control in Uganda: An Assessment of Human Resource Management Capacity in Uganda .................................................... 54 • Rethinking the Enduring Nature of Poverty: A Cultural Perspective to Poverty Debate .................. 67 • Livelihood Patterns and Social Change: Implications for the Rural Youth in Uganda ............ 72 • Fighting Corruption in Uganda: 1986-2006 ............. 89 • Victimisation Among Urban Citizens and Some of their Implications: An Analysis of the 2000 International Victim (crime) Survey in Urban Kampala, Uganda ....................................................... 102 • Ethics in Social Research: The Uganda Context ........................................................................ 111

Mawazo The Journal of Faculties of Arts and Social Sciences Makerere University

Vol. 8 No. 2, December 2007

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EDITORIAL BOARD Chairperson/Editor Dr. Deusdedit R.K. Nkurunziza

Members Ms J. Alowo Dr A. Nuwagaba Dr P. Omach Dr E. Okiria Dr W. Lajul Mr A. Kwitonda EDITORIAL BOARD OF ADVISORS Amartya Sen

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– CODESRIA

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Uganda

Ali Mazrui

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Mahmood Mamdani

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Aseka Eric Masinde

– Kenya

Micere Githae Mugo

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Anders Narman

– Sweden

Nakanyike Musisi

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Uganda

Partha Chatterjee

– India

Pearl Robinson

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Göran Hyden

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Rwekaza Mukandala

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Tanzania

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– Malaysia

P. J. M. Sebuwufu

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Tiyambe P. Zeleza

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USA

Contents

Editor’s Note

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1. Transformations in the Marriage Process among the Bakiga of South-western Uganda Peter R. Atekyereza

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2. Banyankore: An Ethnically Dichotomised Uganda Society With Features Of Castes Fred Henry Bateganya

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3. When Traditional Medicine Provides a Choice for Primary Health Care: A Study of Underserved Communities in Busia District, Uganda James Mangeni Wasike

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4. Customs, Rituals, and Practices Associated with Pregnancy and Childbirth: Implications for Safe Motherhood in Rural Areas Gabriel Jagwe-Wadda

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5. Guardian Needs and Capacity to Care for Aids Affected Children Robert Kabumbuli, Rebecca Nyonyintono, Gabriel Jagwe-Wadda and Laelia Gilborn

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6. Decentralisation of Malaria Control in Uganda: An Assessment of Human Resource Management Capacity in Uganda Dauda Waiswa Batega

54

7. Rethinking the Enduring Nature of Poverty: A Cultural Perspective to Poverty Debate Eria Olowo Onyango

67

8. Livelihood Patterns and Social Change: Implications for the Rural Youth in Uganda Andrew Ellias State

72

9. Fighting Corruption in Uganda: 1986-2006 Steven Arojjo Obbo Ofumbi 10. Victimisation Among Urban Citizens And Some of their Implications: an Analysis of the 2000 International Victim (Crime) Survey in Urban Kampala, Uganda Mathias Ssamula 11. Ethics in Social Research: The Uganda Context Charles B. Rwabukwali

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89

102 111

Editor’s Note Several changes and reforms have taken place in Uganda since pre-colonial times and more particularly in the last two and a half decades with the implementation of structural adjustment programmes for poverty eradication, decentralisation of governance and social service delivery, universal primary education, higher education reform and the adoption of multi-party democracy. The impact of such reforms on the social structures, family processes and livelihoods, household wellbeing, access to health and other social services, is part of what is analysed in research findings presented in this publication. Our intention is to capture some of the pertinent social changes and reforms, and related development outcomes with specific reference to Ugandan societies. The thematic outline of this publication can be summarised as, social structure, social change and development. Articles presented in this publication are reflective of this thematic title, addressing social structure and social change. Each of the 11 articles in this publication addresses unique aspects of Uganda through the lense of social structure, development and change. The articles are arranged in five clusters, including marriage and ethnic classification (1 and 2), health, HIV/AIDS and family (3 to 5), social development and change (6 to 8), white-collar crimes and crime victimisation (9 and 10), and research ethics (article 11). Peter R. Atekyereza in the first article highlights the transformations in the marriage system among the Bakiga of south-western Uganda. He explains the centrality of the marriage to the Bakiga ethnic group’s social structure and the changes witnessed over time. In the second article, Fred Henry Bateganya re-casts the debate as to whether the ethnic Banyankore of south-western Uganda have cultural features akin to caste systems. He elevates the debate to a level that appreciates features of a caste system defined according to social structures in the context of time and space. James Mangeni Wasike describes the role of traditional medicine as a choice in Primary Health Care among the underserved communities of eastern Uganda, Busia District. The rationale of running various health subsystems is explained at different levels and time in history of the Samia community. Gabriel Jagwe-Wadda presents findings of how customs, rituals and practices associated with pregnancy and childbirth have impacted on safe motherhood in rural areas in Uganda. He shows how the social structure of society based on time influence the actions and practices related to pregnancy and childbirth. Robert Kabumbuli and his team discusses the impact of HIV/AIDS on the family structure highlighting guardian needs and capacity to care for AIDS affected children in Luweero District, central Uganda. The authors explain the situation of orphans and vulnerable children. The impact of HIV/AIDS on the family is therefore analysed to bring out the critical position of the family institution in the society’s organisational set-up. Dauda Waiswa Batega describes recent changes in the decentralisation of health services in Uganda, drawing out implications of such changes to human resource management capacity for malaria control in Tororo District, eastern Uganda. Policy reforms, directly or indirectly, impact on the social structure and have implications on the improvement of health care service delivery to individuals, communities and the wider society. Eria Olowo Onyango argues for re-thinking the enduring nature of poverty in Uganda beyond the econometrics and brings a cultural perspective into the poverty debate. He amplifies the cultural role in the definition, manifestation, persistence and control of poverty. Andrew Ellias State discusses vii

viii Mawazo: The Journal of the Faculties of Arts and Social Sciences Makerere University

recent social changes in the livelihood patterns, particularly the implications for the rural youth in Uganda, arguing that social networks influence the youths’ adoption of different livelihood patterns and strategies. He urgues that rural youths’ development efforts, such as informal rotating credit and saving associations have not attracted the attention of the central government despite the extensive decentralisation governance programme meant to take social services nearer to the people. Steven Arojjo Obbo Ofumbi spans through the twenty years (1986–2006) of government efforts to fight corruption. Using several perspectives, he points out the limitations, achievements and potential of such government efforts. He demonstrates the importance of equity in meaningful transformation of people’s material wellbeing and value systems. Mathias Ssamula presents an analysis of the 2000 international victim survey in urban Kampala, emphasising victimisation levels among urban citizens. He demonstrates some of the consequences of uncontrolled structural transformation especially for the urban dwellers. Charles B. Rwabukwali demonstrates the challenges of social research; particularly ethical considerations in Uganda. Rwabukwali recasts the social and professional obligations of the researcher in respecting and protecting research findings and providers of information. Dr Deusdedit R.K. Nkurunziza Editor December 2007

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Transformations in the Marriage Process among the Bakiga of South-western Uganda Peter R. Atekyereza*

Abstract Due to rapid social and other changes, traditional, cultural and behavioural patterns have slowly but strongly shifted to match the present socio-economic and ideological realities which are mainly dictated by the globalisation process. It is not very easy to notice or record the causes of such changes. In Uganda, most societies face similar challenging changeprocesses. The marriage process and/or institution is one such area where these challenges are manifest. Whereas marriage, as an institution, used to be greatly respected among the Bakiga, today various factors have influenced and undermined it. The challenges and changes are manifested in a conflict between traditional and borrowed value systems on marriage. The article argues that whereas it is important to adjust the marriage process to match the changing times, we must also understand the nature, values and rationale of the traditional marriage system in order to meaningfully borrow and integrate positive elements into the cultural traditions and adjust those traditions that must be changed and abandon those which are out-of rational use.

Introduction

phrase ‘husband and wife’ implies mutual rights of sexual intercourse, life in common and enduring union of the two or more persons such as their children. These marital rights and obligations differ from society to society and according to level and pace of development and change, respectively. Different cultural settings produce different marriage forms, processes and, ultimately family patterns (Atekyereza, 2001a). Similarly, the approach in studying and understanding the nature of marriage may expose distinct definitions and interpretations. In Africa, the importance of marriage was primarily in procreation to avert social death after physical death i.e. the lack of people to keep personal memory of the dead. Death before marriage or producing children was believed to completely cut off a person from the rest of the human society and lose all links with mankind (Mbiti, 1969:133). Today, however, marriage has greatly changed and is no longer the only means to family formation, procreation or aversion of social death.

Marriage, is an important stage in the family formation cycle. It is a complex process with personal, emotional, economic, social and religious and, sometimes, political dimensions, which often overlap so strongly that they cannot be mutually exclusive. The marriage concept refers to the process, which leads to and denotes the formation of a conjugal union, in an enduring relationship, between two adults a male and female. In marriage, people primarily invest their human resources and capacity in form of love, emotions, commitment, patience, faithfulness and protection in addition to material resources (Atekyereza, 2001a). Law may ratify this union (Jary and Jary, 1995:387). Once ratified, it becomes a legitimate union between husband and wife. Legitimacy alludes to some kind of law (whether cultural, religious or civil) while the

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* Peter R. Atekyereza is a Senior Lecturer in the Department of Sociology, Makerere University e-mail:[email protected]

Mawazo: The Journal of the Faculties of Arts and Social Sciences Makerere University

The key factors that explain social change relate to the realities of the new sociostructure and behavioural patterns therein. Socio-structural parameters define the purpose of marriage in different societies, they shape the meanings that people attach to or the values they derive from marriage. Despite the changes, marriage and the marriage process remain very important aspects of the individual and family life and marriage as an institution is still respected. In Uganda today, people marry for a variety of reasons and to understand them we are going to use different theoretical perspectives to explain them. A majority of persons understand marriage from the angle of the functions that it is expected to perform (functionalism) while others look at it in terms of what it means for each of the individuals involved (symbolic interactionism). Other people look at marriage as a self-regulating relationship that is well integrated and will change when it is necessary (systems theory) while others would argue that it depends on the level of its development or maturity and context (family development and ecology perspectives). On the other hand, the conflict and feminist perspectives see marriage as an institution of oppression and competition between different power actors who have varied reasons for their involvement in a marriage relationship (social exchange theory). As a result of the different interpretations or expectations, marriage as a process and institution is characterised by either absence or inconsistent normative standards and practices (marital anomie). This is reflected in different new forms which are either based on a number of partners, legislation and level of social approval and acceptability or whether they are primary or secondary marriages. The new interpretations of the meaning, process and purpose of marriage have created new attitudes towards

marriage-related aspects like bride wealth and divorce in marriage, domestic violence and partner obligations and expectations. Hence, in spite of the stereotyping of African and western family types, not all the pre-colonial African family features are still in existence (Kayongo-Male and Onyango, 1984). Even those aspects still in place have been rationally adapted to modern socioeconomic environments. Marriage processes, too, have undergone gradual transformation. Various explanations for general social and family changes have been advanced (see Atekyereza, 2001a; Robertson, 1991; Kilbride and Kilbride, 1990; Parkin and Nyamwaya, 1987; Kayongo-Male and Onyango, 1984; Shorter, 1976; and Goode, 1963). However, such theoretical explanations may not be sufficient in terms of specific changes among different communities such as the Bakiga of Uganda. The Bakiga, like other Ugandan communities, have been affected by different socio-cultural, economic, political systems and the people, in turn, have adjusted differently to the new systems.

The Changing Marriage Process

The discussion of the changing marriage process among the Bakiga is partly based on the findings from a study titled: Critical Factors for Family Studies Analysis in Uganda: A Case study of Changing Family forms and Functions among Selected Ethnic Groups carried out in the year 2000 and a follow-up one in 2001. The Bakiga was one of the selected groups and the study was carried out in the county of Kinkizi of then Rukungiri (now Kanungu) District. The areas selected were three sub-counties of Rugyeyo, Rutenga and Kirima (representing a very rural setting) and Kampala (for urban). A total of 178 male and female respondents (101 rural and 77 urban) were interviewed and 8 Focus Group Discussions (FGDs) conducted. Two

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Transformations in the Marriage Process among the Bakiga

FGDs were conducted in each sub-county and Kampala (one for men and another for women). The quantitative data was analysed using SPSS computer package while the study thematic and content analyses were used to interpret qualitative data. To the Bakiga, marriage is almost synonymous with family because it means founding a family (okutunga amaka) and was primarily intended to bear children to continue the rhythm of life connecting the past, present and the future. Through marriage one could, with social approval, produce children to extend his name and lineage into the future hence facilitating the flow of life through an individual (Mbiti, 1975:98). Marriage provided new relationships in families and clans. It gave social status, sense of responsibility and completeness to the person. Marriage was also the basis of the family. The Bakiga were dominantly polygynous but today they are largely monogamous due to the influence of Christianity and reduced access to land (which has forced a majority of them to migrate from their cradle land of Kigezi). The study found that 84 per cent of Bakiga marriages are in principle monogamous and 16 per cent polygynous. The legal basis of marriage among the Bakiga is dominated by traditional custom and religion despite the various forms as prescribed under the current marriage legislation. A majority of the marriages are customary (57.5%) followed by the purely Christian (29.3%), then cohabiting (6.4%), Mohamedan (4.1% and lastly civil marriages (2.6%). Cohabiting, though relatively on the increase, is not marriage under the current marriage legislation. The dominance of customary marriage implies that the Bakiga still believe in and respect their customs while that of Christianity is explained by modern influences. Christianity in Uganda started from central Uganda, among the

Baganda, from where it immediately spread southwards to Kigezi the homeland of the Bakiga (See Ngologoza, 1998). The increasing cohabitation, which was very uncommon among the Bakiga, is threatening both the conventional legal and cultural or customary system and the values enshrined in the ideal process and meaning of marriage. Some cohabiting couples do so in secret without the knowledge of their parents, relatives or any other recognised authority. Consequently, some partners, especially women, are very vulnerable in situations when their relationships encounter problems. Cohabitation is socially disapproved of by the couple’s families, relatives, friends and colleagues. In principle, these people should express their support or disapproval because they later become part of marital and family life. Though not everybody may be required to assent to a marriage, the underlying principle among the Bakiga like most other Ugandan ethnic groups is that they all practice exogamy (Nzita and Mbaga, 1997) under which nobody is allowed to marry from his/her own clan. Secret cohabiting increases the chances of such deviant behaviour. Marriage among the Bakiga, like in other African societies (see Parkin and Nyamwaya, 1987), was not a single event but a series of logical and sequential activities. Each stage progressed logically to the next in the process and signified an important sociocultural value that the Bakiga attached to the family institution. There were originally twelve stages through which a Mukiga man and woman would pass before they were considered properly married (Atekyereza, 2002). Today, this process has changed. It is no longer possible to pass through all the twelve stages. The Marriage process has been reduced to an average of five stages and it is not possible to draw a clear line between cohabitation and marriage (Kirumira,

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1996). Cohabiting couples, for example, claim the ‘married’ status without any legal basis though under the Domestic Relations Bill, it is being considered as one of the legal marriage forms. The following discussion explains the changing marriage process by comparing what used to happen and what is generally happening today.

Stage One: The candidate search

Information gathering about marriageable brides in a village was often unintentional. Such information was usually collected from beer parties or community gatherings, which were attended by only men from the kindred as the women would be doing domestic chores. Suitability of a bride among Bakiga was based on such criteria as ability to clean the home-stead and other domestic chores like grinding millet, cooking, preparing porridge, ability to cultivate and do other garden work, among others. Ability to cultivate was exceptionally important and earned a bride great respect because it meant that her future family would be assured of food security. Other criteria included how she welcomed visitors, her family background (that there was no witchcraft) and whether the children in the bride’s family would fart loudly at night while sleeping. The latter signified that the bride’s family had sufficient food and children had enough to eat. It is these attributes that differentiated good from bad families. Today, however, most parents and relatives no longer have as much control on who their children will or will not marry. Most young people get information themselves and select their partners on their own. In the study, 61.8 per cent of the respondents selected their marriage partners, only 2.3 percent had their partners selected by their parents, 20.8 per cent by other relatives (sisters, brothers, paternal and/or other aunts, uncles, in-laws or

grandparents), 12.3 per cent by friends (who include former schoolmates or classmates, work mates, a friend‘s relative and sometimes family friend). Other influential people include neighbours and, for men who are polygynous, the first wives may be involved in the selection of additional wives. Various conditions that influence social interaction processes of potential marriage partners may explain dominance of personal selection of spouses. Most young couples may meet each other while at school, at work, social gatherings like parties, drinking joints and other places which did not exist during the pre-colonial Kiga cultural setting. Others may use the internet marriage partner search or matchmaking organisations. This stage has been discarded. Initially the young man (alone) informally visited the girl’s home. The purpose of the visit would be for the young man to know his future bride’s home, her parents and immediate relatives and assess their attitude towards their relationship. At such a time, the bride’s parents may quietly ask their daughter about the groom’s clan and totem. In today’s globalised and globalising world, parents and other immediate kins no longer have total monopoly of knowledge and control over who their children should marry. The partners, for example, may not have full knowledge of their partners’ backgrounds (both self and family) and others are lured into marriage when they are still very young and unable to contain the challenges of marriage. Others may accidentally end up in some kind of marriage, such as girls that start sexual relationships with men for money. This is especially so in urban areas and is popularly known in Kampala as ‘detoothing’. Young ladies acquire‚ Sugar Daddies‘ (rich old men) while young men get‚ Sugar Mummies‘ (rich old women) who finance their accommodation, meals, leisure spending, education, in return for sexual

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gratification. These relationships sometime develop into a marriage.

Stage Two: Scouting by the Groom’s Father (Okutata)

A father or head of the family would look for a person called Kareebi. This person was some kind of spy that went out to verify information collected at beer parties or other gatherings. Kareebi visited the brides’ home and watched the girls as they did their daily chores and noted how they welcomed him as a visitor. He also looked out for information on the family in as far as the practice of witchcraft was concerned. He also established beyond doubt the family’s clan and totem. The importance of knowing the clan and totem was to avoid intramarriages within clans or lineages. This stage is almost non-existent today. Instead, there seems to be a reversal in that the bride, alone or with a sister or close friend, visit the young man’s home. The visit is intended to capture the attitude of the groom’s parents and possibly the immediate relatives towards their intentions to marry. However, such attitude does not often affect the young man’s final decision to either marry or not marry. It is, therefore, increasingly becoming ceremonial for the young men to take their future wives to their relatives to see rather than to seek approval. It has become common practice to skip these first two stages. Since parents no longer select partners for their children because most of them operate far away from home, the role of a ‘spy’ has disappeared. The absence of this role has meant that sometimes the two families may not know anything about each other up to the time of the marriage ceremony. Whereas Kareebi used to establish the bride’s clan and totem, the economic status and family background, today the two families hardly know about one another when they meet for

the initial introduction. Some couples have come to know that they belong to the same clan at the last minute when the two families meet. When the two youngsters fall in love, the issue of clan regularly never comes up. Others discover that they have married from families with a very ‘bad’ background (such as those alleged to practise witchcraft, being lazy or thieves, outcasts, etc) which could not be established by a one-day-visit when those involved go out to look their best in terms of attitude and hospitality.

Stage Three: Seeking Friendship (Okutwara Ebigambo)

On confirmation of the bride’s suitability, on the basis of character and nature of her family, the young man’s father officially visited her family to seek friendship through marriage. It is called Okutwara Ebigambo in Rukiga. Traditionally, it was only the groom’s father and Kareebi that visited. The two would inform the bride’s father of the purpose of their visit. Today, this stage of seeking kinship through marriage is still in place and it is increasingly becoming the first official contact between the families. The suitor, his father, go-between (new version of Kareebi and mediator), close relatives, and his friends visit the young lady’s family to formally inform the bride’s parents of their intention to marry their daughter and discuss issues relating to bride wealth. Sometimes, the groom’s family does a pre-visit with the identified go-between (supposed to be Kiriima2 but who is not in the real sense because the choice is already done This time the go-between is not necessarily from among the relatives of the bride. He can be somebody who knows the two families and is very eloquent so as to adequately handle the formal introduction and negotiation processes at the bride’s home. He may not even be related to the two families but just a friend. 2 This is a person that would appreciate and choose the bride.

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by the groom himself ) to do preliminary negotiations such that the official visit becomes a mere formality. Sometimes when results from such a pre-visit are negative, the next stage may be called off or delayed until mutual understanding is reached. At this stage, the two families officially get to know each other’s clan and totem and the go-between formally asks for friendship with the bride’s family3 through marriage. This is one of the symbolic socio-cultural practices that has survived the times.

Stage Four: Counter-spy Network by the Bride’s Father

The bride’s father would not accept to return the friendship outright. He would tell his visitors to go back home and give him time to think about their request. Meanwhile, he would commission his own ‘spy’ to verify the status of the groom and his family in terms of level of wealth such as land, domestic animals like cows, goats, sheep, and food granaries. These demonstrated the ability of the groom’s family to care for their daughter once married. The family background and the groom’s clan and totem would also be established. The rationality of stages two and four was borne out of the belief that marriage requires extensive consultation (as locally said ‘Oshwera Abuuza!’) in order to build strong and stable families on which the Bakiga tradition of belonging and mutual support was based. Like in stage two, the rationale for this stage has generally been lost for the same reasons given above. The work of spies and counter-spies like agents has been severely weakened mainly due to the fact that the young people intending to get married usually inform rather than consult. ____________ 3 They use phrases such as “Nituronda obuzaare” or “Nitwenda tuzaarwe omuri egy’eka” meaning that “We are looking for affinal friendship” or “We want to be born into this family”, respectively, as it was traditionally expressed.

Stage Five: Agreement to Return the Friendship (Okwikiriza Omukago)

When the bride’s father received positive feedback, he gave a date to the groom’s father. This time, the groom’s father went with his brother(s) and their agent (Kareebi) when they were well prepared. They took a pot of locally brewed beer, which was supposed to be drunk while they discussed. The contradiction, however, is that it would be hidden until discussions were completed and then given as a sign of appreciation. During the meeting, the bride’s side would comprise of her father, brother, a paternal and maternal uncle. During this meeting, before anything could be discussed, the two sides jointly selected the mediator4 (Kishabi or Kiriima). This person would be related to the bride but at the same time friendly to the groom’s side. Indirectly, this was intended to make discussions and negotiations easier. After general introductions, discussions and negotiations would begin. Discussions began by asking the groom’s side to name their clan and totem, for formality purposes, as the spying exercise would have already established it. The most important issue in the meeting then would be negotiating and agreeing on bride wealth (enjugano). If there were prior consultations and agreements reached public negotiations would still take place as a formality. Traditionally, bride wealth was in form of domestic animals (particularly cows and goats) and was very instrumental in providing a basis for acceptability of marriage (Atekyereza, 2001c). After compromises on the bride wealth are reached, eating, drinking, and general entertainment would follow and the groom’s father and his people would also bring the other pot of beer. General agreement on bride wealth normally entailed _________ 4 Also commonly known in Uganda as the gobetween.

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dates for seeing and approving the property to be given, when it would be brought to the bride’s home and when the give-away ceremony would be. This stage has tended to be subsumed under stage three. Whereas in rural areas this may remain a separate stage and activity, most urban-based young people tend to merge the two into one. Where the two stages remain separate, the bride’s father and relatives go to collect bride wealth from the groom’s home if it would not have been given, say in form of money, at the introduction in stage three. The party at bride wealth transfer (okuriira ente) is no longer a common feature since it is money that is currently given and not cows. But those who insist on this stage will be welcomed at the groom’s home and entertained. Merging of some of these activities is intended to reduce expenditure and save for another trip. In some places, the groom and his group must dance the traditional Kikiga dance in the front yard of the bride’s home as a sign that they are happy and appreciative. This signifies that the visit was successful. If the guests were to leave quietly, the neighbourhood would conclude that negotiations failed. After feasting, the guests are given a farewell drink, usually locally brewed beer. This farewell drink would be taken in the front yard of the bride’s home. However this beer is now often taken inside the house and may not necessarily be local brew. The hosts at this point return the walking stick to their guests. The walking sticks were usually collected from the guests on arrival for safe custody. The issue of walking sticks has also either become a formality or completely disappeared. The majority of the guests carry no sticks anymore.

Stage Six: Invitation to Collect the Bride (Okutegura)

This involved the bride’s father sending the mediator and a few favoured members of his extended family to go and confirm the date for the give-away ceremony. The groom’s family was informed to come and collect their bride. Once the date was confirmed both families went through their relatives and neighbours informing them of the imminent ceremony and also requesting for a helping hand (Okutwereeza) The modern form of okutwereeza is in form of wedding meetings to raise funds for the wedding ceremony and bridal reception in preparation for the celebrations. Today, there is no more invitation of the groom‘s family to collect the bride. One reason is that sometimes the bride is already living with the groom. The other reason is that normally it is the groom to give the date when they will be ready to go for the giveaway ceremony partly due to mobilisation of resources for the a bridal reception. After the give-away ceremony, the bridal reception must follow and the two functions require intensive resource mobilisation.

Stage Seven: ‘Give-Away’ Ceremony (Okuhingira)

The give-away ceremony is a western concept that does not clearly portray the intended meaning. The okuhingira was a process of preparing the daughter for marriage. It normally followed several rituals of cleansing her, cutting her finger nails, making a partshave in her hair, shaving her pubic and armpit hairs among others. This was intended to give her in marriage in the cleanest and smartest manner. Other rituals included giving the unfixed hoe to the bride –the hoe that would be fixed for her at a ceremony to end her seclusion when she would be allowed to start her regular duties as a housewife. Another ritual at the give-away ceremony

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was the “shaking of hands”; the father of the groom would symbolically shake hands with the father of bride signifying the seal of friendship (Omukago) that was requested in the first meeting discussed in stage one. After feasting and drinking their last offer of drinks, the bride would be brought out of the house amidst strong resistance. This indicated that though it was her obligation to get married she still loved her parents and family and did not want to leave them. Then, her brother would carry her on his shoulders through the entrance to the front yard. The bride was normally taken in a litter (locally known as engozi or ekigagara) or carried on the shoulders. This stage has not changed much in rationale except that the rituals, which were involved, have gradually phased out due to modernisation tendencies. Traditionally, the father of the bride handed her over to the father of the groom to symbolise the relationship between families not the individuals being married. Today, the father and brother of the bride officially give her to the groom as a wife. However, in very strong religious families, the bride does not go to the groom’s home before the church wedding. It is normally in church that the bride’s brother officially hands her over to the groom as his wife. After the church or mosque wedding, the couple receives their Marriage Certificate. The traditional bridal resistance to go with the groom is now very rare since such a ceremony may not take place at her home and sometimes she may already be living with her husband. Instead of the traditional engozi, the brides today either go on foot (especially in rural areas) while others use vehicles (rented or from friends). In urban areas, this is one particular item that tends to escalate wedding costs since some couples may want to make very lavish weddings including very expensive

cars (sometimes at a rental fee of $200 per car per day).

Stage Eight: Bridal Reception (Okutaasya)

This is when and how the groom and his relatives would receive the bride into their home and family. In her father-inlaw’s compound, she would be met by the groom and led into the room of a house of the groom’s mother where she would first stay. This room was particularly meant for marriage purposes and was locally known as ‘entarure’. If the groom had no mother, then the bride would be accommodated in the groom’s stepmother’s house. This is where the groom and the bride would stay until the end of seclusion, which sometimes would last as long as a whole calendar year. This stage still remains vital to the marriage procedures. A bridal reception is organised at the groom’s home (or at a specially organised place in urban areas) to receive and welcome the arrival of the new wife (omugore) and the married couple. It normally follows the religious wedding in a church or mosque. This often marks the end of the marriage process though some Christians consider it complete when the newly wedded couple goes to church for the first time after the wedding for thanksgiving. However, contrary to the use of entarure as a secluded room for the newly weds, most grooms today take brides straight to their own houses (especially in rural areas) or in their own or rented houses (particularly in urban areas). Others who are financially well disposed may take their honeymoon to hotels within or outside the country ranging from a few days to weeks.

Stage Nine: Ritual of first Sexual Intercourse and Consummation of Marriage

Very early the following morning, slightly before the people who had accompanied the

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bride left, the traditional ritual known as ‘okumurika’ (meaning to show) took place. This was a ritual done before the first sexual intercourse. This ritual defined which of the men in the groom’s family could “legally” have sexual intercourse with the new wife without causing social disgrace. This symbolised that the woman was married to the family and not the individual. After this ritual, the bride would go back to the ‘entarure’ where she was expected to consummate marriage with her husband and stay for the entire seclusion period. Consummation of marriage among the Bakiga was rather difficult. The bride would be wearing a rope with nine knots smeared with cow gee around her waist. This rope was very slippery but before any sexual intercourse with the bride took place, the husband had to untie the rope with his hands or teeth where it was joined together. The groom was not supposed to use anything like a knife to cut the rope, however long it took. This symbolised that the man is supposed to be strong and that the woman is not sexually loose. It was believed that using a knife to cut the rope symbolised that a man had cut his capacity to produce children and above all that he was weak. This ritual part of the marriage process has completely died out. The ritual of okumurika has particularly died out mainly because of foreign religious evangelisation and the spread of the deadly HIV/AIDS disease (Atekyereza and Kirumira, 2004). Most of the Bakiga are not only opposed to okumurika but also resent widow inheritance. In addition, as already noted, most couples have sexual intercourse before marriage, that is, when they are still in a boyfriend–girlfriend relationship. The first sexual intercourse now normally takes place in the absence of the relatives. Hence, the rationality of struggling for the first sexual intercourse does not arise.

Stage Ten: The Visit of the Couple ‘To Finish the Butter’ (Okumara Amajuta)

This visit normally happened four days after marriage (Kawemera, 1994; Ngologoza, 1998) though the research findings indicate that the period varied from two weeks to one month depending on the availability of resources. The bride went back to her parents to clear some cultural obligations that could affect a happy and fruitful family life of the couple, in particular the bearing of children. It was culturally known as okumara amajuta – ‘finishing the butter’. The purpose of this ritual was that the mother would counterfoil any attempts by any evil or malicious person to stop the couple from having children. The cultural values and rituals related to this stage have greatly weakened especially in the urban areas. Most rural young couples still do so. However, their urban counterparts rarely do so due to pressure of resources, work commitments and unverifiable benefits.

Stage Eleven: Honeymoon or Seclusion (Okwarama)

Seclusion is a period that can be equated with the current or western concept of honeymoon. After marriage, the new wife was not expected to do any tedious work until the official end of her seclusion. She was considered a special visitor and stayed indoors. One sister-in-law was specially charged with the duty of attending to her needs. However, if she had no sister-in-law, she would do all the domestic chores herself. This period varied from four months to a year and from family to family. For poor families, the period was usually cut short so that the new wife could start working early. However, for those families that were wealthy, the period could be as long as a year. She would spend all this time wrapped up and would keep her head and face covered.

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10 Mawazo: The Journal of the Faculties of Arts and Social Sciences Makerere University

Today, the honeymoon or seclusion practice is still present but in a different way and for a limited time. People can no longer afford to stay in seclusion for up to a year. After marriage, the young couple must immediately embark on economic activities that will support their family’s socio-economic life. It is worse in urban areas where most people have been preconditioned to hold their wedding functions over the weekends because on Monday they and their friends have to go back to work. However, those who have financial capacity and better working conditions can afford a few days or weeks to enjoy their honeymoon within or outside the country. As a result, the role of relatives in the seclusion period has significantly reduced. Even the sistersin-law that would be required to look after the bride are either at school or working. The traditional rationality of seclusion was that the young couple need rest after tedious activities preceding their wedding.

Stage Twelve: End of Seclusion or Honeymoon (Okwaruka)

End of the honeymoon or seclusion meant that the bride would go out to work like others and the ceremony was quite elaborate. It would begin the bride going back to meet her parents and other blood relatives officially as a married woman. She would be welcomed by her old friends who would lead her into the house. In the house, she greeted her parents, relatives and uncovered her head to go outside to greet other people. On this visit, she would be accompanied by her husband, the husband’s young brother (mafuka or hoe-carrier) and about ten other people including the father-in-law and husband’s uncle who would be leading the group. The following morning was a day for exchange of gifts and also a time to show whether the bride had been found a virgin or not during the consummation of marriage. If

the bride had been found a virgin, she would be showered with gifts and, finally, fixing a hoe for her. She would ceremonially use this hoe to dig in her father’s compound as a sign that she was now ready to start working. Thereafter people would start feasting to celebrate the occasion. Such a feast used to last for two to four days. After this ritual, the young man and his wife would go back and live like other married couples or families. However, sometimes another ritual would take place to formally allow the new family to prepare their own food in their own home. This ritual was known as okutekyesa. So it is after all these stages were completed that a couple would be recognised as fully married and thus constituted a nuclear sub-family within the context of the extended family. Today, this ritual is generally a ceremonial one. Most young families that do not stay near their immediate relatives do not perform such rituals. In addition, the value of reporting on bridal virginity during the first sexual intercourse has completely disappeared. Most young couples may no longer be virgins at the time of the first marriage. Secondly, the presentation of the hoe to the wife is also rarely practised since the livelihood activities have also changed. Remnants of this practice exist in some rural areas. Even the rituals that were often performed for the young couple to be allowed to prepare their own food in their own home (okutekyesa amahega) is weakening and gradually disappearing. Some urban families may get up to three children when they have never performed this ritual. It is of limited practical importance. Urban couples, for example, do not have to wait for the huband’s parents (majority live upcountry) to perform the ritual of okutekyesa before preparing their own food.

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Causes of the Transformation

The major causes for these changes include economic transformations and resultant opportunities or vulnerabilities. It is also due to the nature and position of the political economy in the global economic order, education, urbanisation, the wage employment and inter-marriages. Despite the reported falling poverty trends in Uganda (UNDP, 2005:ix; Republic of Uganda, 2003a and b), wealth is unequally distributed throughout the country. However, even where gains have been made, they are eaten up by negative consequences resulting from AIDS (MoH and OCR Macro 2006), wars and insurgencies etc. So, Uganda continues to be ranked among the poorest countries in the world and (UNDP, 2005; Republic of Uganda, 2003a&b; UBOS, 2002). Hence, very few people can afford to conveniently go through the traditionally prescribed marriage process. Atekyereza (2001a), in particular, identified the most critical factors influencing changing family values, including marriage process in Uganda. The drastic economic changes have left and continue to push many people into abject poverty. People have very many needs but do not have enough resources to meet them. Poverty has in particular affected the payment of bride wealth leading to an increase in the number of couples who choose to cohabit as a form of marriage (Atekyereza, 2001c)! The new context of the monetary economy based on technological advancement especially from the Western world is different from that of the precolonial societies like that of the Bakiga. Both men and women have to work to earn a living to maintain themselves and their families. The modern economy is based on formal skills acquired through formal education or training. However, women access to (especially higher) education remains very low (Kakuru, 2003; Atekyereza

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2001b) Hence, this new development has distorted the former division of labour and offered no better or harmonious alternative. Women, for example, are no longer completely restricted to the homestead to look after the young children and take care of all other domestic chores hence the need to balance work and familial commitments (Nuwagaba, 2001). Though not all women are able to join such categories due to low level of formal education attainment among women (Atekyereza, 2001b), the present role conflict may influence their decisions on when, who and how to marry. In terms of education, modern national politico-economies no longer depend on informally acquired skills through socialisation. People have to go to school to acquire skills through formal training. Most children especially in urban areas start their education from the pre-primary or nursery school at the age of 4 years or less. Some children in boarding institutions may go through university living in environments that detach them from their family. Not only does such education deny parents the effective role of socialisation, it also denies them any important influence they may want to have on their marital decisions later in life. The Bakiga have a proverb that “Akati kainikwa kakiri kabisi” (literally meaning that one can only bend a stick when it is still young and tender) implying that one can only shape a child’s character effectively when one is still young. When one is already grown up with his/her own strong beliefs, one’s advice may be ignored or rather frustrating. The reality of working parents has also meant that children’s character formation is almost entirely in the hands of housekeepers (nannies or house-girls). In addition, the internet and mass media are exposing young people to different values including those related to marriage that may not necessarily be compatible with the traditional values.

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Parental control over children’s sexual behaviour, for example, is now practically absent. Though 69.3 per cent of the sample reported that they still control their children’s sexual behaviour, 53.4 per cent of these agree that it is because their children are still too young to get involved in such relations. The loss of control by parents is building a dangerous permissive culture that is likely to harm parents, children and society in general. The effect urbanisation has mainly been in terms of the necessary or imperative rationalisation of individual ethnic cultures. Urban dwellers and/or families confront many pressures that may dictate rationalisation of their particular indigenous cultural values. The cosmopolitan nature of urban areas, educational differences and resultant occupational patterns and values, intermarriages, strong religious pluralism and liberalism affect urban dwellers much more than their rural counterparts. These directly and indirectly impact on people’s understanding, value systems and practice of traditional marriage processes. The work pressure, in particular, forces many people to shorten these processes. Intermarriages have also had a significant impact in that the marriage process cannot be dictated purely by the marriage process of one tribe. This explains why some of the values in processes of marriages in different ethnic societies are dying out. Even children from such a marriage cannot be socialised in any one particular culture and they end up without any one defined cultural outlook. This partly explains lack of a cultural identity for most children of the current generation especially in urban areas. Intermarriages have been dictated mainly by education, the cosmopolitan nature of urban areas and religion. Most marriage partners meet at work places or schools. Also contrary to earlier times where there was one dominant

traditional religion, there is now a pluralist culture of religions preaching different family and marital values. Generally, there are no more ideal marriage procedures. The interface between tradition and modernity has produced unpredictable behavioural practices. Whereas it is not possible to follow the traditional procedure strictly, one cannot completely abandon it. The process therefore is as varied as there are couples. The stages discussed above are selectively followed on the basis of their importance and convenience in the couple’s view rather than their social relevance. This is a form of anomie that characterises many transitional societies in their attempt to adjust to ‘modern lifestyles’ – there are no clear guidelines to follow because the situations themselves are unclear. Marriage variations today depend on location of families, financial status of (especially the grooms’) families, and how the relationship between the groom and bride started. The role of the paternal aunt (shwenkazi in Rukiga) has completely been weakened because now most couples marry when they have tried out those important issues on which she was supposed to advise before marriage. What the aunt used to advise the young bride on in private, is now openly written about in newspapers and magazines. The other relatives no longer have a significant role in marriage preparation because by the time the relatives get to know, the couple is ready to wed or already has children. It is difficult to advise them on anything at this stage or indicate disapproval of the proposed marriage. If one insists on showing disapproval then he/she is called an enemy (omwisi w’obugyenyi in Rukiga). Most children may not know all their relatives because they do not grow up with them. The children take their relatives for strangers. Hence, advice from such relatives may not be taken seriously when children have not grown up with them.

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Contrary to the systematic and logical procedure that characterised the traditional marriage among the Bakiga, today, the focus seems to be on the couple staying together and/or wedding ceremonies. There is growing emphasis on love, affection and companionship of the couple rather than children though ultimately this affection tends to consolidated and enriched through children. Traditionally, marriage was considered complete after twelve stages but now most people consider the marriage complete after a religious marriage ceremony, a wonderful wedding party or acquisition of a legal marriage certificate in a civil marriage. Others considered their marriage complete after giving or paying of bride wealth. There is now more pre-occupation with the legal rather than the traditional processual perception of marriage. The legal system that is not in consonance with the traditional mores relating to the institutions of marriage and family of Bakiga is partly responsible for scaling down of traditional marriage values. Amidst this transitional situation characterised by anomie, there are no clear guidelines on what an ideal marriage process entails. The increasing poverty is weakening the normative structures of various ethnic communities. Whereas one would like to remain attached to his cultural roots, the dictates of modern society are difficult to reconcile, hence the development of calculative behaviour especially in terms of the rationale and process of marriage.

Conclusion

Marriage is a very important process in family formation cycle. In an African sense and especially in the context of the Bakiga, marriage is a process rather than a single (day) ceremony. Such a process depended on the socio-cultural organisation of a people. Among the Bakiga, this marriage process was traditionally aimed at safeguarding

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the cultural family values that enhanced the cohesion of a community’s social fabric. Such values include value of work, stability of families, avoidance of incest and extension of kinship ties, biological and social reproduction, mutual respect between or among families and to further enhance the extension of one’s lineage. The traditional marriage process among the Bakiga was characterised by twelve stages that logically and progressively followed each other towards the formation of nuclear family sub-system within the broader context of an extended family system. However, this process has undergone significant transformation to the extent that the twelve stages have been reduced to practically five. Traditional marriage process among the Bakiga was in consonance with people’s cultural values embedded in material forms of culture, which were further predicated on their economic mode of existence. However, since the Bakiga are no longer in one geographical area, there is need for the younger generation to properly understand those traditional marriage and family values so that they can be able to rationally adapt and/or integrate them into modern family life styles rather than totally rejecting them as if nothing good ever existed in any of them. The major factors responsible for most of these changes are economic (dominantly characterised by the wage employment and wide-spread poverty), the education system and employment opportunities and their resultant effect on family functioning, urbanisation, inter-marriages and the religious and/or ideological differences on a model family. There are mixed reactions to these changes. Whereas most people support changes by arguing that as society changes to meet new challenges so must its institutions, on the contrary, others argue that most of these changes are not well-intentioned. It

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is important to understand the conditions that promote traditionalism and shifts to modernity. It may not be surprising to find some highly educated people as the best traditionalists. It is important for the Bakiga to evaluate their history to establish the good elements that existed in their traditional marriage and family values, and decide on how they can be viably integrated into the current socio-economic and ideological order. References Atekyereza, P.R. (2001a). “Critical Factors for Family Studies Analysis in Uganda: A Case Study of Changing Family Forms and Functions among Selected Ethnic Groups.” PhD, Thesis Department of Policy and Development Research, Johannes Kepler Universität Linz, Austria. Atekyereza, P.R. (2001b). “The Education of Women and Girls in Uganda”, Journal of Social Development in Africa, Vol.16, No.2, July 2001. Atekyereza, P.R. (2001c). “Bride Wealth in Uganda: A Reality of Contradictions,” The Journal of the Uganda Society, Vol. 47. Atekyereza, P.R. (2002). “The Rationality of Traditional Marriage Process among the Bakiga of Uganda” Mawazo: The Journal of the Faculties of Arts and Social Sciences, Makerere University, Vol. 8, No. 1, June 2002. Atekyereza, Peter R. and Kirumira, Edward K. 2004. “The Impact of the AIDS Epidemic on Families and Family Coping Strategies in Uganda”, Research Review Supplement 15 on Gendered Family Dynamics and Health: African Family Studies in a Globalising World, Institute of African Studies, University of Ghana, Legon. Goode, W.J. 1963. World Revolutions and Family Patterns: Glenscoe Illanois, Free Press.

Hoggett, M. Brenda, Pearl David, Cooke J. Elizabeth and Bates D. Phillip 1996. The Family Law and Society: Case Materials, London: Butterworths. Jary, D. and Jary, J. 1995. Collins Dictionary of Sociology, 2nd Ed. Glasgow: Harper Collins Publishers. Kakuru M. Doris 2003. “Gender Sensitive Educational Policy and Practice: Uganda Case Study”, Kampala: International Bureau for Education. Karwemera, F. 1994. Emicwe n’Emigyenzo y’Abakiga. Kampala: Fountain Publishers Ltd. Kayongo-Male, D. and Onyango, P. 1984. The Sociology of the African Family, London: Longman. Kilbride, P. L. and Kilbride, J. C. 1990. Changing Family Life in East Africa: Women and Children at Risk, London: Pennsylvania State University Press. Kirumira, E. K. 1996. “Familial Relationships and Population Dynamics in Uganda: A Case Study of Familial Behaviour in Central Uganda.” PhD Thesis, University of Copenhagen. Mbiti, John, S. 1969. African Religions and Philosophy, Nairobi: East African Educational Publishers Ltd. Mbiti, John, S. 1975. Introduction to African Religiosn, London: Heinemann Educational Books Ltd. Ministry of Health (MoH) and ORC Macro 2006. Uganda: HIV and AIDs SeroBehavioural Survey 2004/05. Calverton, Maryland, USA: Ministry of Health and ORC Macro. Ngologoza, Paul. 1998. Kigezi and its People, Kampala: Fountain Publishers Ltd. Nuwagaba, Augustus. 2001. “Situation analysis of women in the Ugandan political economy,” Eastern Africa Social Science Research Review Volume 17, Number 1 (Jan). 15-30. Nzita, Richard and Mbaga-Niwampa 1997. Peoples and Cultures of Uganda. Kampala: Fountain Publishers Ltd.

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Parkin, D. and Nyamwaya, D. 1987. Transformations of African Marriage Manchester: Manchester University Press. Republic of Uganda. 2003a. Uganda Poverty Status Report, 2003. Kampala: Ministry of Finance, Planning and Economic Development. Republic of Uganda 2003b. Development Cooperation Uganda: Good Health is a Prerequisite for a Productive Population, 2002 Report, Kampala: Ministry of Finance, Planning and Economic Development. Robertson, A. F. 1991. Beyond the Family: The

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Social Organisation of Human Reproduction, Oxford: Polity Press. Shorter, E. 1976. The Making of the Modern Family, London: Collins. Uganda Bureau of Statistics (UBOS). 2005 “The 2002 Uganda Population and Housing Census – Main Report,” Kampala. Uganda United Nations Development Programme. 2005. “Uganda Human Development Report 2005: Linking Environment to Development – A Deliberate Choice,” Kampala. UNDP office.

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Banyankore: An Ethnically Dichotomised Ugandan Society with Features of Castes Fred Henry Bateganya*

Abstract Debate between different scholars on whether castes exist outside Hindu cultural settings continues since it was triggered by Louis Dumont’s 1966 publication of Homo Hierrachicus. On one side are scholars who argue that castes are a cultural phenomenon defined by specific ideological underpinnings. On the other, are scholars led by Berreman (1968) who argue that castes should be conceptualised as a social phenomenon guided by elaborate principles of social organisation and thus a system of social organisation. Using empirical material (primary) and secondary sources about the Banyankore, an ethnically dichotomised group found in western Uganda, the paper argues that there are societies that possess features of castes and operate along the caste ideologies akin to those found among the Hindu of India. The paper also argues that all castes among the Hindu or whatever they are called elsewhere are status groups that reproduce distinct social relations and are a basis for social organisation. The ascribed status regulates individual behaviour and action.

Introduction

phenomenon defined by specific ideological underpinnings with elaborate “systems of ideas” that guide those societies. On the other hand, structural functionalist scholar, Gerald Berreman (1968) Barth (1981) and Haaland (2003) argue and posit that castes should be conceptualised as a social phenomenon guided by elaborate principles of social organisation that place the people in strata with corresponding roles and obligations. These scholars argue that castes should be looked at as a system of social organisation rather than a static cultural phenomenon. Using empirical material from the Banyankore, an ethnically dichotomised social group found in southwestern Uganda, I intend to show that it used to operate along caste lines and possesses key features of castes akin to those found among the Hindu of India. It is important, from the onset, to define what a caste is. Like many concepts used in the social sciences, there are as many definitions of caste as there are people

The debate over whether castes exist outside Hindu cultural settings has generated interest among scholars since Louis Dumont’s publication of Homo Hierrarchicus (1966). The interest has not only been generated due to the fact that castes are the most general form of social organisation in India but also because it presents a very distinct contrast to many social groups prevalent in other parts of the world. Dumont’s (1966) feeling seems to have been halted by Euro-American scholars who studied castes in India and concluded that these would be seen elsewhere. Indeed his position elicited immense debate from Berreman (1968) and Barth (1981) among others. The point of disagreement stems from the fact that Dumont insisted that castes should be understood as a cultural

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* Member of the Academic Staff of the Department of Sociology, Makerere University. Any correspondences should be made to [email protected]. ac.ug 16

When Traditional Medicine Provides a Choice for Primary Health Care

who have attempted to define it. However, two definitions will be used in this paper since they represent the two sides in the debate. These two definitions can broadly be categorised into symbolic and structural functionist. Among symbolic scholars are Leach (1960) Dumont (1966) and Bougle (1971). They define caste as a total symbolic world, unique, self-contained and not comparable to other aspects (Bartfield et al: 1997). On the other hand structural functionalist scholars include: Berreman (1968) Barth (1981) and Haaland (2003). They define caste as: ...an endogamous and hereditary sub-division of an ethnic unit occupying a position of superior or inferior rank or social esteem in comparison with other such divisions.

Inherent in this definition is the fact that castes are seen as systems of social stratification. Whichever definition one may choose, it is instructive to note that caste is not a term that originated in a cultural tradition of the Hindu of India but was first used by Portuguese to mean, “breed or type”. They used it to refer to closed groups found in India. Attempts to establish whether castes exist elsewhere demands the unpacking of features of castes found in the Indian subcontinent. First, castes have a hierarchical grading. There was a definite scheme of social precedence amongst castes in India. There are four main castes, mentioned here in order of social precedence; Brahmin (priestly castes), Kshatriya (warrior caste), Vaishya (commoners usually known as the trading and artisan caste and Sudra (agricultural laborers) respectively. Amongst the four broad groups, there are sub-castes that number in hundreds and vary regionally.

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Second, castes possess a structural system. This structure exhibits a hierarchy of marrying groups. Endogamy is the rule though there are (some) exceptions to this rule. The exceptions are where hypergamy seems to be the reason for marriage. Hypergamy happens when a man from a higher caste marries a wife from a lower caste. Hypergamy happens only when women marry into a higher caste. Thirdly, occupations in a caste system are hereditary. There is a hereditary functional division of labour. Thus, one’s occupation is ascribed. Brahmin for example are the priests, Kshatriya the warriors and thereby the kings or leaders, Vaishya, the merchants and Sudra, service men, tailors and black smiths. Lastly, there is an element of purity and pollution of activities. There are certain things and actions that could pollute someone. Therefore, in order for a person to remain pure, one has to avoid interactions and contexts that may affect one’s purity. Usually these contexts and actions involve sex, food festivals, worship and ritual. A member of a high caste was likely to be polluted by either direct or indirect contact with a member of a lower caste. In the scale of purity and pollution, Brahmin are generally the purest and Sudra the most polluted. Some of the things that help an individual remain pure include vegetarianism, teetotalism and tight constraints on women. Thus, an individual is solely responsible for keeping pure or polluting him/herself.

Materials and methods

Using empirical materials from in-depth interviews, informal discussions (held with various Banyankore adults between 2000 and 2005) and secondary sources, this paper argues, basing on caste features discussed above, that before the abolition of kingdoms in Uganda (1967), the Banyankore operated a system akin to a caste system. One year

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after Dumont published Homo Hierrarchicus (1966), then Ugandan President Milton Obote abolished kingdoms. Though the Obugabe, the political and traditional leadership establishment was abolished, some kinship groups continued (still continue) to operate basing on the values and norms that were established before the abolition of kingdoms. Celebrated Ugandan historian and Nkore scholar, Karugire (1971) mentions in his doctoral thesis that the Banyankore are divided into two broad classes (sub-ethnic groups) called the Bahima and the Bairu. The Bahima are traditionally cattle keepers or herdsmen while Bairu are cultivators. In terms of hierarchy, Bahima were the rulers/ leaders while Bairu the ruled. Thus, Bahima were (are) above Bairu. Karugire seems to confirm the hierarchical arrangement of the Banyankore when he says that” Nkore society was a class system….in which the Bairu were of lower social standing than the Bahima (1971:66). As it is the case with castes in India, the two groups have smaller sub-groups. The sub-groups are called clans and their members are believed to share a common ancestry. Like it is among the Hindu of India where people from certain castes and subcastes are untouchables, and should not be interacted with let alone marrying them, some clans among the Bairu were despised and were considered not fit for interaction of any sort. For example, the Bahweju were said to be gluttons while the Basingo were associated with great misfortunes. Being a Muhima or a Mwiru gives an individual an identity like it is among the Brahmins, Kshatriya, Vaishya and Sudra among the Hindu of India. This identity comes with a status that imposes on an individual a distinct style of life. Being the rulers, the Bahima held themselves in high esteem and thereby supported values and

institutions that perpetuated their status. This act was not only peculiar to the Bahima but was equally prevalent among the Brahmin of India. Like the case is among the Hindu India endogamy is prominent and pronounced among the Nkore sub-ethnic groups. Before the abolition of Obugabe, it was a taboo and abominable for a Muhima to marry outside the group since they (Bahima) regarded and considered themselves superior to the Bairu. Both Bahima and Bairu discouraged inter-ethnic marriages. To ensure that this was upheld, elders from both groups were involved in choosing suitors/ partners for their children. It should be noted however that in some exceptional cases as it is in Indian castes, hypergamy was allowed. A Muhima man could find himself a Mwiru wife. Both Bahima and Bairu have traditional occupations. Bahima are predominantly herdsmen and the Bairu cultivators. Most informants said that these occupations are ascribed; an issue Karugire (1971) seems to disagree with. A Mwiru elder from Ntungamo noted that before the abolition of kingdoms (1967) a Mwiru who acquired cattle kept them at a Muhima’s home since cattle keeping was the preserve of Bahima. The ascribed occupation among the Banyankore is akin to the ascribed occupations among different castes in India (Brahmins (priests), Kshatriya (warriors), Vaishya (traders and artisans) and Sudra (agricultural labourers)). Purity and pollution is a major feature of a caste system as indicated above. Both groups avoided all interactions that would lead one to become polluted. As a result, there were few interactions and sharing of food between Bahima and Bairu. A number of instances were recollected where interactions Karugire attributes Bahima and Bairu occupations to environmental conditions rather than to ethnic superiority or inferiority (pp41).

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between the two were discouraged or avoided altogether. Stanley (1899) said that Bahima would not permit a person (Mwiru) who eats cooked food to put his lips to any pot, basin or gourd that is used in contact with their cows (in Karugire: 1971:46). In addition to the above, Mubangizi (1963) added that: A person who drinks milk does not eat sweet potatoes, beans, peas or any hot food: because it was believed that if this happened, the cow’s teats would be blocked.

The two examples above show how the Bahima regarded their cows, thereby avoiding any act that would affect them. Several informants narrated how important cattle were to a Muhima, one peculiar example being “losing a cow was likened to losing a human life among the Bahima”. Categorisations and conceptions about each other make it hard for Bahima and Bairu to allow inter-group marriages and other interactions since this would pollute their ethnic group. Some informants narrated cases where Bahima girls who had got married to Bairu were encouraged to look for Bahima men “outside marriage” so as to have a “pure child”. It was reported, for example, that her Bahima relatives did not recognise a child fathered by a mwiru and born by a muhima girl as a child. Thus, social stigma attached and disregard to BahimaBairu marriages deterred marriages outside one’s ethnic group. Several informants noted that ceremonies and gatherings that brought together people from the two sub-ethnic groups were rare. However, when they did, a master-servant relation/status defined the interaction (since Bahima regarded themselves superior, therefore mixing them with the Bairu on an equal standing would be demeaning.

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Continuity and Change

With the opening up of the Indian subcontinent and Africa to external factors and influence, the terrain in which the Hindu Indians and Banyankore, respectively lived changed dramatically. As a result, the politics, economy and social-cultural institutions in both communities changed. The attendant changes placed corresponding demands on the way of life of most people. While formal education, commercialisation of the economy and founding of the Uganda republic affected [the Bugabe in Ankole between 1900 and 1962, the abolition of kingdoms by a Presidential Decree in 1967 tremendously affected] the way the Bairu and Bahima treated and interacted with each other. The abolition of kingdoms brought new power centers and demanded various competencies. Positions of responsibility in the administrative structures ceased to be hereditary, for example an applicant who had more social and cultural capital in addition to the qualifications stood a higher chance of landing a given job. This development opened up the Nkore society; it was then that Bahima and Bairu started interacting freely in schools, offices and other social and political gatherings. While in the pre-1967 Ankole, one’s ascribed status was enough for one to get employed for example, such was not a guarantee in post 1967. Ascribed status was largely replaced by achieved status basing on one’s level of education, position held in central government and rank in the army, among others. However, though the kingdoms were abolished, the Banyakore have to this day continued to identify themselves either as Bahima or Bairu. Some of the effects of the abolition of obugabe on the way of life of both groups include: intermarriages and venturing into occupations that were confined to one

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group. Furthermore, services offered by the Bairu are now paid for which is tremendous shift from the practice where they were given a “token” such as a bull. It is worth noting, however, that some Bahima have stuck to their Hima traditions and are reluctant to cede their rights and positions of honour and prestige, dilute their group with marriages from other subgroups or ethnic groups altogether. Some Banyankore have continued to conduct rites of passage much the same way like in the past. For example among the Bahima, marriage still revolves around cattle, bride wealth is still valued and assessed by the number of cattle. During a Hima okuhingira, a traditional give away ceremony of one’s daughter, among the artifacts given to the new couple are extensions of Hima traditional occupation of cattle keeping. Items given include ebyanzi (gourds) for keeping milk, ebirere (gourds) and ensimbo (cow ghee containers). On the other hand, agricultural artifacts dominate okuhingira among the Bairu. Items such as omusyo gwokugyesha (harvesting knife) and ebiteebo (baskets for harvesting millet) are given during this function.

Discussion

Findings from the research have demonstrated that the features Ghurye (1931) used to describe caste are found in this Ugandan society. Dumont (1966), Leach (1960) and other scholars may disagree, insisting that castes can only be such basing on the extent to which purity and pollution are emphasised. To insist on the purity and pollution feature as a measure for a given society to qualify as operating a caste system presents two fundamental shortcomings in understanding of social organisation. Firstly, whatever the reason, implicit or otherwise, given for the existence of purity and pollution, our attention and concern as social scientists should not be to look

for an exact replica of how given societies are organised in order to qualify to be called such, here caste, but rather look for diversities that exist in the societies being studied. This argument is premised on the fact that specific economic, political and cultural conditions give rise to a given social structure. Just as the case among the Hindu cultural settings, limitations to what an individual Munyankore from either sub-ethnic group can do is enforced by the broader Nkore values, customs and norms. The purity and pollution feature is, in my opinion, a mechanism for stratifying (and separating) society. In both societies, the requirement regulates behaviour of the people. Secondly, to insist on the feature of pollution as Dumont does is to presuppose that society is static and brings out the concept of timelessness, especially when dealing with the developing world. Societies world over, including the Hindu, have opened up and have been exposed to persons from other societies. In addition, the ethnic boundary that defines people from specific societies are not only geographical. Today, there are millions of people living in the diaspora. Some of these people have had to take on some behaviour that is in total contravention of the customs and values that regulate them while at home. While studying in Norway, for example our class comprised Indians and Nepalese Brahims and Khastriya, Chinese and Africans. We are, including Brahmins and Kshatriya ate and interacted together. In the class that followed us was a Hindu married a Muslim from Bangladesh. These Hindu students did not indulge in any acts of restoring their purity after being polluted by the would be lower caste persons. Rather than discussing what is or is not (caste in terms of form), social scientists should pre-occupy themselves with how castes in whatever form affect or impact on

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the people in societies where they operate. Wherever castes exist, pure or generic, they are a basis for social organisation and as such a basis for stratifying societies. The way they operate and evolve is thus bound to differ over space and time. The different castes therefore become status groups that are distinct from each other. Castes among the Hindu of India, just like the sub-ethnic groups in Ankole, reproduce other social relations. Different forms of social stratification are caused by specific interactional, economic[al,] political and cultural circumstances, implying that the way they (will) operate will differ from one setting to another. In debating whether castes are found elsewhere, it should be noted that rules and regulations that govern social organisation in different communities are highly situational and not fixed and the same everywhere.

this will help us understand and thereby explain the dynamics of different societies. Social scientists and other scholars interested in castes should take into consideration Haaland Gunnar’s (2003) advice when he says:

Conclusion

References

In conclusion, the paper has shown that most of the features that are used to describe castes among the Hindu cultural settings do exist among the Banyankore of southwestern Uganda. It has further shown that the features of a caste advanced by Ghurye (1931) perform similar functions among the Banyankore. Castes in India, just like the two Nkore sub-ethnic groups, give an individual a distinct identity and thereby a corresponding status. This group identity regulates individual behaviour and actions. Therefore, rather than splitting hairs over whether castes are only found among the Hindu cultural settings or not, the focus should be the social structures that develop as a result of adhering to the values, customs and norms that regulate behaviour in such societies. While some people may insist on the form the caste may appear in, I suggest that greater focus be laid on the social relations that arise as a result since

...we should avoid giving terms, here caste, a conceptual content defined with reference to structural organisation of groups within a society, but rather define it with reference to the particular ideological premises which legitimises and reproduces the kind of social structures that resemble those of the Indian sub-continent. To insist on the former is to suggest that the societies we study and live in have not changed at all despite contact with and influence from other peoples and nations.

Finally, specific social structures arise due to prevailing political, economic and socialcultural reasons at a given time and are bound to change as Dumont’s Castes have indeed changed. Barfield, T (ed) (1997). The Dictionary of Anthropology, Blackwell Publishers: London. Barth, F. (1981). “The System of Social Stratification in Swat, North Pakistan” in Features of Person and Society in Swat: Collected Essays on Pathans, Routledge and Kegan Paul Ltd: London. Barth F. Haaland, G. Grounhaug, R. (1969). Ethnic Groups and Boundaries. The Social Organisation of Culture Difference, Boston University Press. Beitelle, A. (1965). Caste, Class and Power. California, University of California Press. Berghe, P.V. (1974). “Race, Class and Ethnicity in South Africa” in Social Stratification in Africa. (Ed) Tuden, A. and Plotnicov. Berreman, G. (1968). Caste as a Structural Principle, in Anthony de Reuck and Julie Knight (Eds), Caste and Race, London: Churchill.

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Bougle C. (1971). Essays on the Caste System. Cambridge University Press. Dumont, L. 1970. Homo Hierarchicus: Chapters on Caste, Chicago: University of Chicago Press. Gelllner, L. (1995), An Introductory Essay in “Contested Hierarchies”: A Collaborative Ethnography of Caste Among the Newars of Kathmande Valley, Clarenden Press: Oxford. Gough, K.E. (1962). Essay on the Tanjore Village in Cambridge Papers in South India, Edited by Leach E.R. Cambridge University Press. Ghurye, G. S. (1931), Caste and Race in India, Routledge and Kegan Paul: London. Haaland G. (2003): How Indian is Caste, Sage Publications: London Karugire, S.R. (1971): A History of the Kingdom of Nkore in Western Uganda, Clarendon Press: Oxford.

Leach , E. R. (1960. Aspects of Caste in South India, Ceylon and North West Pakistan: An Introductory Essay to Cambridge Papers in Social Anthropology. Mubangizi, B.K. (1963): Emicwe n’Emigyenzo y’Abanyankore, Entebbe Maquet, J. (1961). The Premise of Inequality in Rwanda- A Study of Political Relations in a Central African Kingdom, London: Oxford University Press Prunier, G. (1995): The Rwanda Crisis 19591994: History of a Genocide Raheja, G. (1988): Centrality, Mutuality and Hierarchy: Shifting Aspects of Intercaste Relationships in North India, Sage, New Delhi). Stanley, H.M. (1965). “H.M Stanley’s Journey Through Ankole in 1889” in Uganda Journal, Volume 29/2/1965 pp.185-92.

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When Traditional Medicine Provides a Choice for Primary Health Care: A Study of Underserved Communities in Busia District, Uganda James Mangeni Wasike*

Abstract In most developing countries, large numbers of people die daily of preventable and curable diseases largely due to lack of simple health care. Most people (i.e. 80- 90%) rely on traditional therapy for primary health care. The present discussion outlines the roles and contributions of traditional healers in Primary Health Care (PHC). The discussion is based on a cross-sectional survey combined with in-depth interviews that was conducted in Busia district, South-Eastern Uganda. It was established that the study community utilised the services of both traditional healers and biomedical providers. Specifically, traditional healers were instrumental in providing services essential to PHC, including health education, community mobilisation for immunisation, counselling and treatment of illness problems not adequately handled by biomedicine. Therefore, the healers’ interrelated roles were desirable for their increased inclusion and participation in PHC programmes.

Introduction

In most developing countries, large numbers of people die daily of preventable and curable diseases largely due to lack of simple health care (Abayomi, 1993; Abayomi, 1996). Most people (i.e. 80- 90%) rely partly on traditional care provided by herbalists for Primary Health Care (PHC) (Bodeker, 1997; Pitt, 1990; WHO, 1997). The traditional healer to population ratio in Sub-Saharan Africa (SSA) is 1:250 people (McCorkle, et al., 1998). In Uganda, the traditional healer to population ratio is 1:150 (MoH, 2000). Indeed, it is often argued that PHC refers to the level of health services closest to communities. It includes a set of activities e.g. health education, promotion of proper nutrition, provision of safe water and sanitation, maternal and child care (including family planning, immunisation against major infectious diseases; prevention and control of endemic diseases; first aid; and provision of essential drugs (WHO, 1995:7). * Author is an Assistant Lecturer in the Department of Sociology. e-mail:[email protected]

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healers are usually the first contact with most patients because they are evenly distributed and more accessible to communities (Clark, 1998; McCorkle et al., 1998). Currently, the physician-population ratio for Uganda is as high as 1:18,700 (HSSP, 2000/01-2004/05). Besides, there are several challenges that further undermine service delivery including poor infrastructure, corruption and insufficient funds (WHO, 1997). In this context, it is impossible to improve service delivery without the increased participation of traditional healers in PHC programmes. Their inclusion in PHC, in many ways can help empower healers with knowledge and skills needed to improve their practices. Unfortunately, Uganda’s health policies and strategies continue to loosely regard traditional healers as alternative healers and their roles in PHC programmes remain unclear. Equally, little is known about how they fill in, in health care delivery at the community level.


Theoretical and conceptual framework

The current discussion is based on Kleinman’s local health care systems model. The model conceives of health care as a local cultural system with regard to its origin, structure, function, and significance (Kleinman, 1980:24-35). It is built on mutually overlapping relationships among three sectors namely the popular, professional, and folk sectors. The popular sector, also known as the lay, non-professional, or non-specialist sector is a matrix of several levels that include the individual, family, social network, community beliefs and activities. It is the largest part of any health care system that provides the popular culture arena wherein illness is first defined and health care activities initiated (Kleinman, 1980:50). In comparison, the other two sectors are centres of resort since people’s choices and actions to seek care from them are anchored in the cognitive and value orientations of popular culture. Another important dimension is that after treatment from other sectors, patients return to the popular sector to evaluate treatment received. What is even more important is that the sector influences people’s ability to determine further courses of action. In view of the above, health care can be described as a special cultural system bound by socially organised responses to disease and illness. In other words, disease and illness and the responses to them, including the social institutions, are systematically connected elements in every culture. Therefore, the sector forms a nexus of boundaries of health care which take the form of points of entry into, exist from, and interaction between the different sectors. In sum, the popular sector’s main preoccupation is health and health maintenance, rather than sickness and care (see Kleinman: 1980:51-53).

The second level of local health care systems is the professional sector, which is founded on the organised healing professions of modern scientific medicine, or biomedicine. This sector is also highly institutionalised and supported by the legal and political structures of society (see Ullrich, 1984: 201). Its organisational and highly institutional nature is what often informs the generally held assumption that the sector equates the entire health care system. This is further reinforced by the power and dominance that the sector enjoys over other sectors of health care. Indeed, it is for this reason that other sectors have in many ways been forced either disband, submit to control, or to retreat into the quasi-legal folk fringe (Kleinman, 1980:56-57; Ullrich, 1984:200211). The unequal power relations among the sectors have implications for both health care seekers and the providers (See NHP, 1999:3-4). Therefore, it is against such a background that the structure of particularly the folk sector is analysed so as to understand its role in health care in general and PHC in particular. The folk sector forms the third structural component of the local health care system. Like the popular sector, this sector is often misconceived and poorly defined. This is partly because it is a mixture of many different components (Kleinman, 1980), some of which are closely related to the professional sector, while others relate to the popular sector. As a result, the folk sector shades into the professional sector forming a largely undifferentiated matrix of the popular sector. Quite often, the sector is classified into sacred and secular parts because they relate to the use of herbs, traditional surgical and manipulative treatments, and special systems of exercise in health care (WHO, 1995:24-45).

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The PHC framework, among other issues, envisages a re-orientation of health care delivery to target the increased use of community health care resources, including folk care. The inclusion of folk care in PHC implies that its role is well understood, defined, and fully identified. It also assumes that folk care is an essential source of care to those communities served by the sector. Furthermore, this suggests that in situations of inadequate biomedical services, folk care turns out as the alternative. While there may be other important aspects of folk care, priority has been given to the analysis of issues highlighted particularly with regard to how traditional healers impact on PHC delivery at community level.

Methods and materials

A cross-sectional survey that combined household interviews with in-depth interviews was conducted in Lunyo subcounty of Busia district. The study site was selected for two important reasons. First, it is a relatively remote sub-county, located furthest from the district central town of Busia and is characterised by poor biomedical health care servcies. Second, being an indigenous researcher, I enjoyed the vantage point of capturing as well as exploring influence of socio-cultural factors on health in terms of how people define health including the socially organised responses to ill health. A total of 120 household members were randomly selected and interviewed using a structured interview schedule about their community health status. Specific reference was made to understanding the issues regarding their access and utilisation of available health care resources in their community. In addition to household interviews, in-depth interviews were conducted with different categories of purposively selected key informants. Among

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these were twelve traditional healers, members of the district health management team (DHMT) and, opinion and local community leaders. The key informants were interviewed using an interview guide. These provided information about the available health care resources in the district in general and the study community in particular. However, particular emphasis was put on understanding the specific roles of traditional healers in PHC in the district. The healers were selected using the snowball-sampling technique (see Peil et al., 1982:31-33). The technique proved effective in identifying as well as analysing the healers’ social networks both within and outside the study community. It was, however, a very challenging exercise because it was not easy to build the trust and gain the confidence of healers. However, after presenting my letters of authorisation from both Makerere University and the Directorate of Health Services (DHS) in Busia district, and after discovering that I was an indigenous researcher who shared socio-cultural aspects with them, I was able to build their trust and confidence. Thus, a healer doubling as a local leader provided the first contact and helped to identify other healers known to him guided by their health care specialities. In total, twelve healers were identified and interviewed. These willingly participated in the information gathering process by providing useful insights about their different healing roles. Of these, eight (08/12; 66.7%) were male and four (04/12; 33.3%) were females. The healers’ description by healing roles revealed that three (03/12; 25%) of 2

A traditional healer is a person who is recognised by the community in which he/she lives, as competent to provide health care using vegetable, animal and mineral substances and certain other methods based on the social, cultural and religious backgrounds as well as on the knowledge, attitudes and beliefs that are prevalent in the community regarding physical, mental and social well being and the causation of disease and disability (WHO, 1995).

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them were herbalists as well as spiritual healers. Two (16.7%) identified themselves as traditional birth attendants/midwives (TBAs) and one (8.3%) was a bone setter while another (8.3%) specialised in the treatment of snakebites. An interesting dimension about these healers is that they shared a mutual client referral system among themselves. Therefore, the involvement of the healer turned guide was used to develop highly interactive but confidential relations with the rest of the healers.

Illnesses and health resources

In order to fully understand the disease burden and responses to illness, community members were asked to identify common illnesses affecting their wellbeing. Malaria, diarhorrea, measles and AIDS, among others were identified as the illnesses that top the disease burden in the study community. To the majority of respondents (73/120; 60.8%), malaria was the commonest illness, followed by diarrhoea, (18/120;15%). Eleven respondents (11/120; 9.2%) indicated that measles was a major ill health condition and 12 (12/120; 10%) respondents reported HIV/ AIDS to be a serious health condition in their community. It was found that community members took different actions to alleviate the above illnesses. These actions were analysed in order to understand how the local community utilised available health care resources. The majority of respondents (68/120; 56.7%) bought drugs from drug shops and private clinics located within their community. Forty-eight (48/120; 40%) sought services of traditional healers (abasawo be ‘siimali/ Abakesi), and only four respondents (04/120; 3.3%) attended a health centre. This finding reveals a service gap in the health care delivery system moreso that the study community had no functional health facility within easy reach of its members.

Initial response to illness

In investigating how healers fill in in PHC, community members were asked about the initial action taken on the onset of illness. The majority of respondents, (82/120; 69.5%), mentioned self-medication, which involved buying drugs from local drug sellers and using local herbs (amanyasii) known to them. A relatively small number, (18/120; 15.2%) of respondents reported that they sought the attention of a trained health worker. A similar number of respondents, (18/120; 15.2%) reported that they used local herbs as well as sought the services of a traditional healer. The respondents, however, stated that choice of care, whether biomedical or traditional, was determined by one’s perception of the nature of health problem. Basing on the above, clarity was sought about those illnesses respondents perceived as exclusively managed using traditional medicine. This was done to establish how these compared with illnesses reported to be effectively managed using biomedicine. Contrary to the small number (18/120; 15.2%) of respondents that reported seeing a trained health worker as stated earlier, the general position established was that biomedicine provided effective care for communicable and infectious diseases including malaria, diarrhoea and cough, among others. It is, however, for illnesses, which were essentially perceived as psychosocial in nature and causation, that community members preferred traditional medicine to biomedicine owing to the community’s experience of repeated biomedical failure in treatment of such illnesses. The specific illnesses in this category consisted of Ekaka (yellow fever), Okuwereketo (skin rash and measles), Lyenyanja (red rectum), Enduhulu (skin rash), Embunda (bone cancer or joint complications), complications of pregnancy, Elalu (mental illness), Endwasii (STIs e.g.

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syphilis), Esihoho (abdominal pains due to charms), Amenno ma’sungu (false teeth), Emisebe (possession by ancestral spirits), and bone setting (okhwonga amakumba) among others. This finding further revealed the existing inadequacy in biomedical service delivery in respect of some of these health conditions. The following clearly demonstrates the community members’ preferences for traditional care: First, herbal cures were considered efficacious and cheap for management of illnesses, some of which biomedicine care was considered to be inadequate as described below: Most herbs offer effective cures and the majority of people in this community know this and therefore trust healers who provide the treatment. There is also a kind of communication network among us local community members in that once one or two people get cured of a certain illness using herbs, then word will quickly go round and spread to the rest of the community members. This is normally the case when different people share experiences about similar illnesses. [Male elderly informant, Busiime Parish]

Second, to some community members, biomedical care was perceived inadequate, less accessible and expensive. Third, community members reported that they had more faith in herbal cures because they shared knowledge about the treatment, including skills of the different traditional healing forms. For example, herbal cures, unlike biomedical cures, were administered fresh, suggesting good and efficacious potent. Fourth, community members acknowledged that traditional healers were easily accessible, affordable, and dependable. This was highlighted thus, Unlike workers in public health centres, traditional healers provide services both from their own premises and quite often at patients’ homes. Therefore, people find their services flexible, convenient and relatively cheaper especially for patients who are unable to move to health centres for any reason.[Middle class female participant, Nalwire Parish]

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Fifth, community members stated that there have been reported cases of ‘unique’ maternal and child complications that require immediate care. Given that the community lacks public health facilities that provide biomedical services, the services of especially female healers skilled in maternal and child care have proved to offer handy recourse, often saving lives of the affected persons. The maternal health needs identified included menstrual disorders, ‘tied’ wombs (literary translating for overdue pregnancy), delivery complications (labour obstruction), and removal of dead foetus or placenta. The child related traditional illnesses were identified as acute abdominal pains due to charms (Esihoho), red rectum illness (Lyenyanja), febrile convulsions (Magita) and Okwomi or Eyiima. Others are hunchback (Esigufu) and accidents like snakebites and bone fractures. Indeed, it is important to note that a number of these conditions were perceived to involve traditional causes, justifying community actions to seek care from the healers.

Healing capacities

One important focus of the study was to establish what capacities traditional healers had in order to understand their contribution to meeting community health needs. It was established that in spite of the earlier argument that biomedicine was preferred for communicable diseases, community members still regarded healers as equally important in the treatment arena of these illnesses. Thus, traditional healers were reported and established to have capacity to manage not only illnesses associated with traditional causes but also communicable infections such as malaria, measles, respiratory infections, yellow fever, STIs and diarrhoea. The other category consisting of traditional diseases comprised of mental illness (Elalu), infertility (Obukumba), impotence (Ohuffa obusacha), menstrual

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disorders, complications of pregnancy, labour obstruction, severe haemorrhage (Ohwidihirira), bone fractures and skin diseases/allergies. Other illnesses were Esihoho, Embunda, Lyenyanja, Emisebe and snakebites. It is imperative to note that the latter category of diseases seems to have no directly known etiology i.e. their connection to known biological causes is rather illusive. Therefore, a lack of clear understanding of the nature of their causation coupled with lack of a biomedical choice, lends credence to community responses aimed at sourcing care from healers. Despite community members’ claims that healers could manage infectious illnesses, what was established as clear in the healers’ mindset was that most communicable infections were beyond their capacities to manage effectively. In general, the healers argued that they had little knowledge about efficacious cures for such illnesses. Therefore, the community members’ actions to seek traditional care could be interpreted to mean inadequate biomedical care or the lack of it altogether. Otherwise, information about the healers’ capacity to provide care shows that they had competencies in handling psychosocial problems associated with traditional beliefs and causes.

Healers’ PHC roles

Although no formal attempts had been made to involve healers in the district PHC programmes, it was reported that healers provided various health care services to the communities they served. These included consultation for different health needs; counselling services and herbal treatment. Herbal treatment was notably important for the management of certain psychosocial problems such as mental illness that was not adequately handled in biomedical service sector. However, the healers’ roles were reported to be varied depending on

community health care needs, thus making it difficult to ascertain their exact contribution to meeting community members’ PHC needs. It was thus established that the DHS had not set up mechanisms for the possible evaluation of the healers’ activities and their contribution to PHC. The DHS official summed up these concerns as follows: Follow up of healers’ activities is a very big problem because there is no legal framework to that, which would provide a mechanism for their supervision by the District Health Care Management Team (DHMT). In the meantime, their activities fall under the Directorate of Community Development. But even then there is no mechanism used to evaluate their actual contribution to health service delivery in the district. [Director of Health Services,

Busia District]

The DHS argument was that healers were only occasionally engaged in PHC programmes intended to promote safe motherhood. Their specific areas of participation in PHC included health education i.e. sensitisation of communities to create awareness about different health care aspects and community mobilisation for the purpose of attending immunization programmes. Interestingly, it was noted that such attempts targeted only the involvement of traditional midwives but not other categories of healers. According to the DHS, the rationale for involving women was that some had received training in maternal care aspects and that most of them were found acceptable to the communities. Follow up discussions with the healers themselves however revealed that they individually carried out different roles that were perceived to be desirable actions in promoting PHC among communities served. Therefore, their specific roles included advising their clientele about health promotional behaviours which targeted aspects like keeping personal hygiene,

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maintaining good home sanitation, access to safe drinking water and immunisation for both mother and child. The healers observed that these practices were essential because they help to prevent communicable diseases. Specific citations presenting the healers’ own voices are described as follows: Very often community members report to me common preventable illnesses like diarrhoea, malaria and skin infections. I normally tell them to seek treatment and improve on personal hygiene in order not to infect others when they are back at home. Male elderly healer interviewed.

Similarly, a female traditional midwife added that, I give advice to expectant mothers on sex education. For example, I convince them to stop active or frequent sex in the last three to two months of pregnancy because they can contract sexually transmitted diseases from their partners or get other complications. I also tell them to bathe at least twice a day for good hygiene.

Additional clarification about healers’ roles in PHC was made by a youthful male herbalist thus, As a husband and parent, I normally appeal to breast feeding mothers who happen to be my clients to wash their hands and those of the baby with soap before breast feeding in order to prevent problems like diarrhoea in children.

In terms of scope, it was established that the healers’ activities targeted community members in general and in some cases fellow healers as some of them assumed additional roles upon receiving some basic training in PHC. Such roles included local community leadership; and as leaders, healers were involved in health information transfer to the communities. In a related manner, healers reported that they were able to offer counselling and social support during the course of their interaction with clients (patients). This function applied particularly to those patients suffering from traumatic and chronic illnesses as well as health conditions of a psycho-somatic

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nature. Other health conditions that would attract their attention included infertility, impotence and re-current miscarriages. In the healers’ opinion, these conditions caused a lot of fear and distress since they were closely associated with witchcraft and bad omens, aspects not attended to in the biomedical sector. Therefore, community members consulted with healers for possible remedies and reassurances of well being.

Conclusions

The present discussion highly enriches the health care systems model. The study shows the significant role of traditional healing in PHC. First, it is a source of handy recourse for a reasonable proportion of health needs. By managing a wide range of minor, complex, and chronic health problems, healers promoted not only the PHC needs and improved the quality of life of many poor people in the community served. Therefore, even if there was no clear indication of the healers’ capacities to cure, these are useful explanatory clues about the complementary nature of their roles in health care delivery. Also, the healers’ role as counsellors who satisfy psychological needs of the community was particularly true about people suffering from diseases for which biomedicine was percieved as inadequate or had no cure altogether. In this way the healers demonstrated greater capacity to adapt to changing health demands of the communities underserved by the biomedical sector. In addition, analysis of community preferences for source of care showed clear distinctions between illness perceived as traditional and those with known scientific causes. Illnesses like mental disorders, those with supernatural involvement (i.e. caused by the punitive action of ancestors e.g. Emisebe, and Ebyo’ngongani), including infertility, and other unique types of reproductive

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health conditions could better be handled by healers. Finally, it can be observed that healers had a broader social role because their therapy goes beyond use of herbs to regulation of social behaviour. Their particular usefulness lies in the handling of psycho-somatic illnesses that require counselling and social support. In conclusion, all these, can be described as interrelated roles aimed at the promotion of PHC in communities in a holistic manner. This reality is indeed being harnessed by the Ministry of Health as evidenced by the drafting of the Traditional and Complementary Medicine Policy that among other objectives includes promoting good and regulating traditional and complementary medical practices in Uganda.

References

Abayomi, S. (1993). Medical Plants and Traditional Medicine in Africa, Spectrum Books Ltd., Lagos, Nigeria. Abayomi, S. (1996). “Research on Medicinal Plants and Traditional Medicine in Africa”, The Journal of Alternative and Complementary Medicine, 2(3): 365372. Bodeker, C.G. (Ed), (1997). “Tropical Medicine and Traditional Methodologies: Maximizing Options for Safe and Effective Healthcare Coverage” in Tropical Doctor (27), Supplement 1, University of Oxford Press. Clarke, E. (1998). “A Prime Example of Collaboration Between Traditional Healers and Conventional Medicine” in Health Systems Trust (HST) Update Issue 37. The Press Gang, Durban. Kleinman, A. (1980). Patients and Healers in the Context of Culture: An Exploration

of the Borderland between Anthropology, Medicine, and Psychiatry, University of California Press, Berkeley. McCorkle, C.M. and Green, C. E. (1998). “Intersectoral Health Care Delivery”, Agriculture and Human Values, 15: 105114. Ministry of Health (MoH), (2000). Health Sector Strategic Plan (HSSP), 2000/012004/05, Kampala, Uganda. Ministry of Health (MoH), (1999). The National Health Policy, Kampala, Uganda. Peil, M. Mitchell, K.P. and Rimmer D. (1982). Social Science Research Methods. An African Handbook. Hodder and Stoughton, London. Pitt, D. (1990). “Potential Roles for Traditional Health Practitioners and Traditional Birth Attendants” in National AIDS Control Programmes, WHO/TRM/ GPA, Botswana. The New Vision, Wednesday, April 26, 2006. “National Policy on Traditional and Complementary Medicine (TCM) in Pipeline”. Vol: 21 No: 099 Ullich, A.C. (1984). “Traditional Healing in Third World”, Journal of Holistic Medicine. 6(2): 2000-211. Wasike Mangeni, J.B. (2001). “The Role of Traditional Healers in Primary Health Care: The Case of Busia District, Eastern Uganda”. (MA thesis). WHO (1995). Traditional Practitioners as Primary Health Care Workers: A Study of Effectiveness of Four Training Projects in Ghana, Mexico and Bangladesh, WHO, Geneva. WHO (1997). Tropical Disease Research. WHO, Geneva.

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Customs, Rituals, and Practices Associated with Pregnancy and Childbirth: Implications for Safe Motherhood in Rural Areas Gabriel Jagwe-Wadda*

Abstract This paper sheds light on the socio-cultural practices associated with pregnancy and childbirth, how they influence access to maternal and child health care services and safe motherhood in rural settings. Data was obtained from 8 focus group discussions with pregnant mothers, mothers of children aged below 6 months, mothers-in-law, and husbands. Data was also obtained from 20 in-depth interviews with trained and untrained traditional birth attendants (TBA). Findings show that childbirth is not a personal experience but involves the family, community members, and health care providers. Given the importance and significance associated with childbirth, restrictions and taboos are imposed on the mother and father in an effort to prevent complications, and reduce health hazards. During pregnancy the mother and father must avoid looking at or seeing certain things or involving themselves in certain activities that are believed to cause bad omen to the child. Cultural restrictions are also imposed on the mother’s diet and parental sexual behaviours. Customs, rituals and practices are observed during and after childbirth with the aim of easing delivery and preventing harm to the mother and the baby. While some of the practices are harmless and only based on superstitions and misconceptions, others may constrain access to antenatal and postnatal health care services. The implications for safe motherhood are therefore three fold: (a) capacity building among community health facility-based personnel to recognise and appreciate the way people construct the events of pregnancy and childbirth; (b) designing health education programs built on local conceptualisation of these events to demystify the taboos and all the associated harmful practices; and (c) improving capacity for TBAs to recognise and make timely referrals for emergency complications.

Introduction

Over the past decade, the global community has given increased attention to the * Gabriel Jagwe-Wada was a lecturer in the Department of Sociology, Faculty of Science, Makerere University, P.O. Box 7062, Kampala, Uganda. He died on 14 September, 2007. † The paper was supported in part by fieldwork data from a Research study titled “Birth Practices and Attitudes Towards Clean Delivery Kits (CDKs): A Study of Kabale and Kisoro Districts” December 2000, which was commissioned by the Commercial Markets Strategies (CMS) Project, Kampala Uganda, through support provided, US Agency for International Development (USAID), under the terms of Contract No: HRN-C-00-98-00039-00.

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importance of maternal health services in an attempt to promote safe motherhood worldwide. Most heath care delivery systems recommend that a woman attends antenatal care services at least four times during a pregnancy to monitor the progress of a pregnancy, identify complications and refer mothers for special care; ensure safe delivery and maintain safe motherhood (MOH, 2004). Despite the importance attached to safe motherhood, vast discrepancies continue to exist in attendance and access to maternal health care, tetanus vaccinations, delivery services and postnatal care services. Pregnancy and childbirth complications remain the


leading causes of death and disability among women in developing countries. Whereas women in developed countries face a 1 in 2,800 chance of dying from pregnancyrelated causes, women in developing countries face a 1 in 61 chance (Population Reference Bureau [PRB], 2005). According to The World Health Report (WHO, 2005: 61) complications of childbirth claim 529,000 maternal deaths per year – almost all of them in developing countries. Maternal mortality ratios range from 830 per 100,000 births in African countries to 24 per 100,000 births in European countries. In Uganda, Maternal Mortality Rate (MMR) stands at 880 maternal deaths per 100,000 live births (PRB, 2005). Maternal and infant morbidity and mortality rank among the biggest risks to safe motherhood. The single most important way to reduce maternal deaths is to ensure that a skilled health professional is present at every birth. It is assumed that if a pregnant woman receives assistance during labour and delivery from a medically trained person, she is more likely to receive appropriate medical care in the event of a life-threatening complication. However, there is a serious shortage of these professionals in developing countries, whether by choice or out of necessity. Whereas 99% of the births are attended to by skilled personnel in developed countries, only 57% of the births are attended to by skilled personnel in developing countries (PRB, 2005). Variations are even greater across the developing sub-regions with only Maternal deaths are deaths from pregnancy-related complications occurring throughout pregnancy, labour, childbirth and in the postpartum period (up to 42nd day after the birth), (WHO, 2005: 62). 2 These include doctors, nurses, midwives and other health workers with midwifery skills, who can diagnose and manage complications during childbirth, and assist normal deliveries (WHO/ FIGO, 1992). 1

41% in sub-Saharan Africa, 59% in Asia, and 82% in Latin America. Within sub-Saharan Africa, Eastern Africa has the lowest figure of only 34%, compared to 83% in Southern Africa. Uganda ranks among those countries with less than 40% of the births attended by skilled personnel (PRB, 2005). Uganda being one of the poorest countries in the world with a per capita income of only US$270, there is an overall shortage of medical personnel mainly due to brain drain to first world countries (World Bank, 2005). Given that over 80% of the population reside in rural areas, this shortage is more pronounced in rural areas than in urban settings. The limited accessibility to health services makes it difficult especially for women in rural areas to meet their reproductive health needs. The process of childbirth is a complex, multilayered socio-cultural event. However, it is worthy noting that conflict and accommodation between modern and traditional values or between modern and traditional practices is a continuing process. Childbirth may occur according to two different idealised models (Beninguisse & De Brouwere, 2004, Bhatia, 1981 RouhierWilloughby, 2003). In addition to the traditional practices of childbirth, there are also biomedical apparatus of scientific services (hospitals, clinic, dispensary, health centres, etc), with care from qualified health personnel (doctor, midwife, nurse etc). Pregnancy and childbirth often involves interaction with health workers whose cultural construction of pregnancy and birth differs from that of local women in a number of ways. In the traditional model, birth may be viewed as an innate, natural process that is controlled by women, particularly by the mother, female relatives and her attendant midwife. In most traditional societies childbirth is more of a social event rather than a medical one and many people view pregnancy and childbirth

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Customs, Rituals, and Practices Associated with Pregnancy and Childbirth

not as a sickness but a natural process. Contrary to the traditional perception of childbirth as a natural process, the medical procedure presumes that the woman’s body is a machine that may break down and needs to be closely monitored as a result (RouhierWilloughby, 2003). Scientific evidence and lower death rates are considered to be on the side of the modern medicine, while customs, lower costs, and convenience are frequently on the traditional side. The traditional models and practices give an explanation of how people construct the evolution of pregnancy and childbirth, which is consistent with the life representations of a given social group. The development of a pregnancy and delivery by the mother is understood in cultural terms and they involve not only the mother, but also her family, neighbours and community. The health beliefs and values attached to pregnancy and childbirth are traditionally understood by the people involved and interpreted as profoundly important social events. Like many other health related issues, pregnancy and childbirth are very much about shared experiences and should not be viewed as individual experiences (Kleiman, 1988). Though universally experienced, these events of pregnancy and childbirth are culturally constructed through beliefs, taboos, customs, and rituals which generate and create different patterns and strategies in the process. This diverse array of socio-cultural practices symbolise the shared experiences and meaning people attach to pregnancy and childbirth, and their interpretation of what is risky during pregnancy, child delivery and after childbirth and the strategies adopted in the process. In some traditional societies, the hospital may be perceived as a place where one goes for treatment when one is sick and a place to deliver when a woman “fears to give birth at home.” The dilemma is - should childbirth be

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a hospital or a home-based event? Whereas the percentage of births attended to by skilled personnel is a key indicator used to monitor progress towards reducing maternal deaths, why is it that a considerable percentage of babies born in developing countries continue to be delivered outside health facilities by unskilled attendants? Why do the traditional midwives or other older women, who are non-literate, continue to command respect in their own communities? Even where the governments have tried to replace them with young, literate, trained health personnel, why is it that the TBAs continue to practice in large numbers and their services continue to be in high demand? Shedding light on some of these socio-cultural aspects associated with childbirth will provide a basis for understanding how these factors influence access to clean delivery and safe motherhood.

Methods and Materials

The study was undertaken to facilitate a deeper understanding of the socio-cultural context within which birth takes place and the rituals associated with childbirth, with the aim of promoting basic knowledge for clean and safe delivery, and proper infant cord care and improving knowledge, attitudes, and behaviors related to clean and safe delivery in CREHP project area districts. Among other specific objectives, the study was intended to study the customs, rituals and practices associated with pregnancy and childbirth. Field data collection took place during December, 2000 and January 2001. Two districts from Community Reproductive Health Care Project (CREHP) project area in Southwestern Uganda namely Kabale and Kisoro were purposively selected for the study. The target population included pregnant women, mothers of children aged CREHP ‑ Community Reproductive Health Care Project.

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below 6 months, husbands/men (aged 20 – 50 years), mothers-in-law (aged 50–65 years), and both trained and untrained TBAs aged between 40 -70 years. A two-stage cluster random sampling technique was used to select the study sites. One urban parish and one rural parish were purposively selected from each district. Bugongi Lower parish in Bugongi peri-urban and Ikamiro parish in Muko sub-county were purposively selected to represent urban and rural areas in Kabale district respectively. Kamonyi peri-urban in North-ward and Bunagana parish in Muramba sub-county were randomly selected from Kisoro district. Bugongi and Kamonyi have been slum areas mainly occupied by low income earners engaged in various livelihood patterns including peasant faming. Given their location in the town centres respectively, the residents have easy access to health facilities. On the other hand, Ikamiro and Bunagana parishes are remote areas respectively. The residents are mainly peasant farmers and have relatively poor access to health facilities. A total of 8 Focus Group Discussions (FGDs) and 20 In-depth interviews were held. Recruitment of FGD participants was focused on pregnant mothers, mothers of children aged below 6 months, mothers-inlaw, and husbands. A total of 4 FGDs were held per district, 2 FGDs (one for male and one for female participants) were held in each parish. The participants were peasant farmers aged between 18 and 60 years. Indepth interviews were also held with 10 trained, and 10 untrained TBAs. Over 70% of the TBAs had served for over 10 years as birth attendants. Many of the TBAs started working either after getting training from their own parents/relatives or through gaining experience and courage, or after witnessing other deliveries, helping pregnant women with complications, or after helping themselves to deliver without assistance.

Data was content analysed following predetermined themes and sub-themes.

Findings Customs, Rituals and Practices in Preparation for Childbirth

Study results from both FGDs and Indepth interviews revealed that when a child is expected in the family, there are customs, rituals and practices observed during childbirth preparations. The woman has to communicate about the pregnancy to the husband, or her mother, mother-inlaw, sister/sister-in-law, female friends; seek advice and antenatal care from healthcare providers (divinatory consultations); maintain good diet and health; and prepare the essential materials and the necessary items for delivery.

Communicating about the pregnancy

Findings revealed that a woman’s realisation of her pregnancy is based on the classic “presumptive” signs such as the absence of periods; a frequent feeling of fatigue after periods cease; engorgement of the breasts; nausea, mainly in the morning; pain in the lower abdomen; and many other related signs. After realising, some women communicate within the first few weeks after conception, while others take long to talk about the pregnancy. The young woman having the first birth, may inform their husbands within a period of 2 weeks to 3 months, out of anxiety, while the old women could keep quite till birth unless the husband finds out himself about it. However, some men can tell that the wife is pregnant even before receiving information from their pregnant wives. The majority of men are alerted about the wife’s pregnancy within 1 - 3 months period, when the wife’s behavior, eating habits, and the pulse or heart beat changes, and when she stops having her menstruation

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periods. It was revealed that some men also begin having counter reactions because of the wife’s pregnancy. Some male participants reported that they can tell from changes in their own health conditions such as stomachache or feeling sleepy as soon as the wife becomes pregnant.

Seeking Antenatal care and making divinatory consultations

Study results from in-depth interviews indicate that some women seek antenatal care from TBAs as early as 1- 2 months. The expectant mother has to go for antenatal care and advice as early as possible. In areas where hospitals are not within easy reach, expectant women can only get urgent help from the TBAs who are within the community. Most women start visiting TBAs to seek help and advice when the pregnancy is about 4-7 months old. Among other reasons, expectant mothers seek help from traditional attendants because TBAs are experienced, easy to deal with, are within the community and therefore can offer urgent assistance. The TBAs indicated that in most cases, the expectant mothers visit to monitor the general conditions, positioning, and the timing of the pregnancy, or to acquire local herbs and seek advice on the necessary steps to take. According to the TBAs, “check up” is done by ‘splashing water on the pregnant woman’s belly’ (okuteera ameizi ahanda- Rukiga, or guteera amaazi kundaRufumbira). The TBAs indicated that once this is done, the fetus moves and its position can be ascertained. As delivery approaches, massage is used by the TBA to position the fetus or to loosen the placenta in preparation for delivery. However, findings suggest that there were no significant differences between the type of advice offered by the trained and untrained TBAs. This has particular implications for the impact created by the training given to the TBAs in the rural areas.

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Findings also suggest that TBAs are aware of the fact that they cannot handle all the cases. The TBAs indicated that they normally refer expectant mothers who have complications or those who are bewitched and might have problems at birth; those who are having their first birth; those who have ever had birth by a caesarian section; or the elderly women who have had more than 6 births, to go to a modern health facility. These study findings collaborate with finding from other studies by Beninguisse and De Brouwere (2004) in Cameroon, Bhatia (1981) in Bangladesh, and RouhierWilloughby, (2003) in Russia, who also found that it is common for women to seek the help of TBAs, and other community members who deliver infants according to local customs and beliefs. A pregnant woman may visit the TBA or be visited by her early in pregnancy, at which time the TBA might determine her delivery date, perform the first prenatal massage, or advise her on diet, activity levels, and sexual relations with her husband. During pregnancy, the TBA who often has a highly developed sense of touch may use massage to relax muscles, relieve discomfort, and estimate the progress of pregnancy. Beninguisse and De Brouwere (2004) also argue that divinatory consultations occupy an important place in the processes of childbearing. This is an investigation technique used by expectant mothers to probe and interrogate the invisible on the physiological state of the pregnant woman and to identify the dangers and means of combating them. It is part of the logic of purification and prevention of anomalies to which the woman may become subject during the process. Given that the pregnancy itself is considered to be a particularly vulnerable time for a woman, the expectant mother has to be protected from all evil things that might come her way as well as from all manner of natural

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phenomenon and daily occurrences that are considered to be harmful to the unborn baby.

Taboos, customs and rituals that must be observed during pregnancy

The findings indicate that there are taboos, rituals, and customs observed during pregnancy. To avoid bad omen, there are a number of dos and don’ts for the pregnant woman and her husband during pregnancy. Among other things, the father must not have extramarital sex because the wife may have problems. “The baby can change in the womb if the father had extra marital sex and that may cause problems to the unborn child” (Women FGD, Bunagana, Kisoro).

The pregnant woman must not have sex during the period when she is about to deliver because it is believed that the husband’s sexual organ might harm the unborn baby during sexual intercourse. Sexual intercourse is generally discouraged during the last few months of pregnancy with the belief that it might harm the child. This also has implications for the mother’s strength during this period. Given her weak status, it is believed that sexual intercourse may make her lose valuable energy. It is also believed that killing certain animals may bring bad omen on the unborn child. For instance, the husband and expectant mother must avoid killing or slaughtering any animal because that is a bad omen. It is also important that they avoid seeing a bull being slaughtered because the wife might produce a baby boy with big testicles. It is important for them to avoid killing a cat, a leopard, a chameleon, a frog, a caterpillar, or a mule because the expectant mother might produce a child that resembles the specie that was killed. The expectant mother is not supposed to kill a snake or else “the baby will also put its tongue

out like a snake.” She is not supposed to see a dead dog because “the unborn baby might have prolonged legs.” She should not see a dead cat or else “the baby will be born with a swollen tummy.” She is not supposed to set a trap or see a trapped mule because “she might produce a child breathing like a mule.” The husband and wife must avoid looking at certain things that might also cause bad omen. For example, although they may attend the burial, they must avoid looking at the coffin or the dead body. Indeed the expectant mother must not look into the grave. She must not go near a dead body because she might deliver a sickly child. It is also important that they avoid seeing a burning house because it is a taboo. “If the expectant mother sees a burning house the baby will be born with patches on the body” (Women FGD, Ikamiro, Kabale).

But this is not only particular to pregnant women. Generally, it is taboo for any person to see a burning house. If one happens to look at a burning house, he/she must cleanse oneself by bathing certain herbs. Further more, the expectant mother must not see someone pulling a boat or else “she risks delivering a child with a crevice in the head.” She must avoid seeing a newly born sickly baby or sitting on a chair with a crack or else “she risks producing a sickly baby.” She must not see newly born twins or else risk producing them herself. She should not see a dog that has just delivered or its puppies or else “she risks delivering a blind child.” Specifically the husband must never tie a thief or any body because “that implies tying the baby in the womb.” In addition he must also avoid seeing a person in hand cuffs or chains or cross a river, or stirring tea before the wife gives birth because that can cause bad omen. The expectant mother is not supposed to go through crossroads or go to a war zone. She must avoid urinating in public places because “that might delay

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her delivery.” The rural study participants revealed that they still practice most of the customs and rituals and most of the taboos were mentioned by the rural participants compared to their urban counterparts. This can be partly attributed to how the rural people construct the event of pregnancy and childbirth or partly due to limited exposure, sensitisation or limited basic knowledge on clean delivery. Consistent with these findings, RouhierWilloughby (2003) observes that studies conducted among indigenous Russians also indicated similar revelations. To them, an expectant mother looking at a fire might cause a birth mark on the child; a sudden fright that caused her to touch her belly would result in a spot on the child; looking at horrifying sights (people, animals or objects) could result in her child’s being deformed; knitting could cause the umbilical cord to choke the child; stepping on a crooked object could make the child a hunchback; if she walked over or stepped on a dog or cat, the child could be born with a hairy spot; and so on. However, these taboos suggest that the mother’s movement is restricted because she must avoid looking at many things to safeguard the child from ill health. They have significant implications for the mother’s access to antenatal care services because it would be hard for her to avoid seeing or looking at certain things especially if the mother has to move to seek health care services. A number of other customs and rituals must be performed by the expectant mother and the husband during pregnancy. For instance, if the husband finds people carrying a pregnant woman to a health facility on a stretcher, he must participate in the act of carrying the pregnant woman as a custom. If he does not participate in carrying other pregnant women, his unborn baby might get a strange disease. This is intended to

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encourage all males to extend help in carrying the expectant mothers especially where health units are not easily accessible, and people have to carry the pregnant women on stretchers. Other taboos are meant to stop women from being lazy when they are pregnant, or avoid dangerous encounters that might exhaust their energy when it is about time for delivery. For instance, when a pregnant mother is weaving a basket, she must complete it otherwise she might not deliver quickly. If the pregnant woman has sex when she is about to deliver, it is advisable to bathe certain herbs so that the sperms don’t affect the unborn baby. She can also drink ‘waragi’ (local potent gin) to clean the baby so that it does not come out with dirt. She must smear cream on the stomach and the private parts to soften the womb. To avoid a caesarian birth the pregnant woman must prepare a mixture (e.g. pound dry cow droppings and snail’s shell) and smear it on her body. She has to pretend that the unborn baby is given a bath by rolling a bottle on her belly. If the expectant mother is still young she has to prepare and bathe local herbs to help expand the baby passage. To avoid bad omen during the pregnancy period, the couple can perform the following rituals: if they go for a burial they must tie pieces of a banana fiber around their waists and throw something or the fibers into the grave; if they looked at a burning house, they must bath local herbs or the expectant mother must collect the ash from the burning house and eat it; if the pregnant woman looks at a dead body or looks at a dead animal, she must drink local herbs and cleanse herself; if she looks at people pulling a boat, she has to throw there a piece of grass; if the husband sees someone in hand cuffs or chains he must also drink some local herbs. These customs, rituals and practices may vary from one community to another, but all have the same goal: to ensure mother and

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child survival. However, some of the rituals though harmless, may have impending implications for access to antenatal care services even when those services may be within easy reach.

Maintaining good diet and health during pregnancy

It is common to have rules and traditions about what may and may not be eaten during pregnancy. The FGDs and in-depth interviews revealed that in addition to seeking antenatal care, the expectant mother is supposed to maintain good health by having a good diet recommended for pregnant mothers to have a healthy child. When the pregnancy has been definitely established, restrictions are imposed upon the woman’s diet. Her food intake and the kinds of food she eats are strictly controlled by her motherin law or by other elderly female relatives. She is advised to eat moderately so that the fetus does not grow too big and make the delivery difficult. She is also forbidden to eat certain kinds of meat, fish and vegetables that are considered to be taboo and may harm the fetus, produce certain deformities in the child or precipitate a miscarriage. Although most of these traditions may be harmless, much harm can be done if the expectant mother is prevented from eating what she needs during pregnancy. It is common in many African countries for pregnant women to be told that they are not supposed to eat eggs, milk, or other foods that are an excellent source of vitamins and protein (Arkutu, 1992). But prohibiting pregnant women from eating some types of foods may thus end up depriving them of some of the best food items that are so vital for the pregnancy. It was further argued that in addition to maintaining good health, the pregnant wife is supposed to reduce on the workload, and have enough rest, in preparation for child

delivery. The study participants pointed out that the male spouse or any other relative is supposed to give the expectant woman the necessary assistance, and help to reduce her workload. However, there was a general feeling that the husbands fail to fulfill their roles because of ignorance, alcoholism, negligence or carelessness, and absence from home due to their personal work outside the home and or extra-marital affairs. Although traditionally the woman is supposed to continue working during pregnancy (Bhatia, 1981), she is refrained from doing hard physical work provided she can find someone to help her. Without getting immediate help, women may continue to do all the cooking, fetch water, and attend to garden work and other domestic chores. However, too much physicallydemanding work during pregnancy can contribute to problems with the pregnancy, such as miscarriage, pre-mature labour, or underweight infants, especially if the woman is not eating enough.

Customs, Rituals and Practices during Childbirth

Findings further suggest that there are basic observations that are meant to protect the baby at birth and facilitate quick delivery. Depending on the onset of labour pains, generally, the expectant mother may continue doing her daily chores until the pains become well established. If the decision is to deliver from home, she may then alert her mother-in-law or other female relatives, who send for a local midwife or an elderly woman in the village who has experience in assisting during deliveries, or even escort her to the TBA’s place to deliver. At delivery time, while in labour the mother should not over-breathe because that will delay delivery and she will lose the energy to push the baby. She must not close the legs when the baby is coming because that

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might close the birth passage and kill the baby in the process. She has to be assisted by the attendant to deliver in the most appropriate position. The TBAs specifically pointed out that the expectant mother must not change her sleeping positions now and then, because this might affect the unborn baby and cause complications. It was thus emphasised that when delivering, she should not squat because the baby will die: “In the olden days the woman was supposed to deliver while kneeling down on the mat or banana leaves spread on the ground but these days she lies on the back to deliver.”(Trained TBA: Nyaruziza, Muramba Sub-County, Kisoro).

Traditional herbs used to ease or induce delivery

A variety of traditional herbs or rituals were also mentioned as very useful in easing child delivery. For example, to induce labour pains for quick child delivery, the expectant mother can: drink black tea or ginger to induce contractions; or drink a variety of local herbs to facilitate quick delivery. She can also be told to blow in a calabash, or some beads may be forced down her throat to make her vomit, or warm water may be pored on her belly to make the baby move and then induce labour pains. It was further revealed that certain rituals or herbs can help to overcome some of the complications that may develop before or during delivery. For instance, to soften the passage, the woman may be given a mixture of ash with water or ‘emumba’ (local herb made out of soil or clay). When she is about to deliver, she can collect and bathe ‘omuyonga’ (soot hanging from the fire place) to soften the passage. If a woman was bewitched during pregnancy, she can make a bow and throw it over the house to prevent complications during delivery. If the expectant mother has complications, the attendant can put pumpkin flowers collected from the forest

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in a calabash that has no holder, add water, and give it to the expectant mother to drink. This is believed to treat the complication and help the woman to deliver. Wondering Jew, (Intejja - Rukiga or ‘ennanda’- Luganda), or the stem of a young edible banana leaf can be used to induce the placenta to come out. However, according to some TBAs, some complications such as ‘Okuhanikira’- Rukiga or ‘Guhanikira’ – Rufumbira (a woman who has been bewitched and cannot give birth) may necessitate medical operation if the herbs applied fail to solve the problem. It is normally under such circumstances that the TBA may refer the woman to go and deliver from the health unit.

Customs and rituals that must be observed during childbirth

The findings also indicate that childbirth is accompanied by many customs and rituals that must be adhered to and performed to ensure quick delivery. If the bed curtains are raised or the expectant woman’s clothes are hanging they must be pulled down otherwise the pregnancy will be hanged. The mother should untie her hair because leaving it tied means tying her pregnancy that she may fail to get labour pains. When the woman is about to deliver, she should smell the scent in her husband’s shirt or coat. It was vehemently argued that for some women smelling the husband’s scent eases delivery. Although childbirth is almost always attended and assisted by female relatives, the husband is also supposed to observe certain customs that are believed to facilitate quick delivery. He is not supposed to hang the wife’s clothes because this may cause the pregnancy to hang. The expectant mother may fail to get labour pains and thus delay childbirth. During child labour, the husband must not have extramarital sex or commit adultery because that may cause untold complications for the mother and cause evil spirits for the

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baby. When the wife is about to deliver the husband is not supposed to go far away. The husband must stay nearby, and should not allow anybody to enter the house during delivery time because the placenta may fail to come out. When the wife gives birth, he is supposed to make a sound of joy (gutera impundu - Rufumbira, or kuteera empunduRukiga) to acknowledge the arrival of a new baby, and give thanks to God for receiving the new member in the family. All these customs and rituals may be intended to restrict the husband’s movements and encourage him to take responsibility at delivery time even if he is not directly involved in childbirth.

Customs, Rituals and Practices after Childbirth

The participants observed that immediately after delivery, it is important to ensure that the baby has no deformity and then take care of the new-born. In addition to cleaning and wrapping the new born, the sex of the new born must be determined, the umbilical cord must be tied and cut, and the placenta must be induced to come out. Overall, the female participants had fair knowledge about the relevant steps taken immediately after birth. Some participants also emphasised that immediately after childbirth, it is important to put Aspirin in the baby’s gums to prevent it from ‘ebiino’ (false teeth). One participant said that ‘ebiino’ disease attacks young children and explained that: “There are women who bewitch others using ‘ebiino.’ Once the ‘ebiino’ are removed from one child, they are dropped along the road. If a pregnant woman passes through that road, the unborn baby will suffer from ‘ebiino’ after birth. So after childbirth, the mother has to look for Asprin and put it in the baby’s gums. When the baby grows up it will not suffer from ‘ebiino’, (urban men FGD, Kisoro).

However, this is a grave misconception which was very common among rural folks in early 1980s, that has persisted in

some communities and calls for effective sensitisation. This belief has health implications for the baby because in the guise of treating the false teeth, the baby might develop other health complications that might cause dental problems. After delivery, midwives often have to help to extract the placenta and dispose it safely. Apart from cutting and dressing the umbilical cord, one of the most important duties of the midwife is ensuring proper disposal of the placenta. Disposing of the placenta assumes ritual significance in many traditional settings. For instance, the study participants reported that for women who give birth at home, the placenta must be disposed of by the mother herself or somebody she trusts because if she has enemies, once they get it she may be bewitch and she may fail to conceive or give birth again. These finding are also consistent with practices in other societies. For instance, despite the sufficient number of maternity units in some areas in Central Uganda, one reason why some traditional Baganda women may continue to deliver at home or with the help of the TBAs is to guarantee proper disposal of the placenta. Among the Baganda, after the placenta (referred to as “the second child”) has been delivered and the baby is separated, it is carefully covered at the stem of edible banana plantain. That act is referred to as okufugika among the Baganda. This custom is also consistent with a common practice among some cultures in Cameroon (Population Reports, 1980) and in Bangladesh (Bhatia 1981). According to Bhatia (1981), in Bangladesh the placenta is placed on a banana leaf and buried along with the other discharges outside the house. This act caries a lot of significance and may hinder delivery at the health units where the placenta is not considered to be properly disposed of after childbirth.

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Customs and rituals after delivery

After childbirth there are a number of other rituals that must be performed to express happiness and congratulate the mother for her achievement and welcome the new child in the family. If the birth took place in a health facility, when the new mother comes home, the father and mother must go into the house and urinate on the rear part of the bed. After that ritual, the parents then make a sound of joy to welcome the baby in the family. The husband is supposed to inform his relatives and friends about the good news. If the wife has produced twins before the husband goes into the house to see them, he is supposed to announce that “yazara babiri nkembuzi”- Rukiga (literally meaning that my wife has produced two like a goat). The father has to throw sorghum in the sitting room and then onto the twins or else the twins won’t grow well. The couple is not supposed have sex after child delivery during ‘Ikyiriri’ (in Rufumbira) or Ekyiriri (in Rukiga) period before the baby’s umbilical cord falls off. Even the actual bed on which the new mother sleeps after delivery is referred to as Ikyiriri/ikyiriri. The father is supposed to make a fireplace in the house to provide warmth. Nobody should get fire from this fireplace. The mother is supposed to lie in front and the baby is put at the back away from the fire. One participant said: “In the past, people used to make a strong fire causing a lot of smoke that could make the baby’s eyes swell. Little did they know that the swelling was caused by smoke! They thought that it was a disease that attacks babies. So they would burn the baby with a sharp metal on the forehead to protect it from illness but after the Ikiriri period the eyes would turn back to normal.” (Rural men FGD, Kisoro)

In addition, the father is not supposed to have extramarital sex or go to war after the wife has delivered. He is not supposed to undertake any long journey before the child’s umbilical cord falls off. If the husband has

41

extra marital sex before the umbilical cord dries and falls off, the child may have health problems. It is believed that the baby might develop a strange disease (amahano) if the father fails to observe these customs. To avoid this, the father must perform a ritual where “the mother sits in the middle of the room stretching her legs and the father jumps over her legs.” The same ritual is performed if the mother continues to bleed after the ekiriri period. Even the mother must not commit adultery immediately after childbirth because the baby might become lame or delay to start walking. She must not take the baby out of the house before the umbilical cord falls off. She must not go beyond the compound gate during the first 4 days after delivery because if the wind blows over the umbilical cord, the baby may feel pain. The mother is not supposed to be called by anybody to go out of the house or take the child outside before the naval cord recovers. Once the umbilical cord dries and falls off the baby, the mother must throw it out to be eaten by rats and then put millet in the doorway to prevent problems. These findings suggest that the parents’ movements immediately after delivery are restricted to take precaution to avoid behaviours that are considered harmful to the mother and child. Although some of these customs and rituals may appear to be harmless, they may have unintended implications for access to postnatal health care.

Postnatal care and treatment of child illness

Traditional birth attendants also perform medical functions after child delivery, such as providing herbs and medicines to stop heavy postpartum bleeding or to stimulate the milk supply and helping women start breastfeeding. Many TBAs take an active role in hastening the recovery of the mother using a wide range of traditional treatment such as massage, baths, and herbal medications.

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These postpartum duties bring the TBA into close and frequent contact with village women and provide many occasions to discuss questions of health, childbearing, and fertility (Population Reports, 1980). If the baby has “amahano” it is given herbs. ‘Amahano’ (‘Eyabwe’ − its equivalent among the Baganda) is a strange disease (with similar symptoms like epilepsy) that may be acquired by the baby if the parents fail to observe certain norms and customs. The herbs will make the baby grow well or the baby is taken to the herbalist or shrine to be treated as soon as possible. If the father looked at a dead dog or cat during the wife’s pregnancy, he must look for certain herbs, put them on a string and tie it around the baby’s waist. If the baby is bewitched or it is very small at birth, the husband must look for certain herbs because it is a sign of bad omen and the mother has to put beads around the baby’s waist to prevent sickness. The belief that the illness can be treated using local herbs has very significant implications for access to postnatal health care services. These practices may prevent mothers from seeking immunisation services because it is believed that the baby is bewitched or the cause of the illness is due to failure to observe the taboos during the pregnancy period.

Discussion and Conclusions

The above findings shed light on some of the customs, rituals and practices associated with pregnancy and childbirth in a rural setting. The purpose of describing these aspects as they relate to pregnancy and childbirth is not merely to broaden our knowledge on these issues but also to provide specific basis for understanding how these socio-cultural issues influence access to services that can ensure clean delivery and safe motherhood. In all traditional societies, pregnancy and childbirth are welcome events that are considered with utmost significance. This

is demonstrated by the measures based on traditional customs, rituals and practices to cope with the problems that may be encountered during pregnancy, childbirth and the postpartum period. Given that the pregnancy itself is considered to be a particularly vulnerable time for a woman, the expectant mother has to be protected from all evil things that might come her way as well as from all manner of natural phenomenon and daily occurrences that are considered to be harmful to the unborn baby. In an attempt to prevent complications and reduce health hazards, various restrictions and taboos are imposed and these must be observed and/ or avoided. Most taboos are predominantly concerned with the expectant mothers’ diet and movements during pregnancy. Although some of the practices may be harmless, some taboos and rituals may have unintentionally negative side effects and detrimental effects on access to foods that are rich in the nutrients that are vital for a pregnant mother’s health and access to antenatal services. Customs and rituals associated with pregnancy which restrict and prohibit the expectant mother to move freely have significant implications for access to antenatal care. In the guise of avoiding bad omen, the mother’s mobility is restricted and therefore she cannot go for antenatal check-up outside her community. Such taboos like: not going through cross roads, and not looking at a burning house or seeing dead animals, etc., to avoid bad omen have a lot to offer in identifying and explaining obstacles to safe motherhood. These may provide a better understanding why women in traditional societies fail to utilise antenatal services even when these are located within easy reach. Given that some of the customs are not supportive of antenatal care services, it is common for women to make consultations and seek the help of TBAs, and other

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community members who deliver infants according to local customs and beliefs. The efforts made in the delivery of maternal and child health care have had relatively limited impact, as demonstrated by the underutilisation of health units for delivery in the rural areas. Despite these efforts, maternal and child mortality and morbidity remain high especially in the rural settings. The belief that the complications during childbirth can be solved through performing rituals and using a variety of herbs to ease and quicken child delivery has grave implications for safe childbirth. Failing to recognise problems in time and advise the woman to seek medical assistance is one of the grave mistakes the TBAs normally make because they believe that such complications are caused by failure to observe the customs and taboos. The practices and belief that child illness can be treated using local herbs and by performing rituals to stop bad omen on the child have very significant implications for access to postnatal health care services by the mother, particularly to immunisation services. Given that the mother’s movements immediately after delivery are restricted to avoid child sickness, the mother may not see the need to go for postnatal care services. Therefore, any sign of sickness may be associated with bad omen or causes due to failure to observe the taboos and customs during the pregnancy period. A number of customs, rituals and practices such as treating false teeth, strange childhood diseases, and other beliefs associated with the postnatal period are based on superstitions and misconceptions about causes of child illness, and therefore call for effective community sensitisation and health education programs. It is important that the health workers understand the local conditions and how rural people construct the events

43

of pregnancy and childbirth. It is also important to recognise and appreciate the meanings attached to the rituals and customs associated with childbirth practices. Such an understanding can form a basis for designing health education programs for improving knowledge and attitudes among the rural folks, and promoting good practices towards clean delivery. In particular, it is important to focus interventions on promoting knowledge and education to increase awareness among the TBAs about the importance of ensuring clean delivery for safe motherhood. Health programs might achieve better results especially if the program priorities are well targeted and determined according to the perceived needs of the community. It would be wise to study the community’s acceptance, especially the ultimate acceptability of the TBAs, before any program for training of the local birth attendants is undertaken. The TBAs can be effectively trained to help them avoid harmful practices, conduct clean deliveries, recognise danger signs and complications early enough and to bring difficult cases to clinics or hospitals. However, they need emergency back-up support because if the trained health personnel are not there, the outcomes could be worse. This training may not decrease a woman’s risk of dying in childbirth if skilled health personnel are not available. Therefore, most significantly, there is ardent need to train and motivate more skilled health staff to work in rural settings.

References

Arkutu, A. A. (1992). Your Health, Your Pregnancy: A Guide for the African Woman, (1st Ed), Family Care International, Inc. New York. Beninguisse, G. & De Brouwere, V. (2004). “Tradition and Modernity in Cameroon: The Confrontation Between Social Demand and Biomedical Logistics of

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Health Services”, African Journal of Reproductive Health, Vol. 8 (3), pp. 152 – 175 Bhatia Shushum (1981). “Traditional Childbirth Practices: Implications for Rural MCH Program”, Studies in Family Planning, Vol. 12, (2), pp.66 – 75. CARE (1997). “Community Reproductive Health Care Project (CREHP) Baseline Survey in Southwestern Uganda”. CREHP, “Community Reproductive Health Care Project”. Kleiman, Arthur (1988). “The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books. MoH (2004). “Strategy to Improve Reproductive Health in Uganda 2005 – 2010”, Ministry of Health. Population Reports (1980). “Family Planning Programs” Traditional Midwives and Family Planning, Volume 8, (3): Series J No. 22, May 1980, J-439 – J-481. PRB (2005). Women of Our World: Taking

Stock of Women’s Progress, Data Sheet” Population Reference Bureau, Washington, D.C. Rouhier-Willoughby, J. (2003). “Birth Customs: Ancient Traditions in Modern Guise”, The Slavic and East European Journal, Vol. 47 (2), pp. 227 – 250. World Bank (2005). World Development Report 2006: Equity and Development, 2005. The World Bank: Washington, D.C. WHO (2005). “Attending to 136 Million Births, Every Year”, Ch. 4, The World Health Report (2005): Geneva WHO/FIGO International Confederation of Midwives (1992). “Definition of the Midwife” WHO (1996). “Midwifery Education: Action for Safe Motherhood: A New Approach by WHO/UNICEF”, Geneva. Wynne, L. C., Shields, C. G., and M. I. Sirkin (1992). “Illness, Family Theory, and Family Therapy: Conceptual Issues”, Journal of Family Process, (31): 3 –18.

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Guardian Needs and Capacity to Care for Aids Affected Children A Case Study of Luwero and Tororo Districts in Uganda* Robert Kabumbuli, Rebecca Nyonyintono, Gabriel Jagwe-Wadda† and Laelia Gilborn

Abstract This paper focuses on the capacity of guardians to provide for orphans and on the needs of the guardians themselves. It is based on survey data that was collected for a study to assess the impact of two intervention programmes, the Orphan Support and Succession Planning programmes, on the well-being of children affected by AIDS in two rural districts of Uganda. Guardians face considerable challenges in providing for dependent orphans. Many of them were experiencing health problems. Among the 227 guardians interviewed at baseline, 30% were in ‘somewhat’ or ‘very poor’ health. Of those who knew their HIV status, one third was HIV-positive. The demographic characteristics of many guardian households were also unfavourable. There were relatively high dependency ratios, hence the burden of providing for the household needs. A quarter of the guardians were either widowed or divorced, which has all the implications of single parenthood, and yet almost half were caring for two or more orphans, in addition to their own biological children. The study also showed that women shoulder a disproportionate burden of the responsibility to care for orphans, and those women outnumber men as active guardians with direct responsibility over the children. Guardians therefore need a lot of support to boost their capacity to care for AIDS-affected children. Most of them reported that they needed material assistance, as well as assistance with income-generating activities to improve their incomes. The guardians also reported the need for advice and training on how to talk to and counsel orphan children about difficult issues such as the loss of parents and HIV/ AIDS.

Introduction

experimental intervention programmes, The Orphan Support Programme and Succession Planning Programme, both of which were implemented by PLAN International in Luwero and Tororo districts of Uganda, were used as case studies. The Succession Planning Programme targeted HIV-positive parents, their children and the standby or future guardians of these children. It was designed to reach

This paper is based on findings of a threeyear operations research project entitled ‘A Modified Approach to Outreach for AIDSAffected Children in Uganda’ that was carried out in 1999-2002. Its overall goal was to identify effective ways to meet the needs of children affected by HIV/AIDS both before and after parental death. Two *

This study was funded by The United States Agency for International Development (USAID) through the Horizons Programme of the Population council and the Department of Sociology, Makerere University. † The three are lecturers in the Department of Sociology, Faculty of Social Science, Makerere University. Mr. Jagwe-Wadda, passed away before the printing of this journal.

The Succession Planning Programme encouraged HIV+ parents to identify future guardians of the children, and these were called ‘standby’ or ‘future’ guardians. The rationale for this is enable the future guardians to prepare for their future role and responsibilities towards these children, and for the parents to provide all the necessary information to the future guardians. 45


children while their HIV-positive parent(s) was/were still living. Its design was based on the principle of working closely with people living with AIDS so that they could make future plans for their children (JagweWadda et al., 2001; Muwa, 2001). The strategies of Succession Planning include counselling for HIV-positive parents on disclosure through memory books, support to parents to appoint future guardians, legal literacy and will writing, training in income generation, support with seed money to HIV-positive parents, assistance with school fees and school supplies for children, as well as community sensitisation. The Orphan Support Programme targeted children who had lost their parent(s). Its strategies included improved access to health care services for orphans, provision of school fees and supplies, health and sex education, vocational/agricultural training for older orphans, seed money and incomegeneration training for guardians and older orphans, training of guardians, counselling, and community sensitisation. This paper mainly focuses on the capacity of guardians to provide for children orphaned as a result of HIV, and on the needs of the guardians themselves. It describes the socioeconomic characteristics of the guardians and makes an analysis of the relationships between the personal characteristics and capacity for orphan care. This capacity is also assessed through the guardians’ own self-assessment of their ability to provide for the orphans, as well as household and socioeconomic characteristics. In some instances however, data from other respondents in the study has been used to supplement the active guardian data.

Background to the study

One of the devastating outcomes of the AIDS pandemic is the growing population of orphaned children, estimated to have reached 15.6 million by the year 2000 (UNAIDS 1999). The majority of these orphans are living in sub-Saharan Africa. By the turn of the millenium, it was estimated that at least 2.5 million Uganda children under the age of 15 had lost one or both parents to HIV/AIDS. Given the increasing number of orphans, the traditional support systems within the extended family structure are likely to get over-stretched. Therefore, the AIDSaffected children are at a heightened risk of malnutrition, poor health, poor schooling, early entry into poorly paid labour, property grabbing, depression, abuse, early marriage, and HIV/AIDS infection through sexual transmission. They are increasingly living in households headed by siblings or grandparents who have very limited capacity to cater for their well-being. Many of the programmes seeking to assist AIDS-affected children, particularly those funded by international donors, have focused mainly on material support for the orphans themselves. Yet the problems faced by AIDS-orphaned children start right from the moment their parents fall sick or have tested HIV-positive. An alternative strategy therefore should not only be to target these orphaned children but also the HIV-positive parents and the community support network before the death of the parents. This would help the parents to begin preparing for and safeguarding the children’s future wellbeing, while at the same time fortifying the guardians and larger communities that will raise them.

Study design Seed money was the money provided to families to start or improve an income generating activity.

The study was carried out in two sites in two districts of Uganda; Luwero district in

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Guardian Needs and Capacity to Care for Aids Affected Children

central Uganda and Tororo district in eastern Uganda, where the experimental intervention programmes were being implemented by Plan International. The programme in each district was implemented in one county, and each county was divided into three experimental arms. One arm hosted the Orphan Support Program, the second arm hosted the Succession Panning Program, and the third arm was used as a control which did not receive any of the services for a specified period of three years. Data was collected in three rounds; baseline in August 1999, rounds two and three in August 2000 and August 2001, respectively. Baseline data was collected just before the start of implementation of the interventions. Structured questionnaires were used at baseline to collect data from a purposive sample of 353 HIV-positive parents, 99 stand-by guardians, 495 children of people living with HIV/AIDS, 227 current guardians and 233 orphans. The whole sample was categorised into seven groups namely: (a) HIV-positive parents; (b) The children of HIV-positive parents, age 5-12; (c) The children of HIV-positive parents, age 13-17; (d) The standby guardians for the parents’ children; (e) Current (active) guardians of orphaned children; (f ) Orphan children under guardian care, age 5-12; (g) Orphan children under guardian care, age 13-17; These young children could not be interviewed directly, so the parent or guardian was the one interviewed about them. A standby guardian is defined as anyone identified by an HIV-positive parent as being the most likely person to care for his/her children in future. In most cases these are close relatives.

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Study Findings

Socio-economic Characteristics of Guardians Ethnically, the guardians were predominantly from the Ganda, Atesot and Japadhola tribes. In terms of religion, most of them were Protestants or Catholics, but there were also smaller proportions of Muslims and Seventh Day Adventists. There were more female guardians (60%), than the male ones. The age range of the guardians was between 20 and 88 years. More than half (63%) of the guardians were married, 9% were separated/divorced, while 25% were widowed. The rest were single. Figures 1 and 2 below show the distribution of guardians by sex and by marital status respectively. Fig. 1: Distribution of Guardians by Sex (n=227) 59

60 50

41

40 % 30 20 10 0

Male

Female

Fig.3: Marital Status of Guardians by Gender 80

75

70 60 50

54

46

% 40 30

25

20 10 0

Married Male

Single Female

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The main source of income for the majority (90%) of the guardians was subsistence farming, and most of them have very small pieces of land. Although 96% of the respondents claim to have access to land, over 70% of them have access to less than five acres. Other sources of income reported included brewing, artisanship, trade, as well as casual and regular employment.

Gender and Orphan Care

Most of the active guardians involved in the study were women, and constituted almost 60% of the guardian sample. This indicates that women bear the bigger share of orphan care and responsibility. Connolly (2001) has made similar observations about the role of women and girls in relation to caring for people with AIDS and orphans. Whereas the typical African rural household tends to perpetuate this pattern of gender responsibility in any case, the inequitable allocation of household chores and responsibilities to women has particular significance in the case of care for orphans. When we take stock of the woman’s economic and social role and status in an African rural family setting, it becomes evident that the woman is still underprivileged. She has very little control over household resources and decision-making, despite the enormous responsibilities that she shoulders within the household socio-economic milieu. Lack of control over resources effectively means that a woman is not in a good position to plan, and this is a big handicap. Connolly (2001) too has noted that while it is recognised that men must carry greater responsibility in providing care, it is not something that is often put into practice. The underprivileged status of a woman therefore is a considerable constraint to her capacity as a guardian to care for orphans and other vulnerable children. Other authors such as Nalugoda (1997) and Nyambeda et al (2001) have shown that the

Single Parent Households

It was found that 36.3% of the guardians in the study were living as single parents, having been either divorced, widowed or never married. In a society that is already poverty stricken and lacking in formal social welfare systems, single parenthood poses a serious threat to the material, social and psychological well-being of the household members. A single parent is much more likely to be less able to satisfy one’s own and family needs, and much less so for dependent children such as orphans. Living as a single person, with the responsibility of providing for others, exerts a lot of demands that are normally shared jointly between two spouses. This is mainly because men and women have different but complementary capabilities in the home. Therefore, any single parent is likely to miss the advantages of such combined capabilities. A cross-tabulation of guardian sex with marital status revealed that female guardians have a higher tendency than the male ones to be single as shown in Figure 3. It is possible that social and specifically gender factors do give rise to the prevalence of this tendency. For example, women are for various reasons less likely than men to remarry after becoming widowed or after divorcing a spouse. In addition, the decision to marry or remarry is quite often outside the control of the individual woman. This multiplicity of disadvantages that women experience because of the social-cultural construction of their role and status in society inevitably weakens the female capacity to take care of orphans. This situation prevails despite the fact that women seem to carry the bigger burden of the responsibility to care for orphans and other children.

woman’s underprivileged status and limited economic capacity have been a great constraint on their ability to care for children.

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Guardian Needs and Capacity to Care for Aids Affected Children Fig.3: Marital Status of Guardians by Gender 80

75

70 60 50

54

46

% 40 30

25

20 10 0

Married Male

Single Female

Guardian Preparedness and Worries about Orphan-care

Interaction with the active guardians (as well as the standby guardians) revealed that they were psychologically prepared to take care of orphans when they learnt that they were expected to do so. For the majority (74%) of the guardians, it was understood before the actual death of the parent that they would take care of the children when they became orphaned. A slightly smaller percentage (53%) of guardians made an actual promise to the parent that they would look after the children when it became necessary. However, when asked if they felt that it was their responsibility to look after the children, practically all of them (96%) said yes. The psychological readinesses to take care of the children notwithstanding, a number of guardians were ill-prepared for the task in other ways. The economic/material demands which the orphan care imposes on the guardians were the leading cause of ill-preparedness for the guardians to look after orphans. For example, 26% of the 227 guardians in the study had to make specific preparations after learning of the impending responsibility. Of these, 56% made preparations such as expanding/starting an income-generating activity, and others built,

49

expanded or improved the house. Table 1 summarises some of the essential features of guardian preparedness at the time when they learnt of this responsibility. Table 1: Guardian Preparedness to Care for Orphans Nature of preparedness Agreed with parent to care for children Psychologically/mentally prepared Made specific preparations Built/extended house Started/expanded income generating

(n)

Yes

227

74%

227

96%

227 60

26% 36%

60

56%

In addition, the majority of guardians also expressed various worries about their responsibilities towards the orphans. These worries were mainly of an economic nature and included money to send the children to school, money to feed and clothe them, and other financial concerns. Despite these worries, however, 69% of the guardians said they are able to feed the children with enough food, and 61% said they are able to send the children to school consistently (see Table 2). Given the background and economic context of the guardians, however, it comes as no surprise that when asked what form of assistance they would like as guardians, most of them expressed the need for various forms of material assistance. Table 2: Current Guardian Capacity for Orphan Care Capacity

Percentage

Able to send child to school consistently

61%

Able to feed the child enough

69%

Other worries were related specifically to the fact that the children’s parent(s) had AIDS. They worried about caring for a child who may be sickly, as well as the fear that the

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child may infect the guardian him/herself or other members of the family. They also worried about how to handle the stigma and discrimination attached to the children of AIDS-infected parents. Amidst the struggle to provide basic needs for the children, therefore, it may be very difficult for the guardians to meet higher order needs such as the psychosocial ones. Indeed, many of the guardians expressed the need to be trained in the communication skills that are essential for communicating with and counselling young children about difficult issues. These skills are increasingly becoming important with the acceleration of the orphanhood and vulnerability problem. Guardians, and the whole society in general, need to be equipped with these skills in order to be able to deal with the problem.

Guardians’ Health

The guardians’ own health played an important role in their capacity to care for the AIDS-affected children. For the AIDS orphans who have had to endure an extended period of agony as a result of witnessing the long physical and psychological suffering of their parents, which culminates into their very orphanhood, the guardian’s health status carries special significance. It was a matter of concern therefore to find that 30% of the guardians assessed their own health to be poor. This of course gives rise to questions regarding the impact of poor health on the guardian’s capacity to care for their own and orphan children, since this capacity is inevitably influenced by physical ability to be productive. An important aspect of guardian health was that among the guardians who were aware of their HIV status, 33% were HIV-positive. It is commendable that these guardians had taken the initiative to establish their

sero-status. On the other hand, however, the percentage of guardians who are HIVpositive raises very serious implications for the children under their care. The question is, what is these guardians’ present and future ability to care for their own and other children? The future of those children who are already orphaned is even more uncertain. Does it not, for instance, become increasingly difficult for orphans to be passed to subsequent guardians, to whom they may be distantly related or even unrelated to at all? To what extent can the social security networks established through the extended family be stretched to accommodate the problem? And as Bjorklund (2001) asks, “What happens when this extended family system is not functioning any more?”

Orphan Well-being: A Comparison with other Affected Children

The study established that orphan children under guardian care have comparable levels of well-being with children under the care of their own parents, albeit parents who are living with AIDS. This paper acknowledges that the children under parental care in the study are not an effective control for comparison purposes because they are themselves already affected by AIDS, but would still like to point to the fact that children living under very different circumstances appear to have comparable well-being levels. In this study, some of the indicators used to measure well-being included attendance at school, possession of ordinary household and school requirements, feeding, etc. However, other studies such as Schonteich (2001) and This relatively high level of awareness is in part a credit to the local and national HIV/AIDS awareness programmes and campaigns. This author notes that orphans are often at greater risk of being stunted than children who have parents to look after them. That they are often the first to be denied an education when extended families cannot afford to educate all the children of

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Halldorsdottir (2001) have demonstrated different scenarios on this point, and showed that large differences exist in wellbeing between orphans and non-orphans. Muwa (2001) has also indicated that children orphaned due to AIDS sometimes face discrimination, stigmatisation and sometimes denied education because their sero-status is unclear to the guardians and the schools. Whereas the comparative well-being may imply that guardians are performing as well as parents in looking after children, other factors must be taken into account when interpreting this. As shown above, other studies have pointed to marked differences in well-being between orphans and children under parental care. One must therefore take into account the real life situations in many African families where foster or dependent children are located. This African reality often points to cases of discrimination, outright mistreatment or exploitation of foster children. At the same time, this unequal treatment is often a closely guarded secret, so guarded that even the affected children themselves would not dare to disclose it to ‘outsiders’. This is an area in which further research could be done. Another dimension relates to the role of children in the home. Children in an African rural household are often looked upon as a source of labour, so it may be reasonable to think that foster children are not just a liability to the guardian household, but an asset in many ways and contribute significantly to the household economy (depending on age of course). The study shows that the younger (5-12 yrs) and older (13-17 yrs) orphans are engaged in undertaking household chores the household, and especially the female orphans. This author notes that some research has shown differences in the treatment of orphans depending on who takes care of them. He reports that aunts and uncles, when they become guardians, are very prone to discriminating against orphans.

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such as farm work, domestic work, caring for the sick and looking after younger children of the household. This is in addition to getting engaged in wage employment and contributing to their own as well as household needs. Although such chores are often considered ordinary childwork, they sometimes slip into real child labour.

Dependency and the Extended Family Structure

The phenomenon of dependency, though a common one in many African households, is increasingly becoming a major concern in the household economy. The study established that close to 50% of all the adult respondents (i.e the parents as well as the future and active guardians) had at least one foster child in the family. For the active guardians, this was in addition to the orphan child that was enrolled in the study. Dependency in this context basically refers to having to rely on somebody else to meet one’s needs. However, the increasing number of orphans, accelerated by the AIDS pandemic, has inevitably tended to increase the dependency ratios in many communities. This is a phenomenon that is bound not only to constrain the breadwinner at the individual and family levels, but also to inflict substantial damage on economic growth. Yet, in a country where no formal welfare systems meant to take care of vulnerable and destitute people exist, the ability of individuals to fill this vacuum through personal productive efforts becomes very important. One may argue therefore that the high dependency ratios themselves do undermine the very socio-economic framework that is meant to support dependants. Nevertheless, the accelerated dependency must be looked at from a functionalist perspective, especially within the context of the African extended family system. Dependency is a direct outcome of the

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informal social security strategies which the extended family system and social networks provide to would-be destitutes. And yet, despite the extended family system, or because of it, as some people may prefer to argue, it was found that often orphan siblings cannot be fostered together in one guardian household. It was found that in only 34% of the cases was there an understanding between the parent(s) and guardian about keeping the siblings together. In other cases, this decision was reported to have been left to the guardian and other relatives, or to the children themselves. However, even for those guardians who had reached an understanding about keeping the siblings together, it was often not possible to do so, for a variety of reasons. Other authors such as Cheek (2001) and Sayson (2001) have reiterated that such social phenomena as the increasing urbanisation have already weakened the traditional family and village ties, and that the onset of the HIV/AIDS crisis has stressed these ties even further. It is therefore arguable that even if keeping all siblings together would be the ideal scenario in order to ensure their family unity and psycho-social well-being, it is obviously a big strain on the host family.

Conclusions

This study has shown that orphans due to AIDS who are under the care of guardians are at the best of times in need of some provident hand to assist them in meeting their material and psycho-social needs. The data shows that whereas guardians are often mentally ready to foster such children, they are also often unable to cater for their needs. Because of the African extended family system, it has thus far been possible to find close or distant relatives that can and are willing to foster orphans. But the increase in the rate of orphanhood as a result of AIDS is fast overstretching this social safety mechanism, and

many households can no longer cope with the extra load of dependants. The situation is made worse by the fact that AIDS often claims the more youthful and productive members of the society, and the burden of responsibility for the orphans often falls on the elderly or the very young. The capacity of guardians to take care of orphan children is therefore determined and constrained by many factors. The conditions of poverty under which most African rural households operate make it difficult for most households to offer a decent livelihood for their members. In addition, other factors such as the social construction of the gender roles and status, which puts a disproportionate burden of child-care onto the woman without giving her adequate power, have constrained the capacity for orphan care.

References

Bjorklund Leif (2001): Children as well as Land are Gifts from God - Zimbabwe’s Orphans are Nobody’s Babies, Paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Cheek Randy (2001): A Generation at Risk - Security Implications of the HIV/ AIDS Crisis in Southern Africa, Paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Connolly Mark (2001): Principles to Guide Programming for Orphans and Other Children Affected by AIDS, Paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Halldorsdottir Erla (2001). “Children and HIV/AIDS in Uganda”, paper presented

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at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Jagwe-Wadda G., Nyonyintono R., Gilborn L. and R. Kabumbuli (2001). “A Modified Approach to Outreach for AIDS-Affected Children in Uganda: Examining the Responsiveness of two Experimental Interventions to Community Needs in Luwero and Tororo Districts”, Paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Kamali A. et al (1996). “The Orphan Problem: experience of a Sub-Saharan African Rural Population in the AIDS Epidemic”; AIDS Care, Routledge, London. Muwa Beatrice (2001). “Current Challenges and Opportunities in Helping Children Affected by HIV/AIDS”, paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims

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or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Nyambedha, Erick Otieno, Simiyu Wandiba and Jens Aagaard-Hansen (2001). “Policy Implications of the Inadequate Support Systems for Orphans in Western Kenya”, Institute of African Studies, Nairobi Sayson, Rossette M.M. (2001). “Breaking Barriers and Building Bridges - The Impact of HIV/AIDS on Uganda’s Children”, paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. Schonteich Martin (2001). “A Generation at Risk:AIDS Orphans, Vulnerable Children and Human Security in Africa”, paper presented at Conference on Orphans and Vulnerable Children in Africa: Victims or Vestiges of Hope, Sept. 13-16th 2001, Uppsala, Sweden. UNAIDS (1999): “Children and HIV/ AIDS” UNAIDS Briefing Paper UNAIDS, Geneva.

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Decentralisation of Malaria Control in Uganda: An Assessment of Human Resource Management Capacity in Uganda A Case Study of Tororo and Bugiri District Dauda Waiswa Batega*

Abstract Malaria is one of the leading causes of morbidity and mortality in Uganda. Malaria control services are now the responsibility of local governments under the decentralization arrangement. Using a qualitative study design, this researcher assessed the human resource management capacities and policy options for the design and implementation of decentralised malaria control in Tororo and Bugiri districts. In both districts, emphasis in malaria control was put on case management through the public and private sector. Preventive malaria control activities were concentrated around urban areas. It was established that in both districts preventive services coverage was very low. The human resource staffing level and profile were inadequate and unevenly distributed, thus, affecting the capacity to plan and implement malaria control adequately in some areas. Support supervision and capacity building were mainly targeted at the public sector, though both districts recognised the significance of the private sector in malaria control. There was no clear planned collaboration between the public and the private for profit health sector involved in malaria control. Based on the evidence gathered, the study recommends that malaria control activities be put under the private sector, while the districts retain roles of promotion and advocacy and facilitate the use of these services. The study also recommends redistribution of health providers and the training of nursing aides to reduce on the mismatch between planned malaria control services and staffing profile. Health staff working in hard to reach or remote areas of the districts should be accorded special privileges to encourage them to remain in service. Capacity building and support supervision should include the private for profit health sector and community resource persons like traditional birth attendants.

Introduction

outpatients morbidity, 20 per cent admissions to all health units and 15 per cent of all inpatient deaths in 1992. Between 19941995 an average 26-30 per cent of morbidity of all patients was attributed to malaria (see MoH, National Malaria Control Policy, 1998; Ministry of Health Planning Annual Unit Reports, 1993-1996). Such levels of morbidity and mortality have a general negative impact on the nation’s productive force and resources. It is estimated that malaria reduces the Gross Domestic Product (GDP) by 1.3 per cent per annum and

Malaria is one of the leading causes of morbidity and mortality in Uganda, with a major negative impact on the national development process. According to the Ministry of Health (MoH), malaria accounted for 25 per cent of the total ∗

The author is currently member of staff and PhD fellow in the Department of Sociology, Makerere University. This study was financed by The Alliance for Health Policy and Systems Research Alliance of the World Health Organisation (WHO) Small Grants Program – Geneva, Switzerland, 2003. The author can be reached at [email protected]. 54

Decentralisation of Malaria Control in Uganda

accounts for 23 per cent of total discounted life years lost. The household expenditure on malaria for the whole country is estimated at a conservative US $ 90-300 million annually (see National Malaria Control Policy, 1998). The average direct cost of treatment of suspected uncomplicated malaria episode ranges between Uganda shillings 2,000/= to 5,000/= (see Okello, 2001; Twebaze, 1998). In Uganda, very few people are reported to be using malaria preventive methods, with the numbers getting much lower in the rural areas. This is mainly due to the high cost of mosquito nets, ignorance and wrong perceptions about the causes of malaria, unavailability of preventive utilities in some areas, and lack of organised and institutionalised community participation to control malaria (see Isabirye and Wendo, 1998; State, 1992; Makanga, 1997; 1998; Kallisa, 1997). In order to increase accessibility to and utilisation of malaria control services, attention has therefore been put on decentralisation of malaria control services. Before 1992, the health delivery system was highly centralised with little participation by local communities. The districts and sub-counties served only as delivery points. Currently, malaria control plans and activities are in tandem with and guided by other national developments like the Local Government Act (LGA), 1997 and the 1995 National Constitution, which devolved responsibilities for the delivery of social services to local governments. Every local government now has a health system running under the District Directorate of Heath Services (DDHS); health sectoral committees; and the local health sundry suppliers. Local governments are supposed to initiate, plan and implement malaria control activities in line with the NMCP. In this context, local governments are supposed to play an increased role in malaria control.

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Health delivery system

The design and delivery of primary health care including malaria control, as we have already seen, are now the responsibility of local governments. However, the process of decentralising malaria control activities through local governments and the local community is relatively new in Uganda and is still undergoing transformations. The integration of local governments and local councils into malaria control and prevention programmes as planners, monitors, resource and community mobilisers and policy makers at the local level poses a number of challenges. Some of these challenges are general in nature and include lack of adequate management capacity for realistic planning and integration of NMCP (Kalisa, 1997), inadequate resources for the implementation of planned programmes and lack of cordial relations between civil servants and local leaders (Makerere University, Study on Decentralisation, 2000), lack of leadership skills for planning and mobilising resources, corruption and poor accounting practices (Kostanjesk, 1997; Kullenberg and Porter, 1998; Batega, 2001). These challenges have been described in a more general way without highlighting the impact on particular subsectors like malaria control. Also, the evidence of local government’s human resources management capacity (existing and potential) for decentralised malaria control needed to be documented. This is because the decentralisation of malaria control greatly depends on the management capacity of local health managers and policy makers to interpret and take on new roles. According to NMCP, the private sector and civil society are supposed to play a According to the LGA, 1997, local councils are elected at village, parish, sub-county, and district levels. At the district and sub-county levels the local councils form local governments from which a number of functional sectoral committees, such as health committees, are formed.

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collaborative role with local governments in malaria control and prevention. The dynamics of the private-public sector mix for malaria control and its implications for human resources management capacity at the local government level are also not clearly known. There is need for a systematic evidence based inquiry that enhances our understanding of the implementation of malaria control through local governments. This study, specifically particularly focused on the current management capacities of local governments to effectively plan and implement decentralised malaria control activities as defined in the NMCP and the HBMF/M strategy. Objectives of the study were to: (i) describe the current malaria control programme activities at the district level; (ii) assess the management capacity of local governments to implement decentralised malaria control programme; (iii) identify management capacity requirements for planned malaria control programs at the local government level; and (iv) explore alternative strategies to enhance management capacity for the design and implementation of malaria control at local government level.

Conceptual and theoretical framework

Decentralisation, can in theory, take place in several forms: deconcentration, delegation, devolution, and privatisation. In the typology of Silverman (1992), deconcentration, which is the most common form, involves assigning of functions to lower level units of central ministries. In contrast, delegation involves assigning responsibility for implementation of services to semi-autonomous bodies that may be indirectly controlled by central government. Devolution, which

closely approximates to the Uganda case, involves the creation of autonomous local governments and the transfer of authority and responsibility to plan, manage and deliver a defined number of social services on a sustainable basis. The theoretical basis for decentralisation is diverse but related to anticipated outcome propositions. The case of Uganda, at the moment appears to combine popularcum political ideology and some aspects of genuine empowerment. There are a number of arguments for decentralisation and local government as the level at which basic social services should be planned and delivered. First, local governments are more likely to know the patterns of local demand and are able to equate the health (plan) demands to social services delivery (see Musgrave, 1993; Amonoo, Ebrahim, Lovel & Ranken, 1994). For the health sector, Hutchinson (2000), observes that decentralisation improves management efficiency and effectiveness by lessening the burden of planning and management requirements at the central level, reduces role duplication and expands managerial capacity by providing local administrators with more “meaningful” responsibilities. Other authors like Collins In the context of this study and according to the Local Government Act, 1997, decentralisation was conceived at a two-tier system between the state as the central government and the district as the local government. The local government is responsible for the planning of social services delivery, implementation of national and local plans, human resources recruitment and supervision, co-ordination, monitoring and evaluation. The central government retained functions of macro level planning and policy development, legislation, funding and resources allocations, capacity building, co-ordination, and monitoring and evaluation.. In some contexts, decentralisation may be ideologically motivated with the overall aim of getting the communities closer to the ruling interests and beliefs. In other contexts, decentralisation may be more of a managerial technique of enhancing delivery of services within a country (see Mills, 1990; Amonoo et’al, 1994).

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and Green (1994), contend that management efficiency and effectiveness may not be realised due to lack of human resources management capacity at the local level. Decentralisation, if not carried out properly, can produce negative effects, it was originally meant to overcome. For example, the interests of low income groups being ignored, over-centralisation at the decentralised level (district), insufficient political support from the central level, inappropriate design and policy guidelines and failure to transfer sufficient resources to match devolved responsibilities (see Hutchinson, 2000, Collins & Green, 1994). This study, (Makumbi, 1994; Collins & Green, 1994; Mills, 1990), has elaborated that whereas shortage of managerial capacity can be a reason for decentralisation, it can also be its downfall. Decentralisation without the adequate strengthening of local government management capacity can limit the effectiveness of planning for and delivering of services at the local level. The strengthening of management capacity including personnel of local governments as well as civil society organisations to be able to carry out new functions and responsibilities in a more collaborated way is key (see: Rondinelli, Nellis & Shabir, 1983). This study further argues that the expected outcomes of decentralised malaria control services delivery depends a lot on the management capacity of local governments to implement planned malaria control programmes, among other prerequisite factors like: re-organisation of central government ministries to take on new roles, sustained political commitment at all levels, process consultation during the reform, legal and constitutional framework to support the reform process, clear policies and lines of responsibilities and an appropriate funding mechanisms between the central and local government levels (see Muzaale & Birungi,

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1997; Collins & Green, 1994; Hutchinson, 2000; Makumbi, 1994; Mills, 1990). The aspect of management capacity that was examined in this study was the human resources management capacity for the implementation of planned malaria control programmes at the local government level. Human resources management capacity was conceptually derived to imply the necessary human resource staffing profiles, distribution, skills, abilities and other related resource requirements that can enable the local governments to plan, implement, monitor and evaluate decentralised malaria control activities. The related variables to the concept of human resources management capacity are, planning, staffing profiles and distribution, case management and filling returns, coordination, support supervision, collaboration, monitoring and capacity building.

Methods and materials

The study was carried out in Bugiri and Tororo districts in eastern Uganda. This study adopted a qualitative design and was carried out in three phases between April 2002 and March 2003. The first phase involved the review of relevant literature at identified resource centers around Kampala. The second phase dealt with literature review at the district level. The third phase involved key informant interviews and Focus Group Discussions (FGDs) and participatory The sites for documentary review were resource centers around Kampala and at district level including: Makerere University libraries, central government ministry resource centers, non-governmental organisations (NGOs) resources centers, donor agencies (World Health Organisation, World Bank). The review included: Evaluation reports, academic dissertations, working policy documents on decentralised malaria control and country specific reports, district working plans, district development plans and quarterly reports and models on effective human resources management for decentralised services.

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review workshops at the central and local government levels. All respondents were purposively selected. The study was carried out among policy makers and technocrats at three levels: At the central government level the study was carried out among programme managers at the Malaria Control Unit (MCU)-MoH. At the district level, the study was carried among policy makers, health managers and providers; including members of planning committee (district and subcounty executive committees), the district health committee, the sub-county health committee and members of the District Health Team (DHT). At the village level the Parish Development Committee (PDCs) members and local council executives were among the respondents.

Findings Staffing profile According to the norms of establishment at the time of the study, Tororo District was understaffed with critical staff such as; 9 medical doctors out of the approved 11 (19% less); 21 nursing officers out of the approved 29 (27.5% less); 58 enrolled nurses out of the approved 90 (36% less); 3 anesthetic officers out of the approved 7 (57% less); 3 dispensers out of the approved 7 (57% less); 8 laboratory assistants out of the approved 18 (56% less). The district was over staffed with 102 nursing aides out of the approved 66 (45% more). The Bugiri District Development Plan 2002/2005 indicated that the district needed more 9 (medical) clinical officers, 25 enrolled nurses, 11 laboratory assistants, and 37 clinical officers. This is the reason some Health Center IIs in both districts were manned by nursing aides. Consequently, the capacities of such providers to initiate and make plans for malaria control and delivery of other health services were seriously constrained. All districts visited

did not have locally generated resources for capacity building. Existing capacity building programmes at the time of the study were all donor supported. Where attempts have been made to employ new staff, some of the recruits do not turn up for reasons such as; poor pay, lack of accommodation at health facilities and lack of special amenities to attract and retain health workers at peripheral health units.

Case management

This is the major malaria control activity in both districts. The treatment of malaria patients is done at public (free of charge) and private health facilities. Case management is provided in all sub-counties in Tororo District. In Bugiri District, public health facilities providing malaria case management was spread in most sub-counties apart from Budhaya, Bulidha and Mutumba. Such a situation has a negative impact on timely management of malaria cases and referral system within the districts. All key informants reported an adequate supply of the three line anti-malarial drugs recommended by the NMCP at all public health facilities. It was reported that several of the private for-profit health facilities do not provide feedback information to the HSDs and DDHS on malaria cases handled. This was due to a number of reasons. Some of the private for-profit facilities are not registered, some were licensed as drug shops yet offer treatment services as well and yet others employ under qualified staff contrary to the law while others were far from the nearest supervising centers. There is also lack of proper framework through which reporting Goodman et ‘al note that cost effective studies in low income countries indicate that improvement of case management is the most effective intervention costing USD 1-8, compared to the provision of ITNs(USD 19-35),two rounds per year residual spraying(USD 32-54) and chemophylaxis for children (USD 3-12) assuming the health system already exist.

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back to the district health managers and leadership can be done. Both districts were providing free anti-malarial drugs through a number of selected NGO health facilities. In return, these NGO facilities were supposed to provide regular feedback through the HIMS and accountability about antimalarial stocks dispensed.

Promotion of use and sale of mosquito bed nets

Both districts were promoting the use of insecticide treated bed nets (ITNS) through subsidised sales. In Bugiri District, the promotion of use, and sale of ITNs was concentrated in Bukooli North HSD mainly because of the urban influence of Bugiri Town Council. In Tororo District, the promotion and sale of ITNs was spread across the whole district but with more client response from Tororo municipality. This is mainly due to poverty, and ignorance about the need for ITNs among the rural folk. In Bugiri District the promotion and sale of subsidised ITNs was also done through the district hospital. There was no laid out strategy by the district to have the promotion of ITNs through the radio as medium of campaign. Radio is a preferred method because its coverage is wide, cheap, This finding agrees with earlier studies which show that in Uganda, few people are reported to be using malaria preventive methods, with lower numbers reported in rural areas. This is mainly due to high cost of mosquito nets, ignorance and wrong perceptions about the causes of malaria, unavailability of preventive utilities in some areas. (see Isabirye and Wendo, 1998; State, 1992; Makanga, 1997). This observation is collaborated by findings from the Uganda Demographic and Health Survey 2000/2001, in which it is observed that although the use of ITNs is a proven way of preventing malaria, only 13% of the households in Uganda have mosquito nets. Furthermore, only 7% of children under 5 and 7% of pregnant women aged 15–49 slept under a mosquito net (see Uganda Demographic and Health Survey, 2000/2001).

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requires less manpower and the massages can easily be understood if broadcast through the local languages. Programme performance indicators in Bugiri and Tororo districts show that ITNs were being sold at a subsidised average fee of 8,000/= Ug shs. each. However, key informants observed that the price was still high for majority of the community members. In both districts, the private sector was also involved in sale of mostly ordinary bed nets (OBNs). The private sector was, for obvious economic reasons, mainly concentrated in urban areas. The prices of OBNs ranged between Ug sh 5,000 to 10,000 in both districts. At the time of the study both districts did not have any clear collaborative strategy with the private for profit sector in the promotion and sale of OBNs. Both districts also lacked adequate capacity in terms of skills and resources to undertake social marketing of ITNs and OBNs on behalf of the private sector.

Indoors residual spraying

Both districts were piloting residual spraying using Icon powder through the Office of the District Vector Control (DVCO). In Tororo District, only five households had been sprayed in Tororo Municipality while in Bugiri District, only 30 houses were dusted mainly around the town council in the financial year 2000-2001. This was largely due to the high costs involved (average cost per house sprayed was Ug shs 10,000/= to 20,000/=. Closely related to this factor was the issue of human resource where only one officer; in the DVCO was carrying out the residual spraying activity in each district. There was also lack of community awareness about the benefits of indoor residual spray in both districts.

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Presumptive intermittent treatment of malaria in pregnancy

Intermittent presumptive treatment of malaria in pregnancy (IPT) was being offered at all public health facilities with antenatal care. Also IPT was on offer by NGO health facilities (with antenatal care) which had a collaborative framework with the districts.

Improving environmental sanitation

In Bugiri District, the DDHS had in conjunction with Bugiri Town Council planned to clean up the surface drainage system, get rid of stagnant water and clear bushes around town between 2001-2002 financial year. This was intended to get rid of mosquito breeding grounds around the town council. However, this activity was not implemented due to lack of sufficient funds by the urban authority. Whereas Bugiri Town Council officials understood the gravity of the malaria situation it did not have any malaria control plan. Only drainage clearance had been budgeted for in the 2002/2003 financial year. One key informant observed that there was little the DDHS could do to influence the town council authorities to integrate malaria control into their planning and budgeting. This is because the town council is an autonomous authority with separate sources of revenue. The other thing is that town council is autonomous and for them I think malaria control is not a priority because they believe that the nearby Bugiri hospital can do what they are supposed to have done (key informant-Bugiri district).

Management capacity in terms of collaborative planning for malaria control between Bugiri District Local Government and Bugiri Town Council was lacking mainly due to different priorities. In Tororo District, it was reported that Tororo Municipal Council had planned for the eradication of malaria breeding

grounds through periodic clearing of bush, maintenance of drainage and “oiling” of common sites of stagnant water pools. Evidence from the records of municipal council show that all these activities apart from the “oiling” of common sites of stagnant water were already tendered out to the private sector. Given the limited staffing or manpower available, the option to tender out such activities to the private sector was a better management strategy in malaria control.

Community health education

Both districts reported that they had carried out community health education and sensitisation about malaria control. It was observed that community sensitisation about malaria control was aimed at promoting voluntary adaptation and change of behaviour conducive to malaria control within their localities. In principle, each Health Center II is supposed to conduct quarterly community health education. However, in both districts, only Health Centre IIIs were intermittently engaged in community health education outreach about malaria control. This is due to lack of adequate funds and manpower at both levels.

Support supervision and capacity building

It was observed in both districts that support supervision is carried out quarterly. Support supervision is carried out through; on spot audit supervision and Health Information Management Systems (HIMS). According to the recently revised organisational structure from the MoH; the DDHS and the HSD are supposed to provide support supervision to Health Center III. The Health Center III is in turn supposed to provide support supervision to Health Centre II. The DDHS and HSD are also mandated to provide

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support supervision to NGO health facilities collaborating with the local government. There was no support supervision to the private for-profit sector, apart from regulation inspections by the district drug inspectors for the private for profit drug shops. In order to improve on the capacity for service delivery; both districts reported that they were conducting in-service training for the nursing aides to become nursing assistants. This would have a positive impact on malaria case management at the health units/areas where most of the nursing aides are stationed. Both districts also reported that they had seconded some of their health staff to peripheral NGO health facilities in order to improve on service delivery including malaria control. In Bugiri District some staff had been seconded to Kyemeire Church of Uganda health centre, while in Tororo District, some staff had been seconded to St. Anthony Hospital. All the seconded staff was being paid by their respective local governments.

Discussion Planning for malaria control A three tier system of planning for malaria control was identified in both districts. First, beginning with the 2002/2003 financial year, the district malaria control programmes were According to the current organizational structure, the DDHS and HSD can also provide support supervision to the lower level health centre III, and II respectively, when ever the need arises. There were no reported planned support supervision for the private for profit sector involved in malaria control in both districts. Both districts reported that they were carrying out support supervision in an integrated or holistic approach that covered several health issues besides malaria control. This approach was mainly used; due to limited funds; in order to optimally utilize existing manpower without disrupting service delivery; and in support of the concept of primary health care which emphasizes a holistic approach of health services delivery at the community level.

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planned and organised around the concept of HSD. The HSDs in collaboration with the lower level health centers were supposed to plan and implement malaria control services in areas of their jurisdiction.The lower level health centers were supposed to develop their own malaria control plans which would then be integrated into the overall health plan of HSD. Secondly, the DDHs were supposed to plan and budget for only support supervision, coordination and capacity building in addition to the traditional roles of administration. Thirdly, the hospitals in the various districts were also supposed to develop their own malaria control plans, which would then be integrated into the plans of the HSD and DDHS. The lower level HUMCs members and health providers were reported to lack adequate skills for planning and management. In both districts, there were no local initiatives to get the HUMCs of NGO and private for-profit health facilities trained, mainly due to lack of capacity in terms of resources (human and financial).10 For the purpose of scaling up malaria control services, it is important for HUMCs The urban local authorities are supposed to make their malaria control plans, which are then integrated into the plans of HSD where they fall. Evidence shows that Tororo Municipality had developed relatively adequate plans for malaria control. This was not so for Bugiri Town Council. This is due to the different levels of management capacity and resources between the two urban authorities. Tororo Municipality had an established staff of 14 health providers of whom only 8 were present. Bugiri Town Council had an established staff of 3 health providers of whom only one was on ground. 10 UNICEF, which was partly sponsoring the training of HUMCs for public health facilities was also taking the initiative (the initiative is external rather than from within district plans) to have NGO health facility HUMCs trained. In a number of districts, UNICEF had also trained District Implementation Teams (DIT) which can then retrain the HUMCs. However, UNICEF covered only 31 districts in Uganda out of 56 at the time of the study.

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of NGO and other private health facilities to be trained in planning and implementing malaria control among other relevant issues.

Levels of staffing

Both districts reported inadequate staffing and inadequate skills among some health providers. Inadequate staffing among critical staff and an overstaffing of support staff (nursing aides) was reported in both districts. Four management capacity related challenges arise out this situation. First, several of the planned malaria control activities do not match the existing staffing capacity and profiles in both districts. Second, the districts have to make considerable plans for staff development (capacity building) instead of financing direct malaria control services. Thirdly, inadequate staffing compromises community’s accessibility to prompt malaria treatment and health education. Lastly, whereas all health units are supposed to develop health services delivery plans, this is not easily possible for especially the lower level health units manned by nursing aides as was the situation at the time of study. Unfortunately, some of the NGO health facilities suffer from the same staffing problem as the local government health facilities. Tororo District, for example, had all the Health Center IIIs equipped with laboratory equipment and reagents. However, only three out of the 13 Health Center IIIs had laboratory technicians. This greatly affected the referral system in the management of malaria cases referred (from Health Centre IIs and the community) to Health Center III level. According to the NMC policy, referred malaria cases are supposed to go through clinical laboratory tests before being recommended for second or third line drugs. Bugiri District also required 11 laboratory assistants at Health Center III level. In another related example, Bugiri District did not have assistant health educators (who are supposed

to be at HSD). The HSD is supposed to plan for and carry out health education. The appointment of health educators at HSD level would go along way in strengthening malaria control health education activities. Where possible, a redistribution of some of the health providers from the hospital sector to peripheral health units seems a feasible alternative especially for critical staff such as laboratory technicians and health educators.

Support supervision and capacity building

Support supervision is carried our quarterly in both districts. Due to limited staffing and lack of adequate skills especially at Health Center IIIs the support supervision was not timely and at times disrupted service provision at health facilities. When some of our staff are involved in support supervision in the field, some of the duties are suspended until when the officer returns (Key informant –Mukuju Health Center, Tororo).

In addition, as part of support supervision system, all health units were supposed to fill in monthly Health Information Management System (HIMS) files and returned to the high level supervising units. However, the filling in of HIMS was found to be problematic to some of the health providers especially at lower level health units such as Health Center IIIs and IIs, hence compromising the quality and validity of such data. It is important to note that HIMS data is supposed to feed into the planning and identification of weakness in the health delivery system–including malaria control. HIMS data is therefore supposed to be used in the design of technical support services among others outcomes. However, in both districts, the HIMS data was being used mainly for disease surveillance rather than as a deliberate attempt to identify weaknesses in malaria case management and plan for improved support supervision for malarial control.

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In both districts, support supervision was extended to only selected NGO health facilities, but not to the private for-profit health sector. In Tororo District, some well-developed NGO health facilities like St. Anthony Hospital had been subcontracted to provide support supervision to the nearby health centers on behalf on the local government. This was not the case in Bugiri, due to lack of a collaborative framework between the local governments and the private sector that includes support supervision by the latter on behalf of the local government. The districts were unfortunately not aware of the actual capacities of the existing manpower involved in malaria control in the private sector, complicating further the process of planning for malaria intervention through this sector. The management capacity to implement health education, residual spraying and marketing of ITNs using the public health distribution channels was seriously compromised in terms of staffing and skills within both districts. The lower level public health facilities were more constrained than the upper level ones in terms of staffing and management skills. In both districts, the hospital sectors commanded a lot of manpower compared to the combined needs of the HSDs and the peripheral health units. No health providers talked to at Health Center II and III had had any specialised training in social marketing yet this was essential to promote community based advocacy for use of ITNs and other malaria preventive services.

Conclusions: Alternatives to enhance management capacity for malaria control Decongestion of malaria control activities through private sector Evidence shows that among decentralised malaria control services, case management

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was fairly well handled and the coverage was relatively wide through the public health channels. However, the coverage of other malaria control activities, such as preventive interventions was relatively low and limited mostly to urban areas. Evidence also shows that hospitals or Health Center IVs, in addition to several NGOs and private forprofit malaria control health facilities service mostly urban areas. The local governments do not have the necessary capacity (in terms of manpower and skills) to undertake social marketing to promote use of ITNs, IRS and IPT. Given such a situation; there is a need to decongest the decentralised malaria control services in a way that scales up access without compromising accessibility to treatment by socially-disadvantaged groups in society. Such a model of decongestion of malaria control activities at district level would include a move away from public sector decentralisation to include modest involvement of the private sector at the district and sub-county levels. The NGO and private for-profit sector should be integrated and co-opted to provide IRS, and also market and retreat ITNs at subsidised costs. Given limited capacity of public distribution channels, the DDHS and HSDs should mostly retain roles of advocacy and promotion of use of ITNs, and other preventive services through appropriate communication channels.

Redistribution of health providers

Evidence, shows a mismatch between planned malaria control services and staffing profiles and skills, especially at lower and peripheral health units, with some Health Centres IIs being manned by nursing aides. Given that adequate recruitment is not about to happen in both districts; the functional capacity of some the peripheral units in providing case management, health education and support suspension, could be enhanced through modest redistribution of health providers

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from especially the hospital sector to the lower levels. There are optimum reasons to support the proposition of redistribution; First, strengthening functional capacity at the lower levels would indirectly imply that the hospital sector would largely remain referral centres. Cases of primary health conditions including malaria can first be attended at the peripheral units. Secondly, the fact that the hospital sector largely serves urban enclaves distorts the provider –population ratio and the affects accessibility to prompt malaria treatment for the rural communities. Modest redistribution of health staff can redress this imbalance. Thirdly, redistribution of specialised staff to HSDs can also strengthen the referral system around the concept of HSD, making it possible for complicated malaria cases to be handled near the communities. Given the complexity of social informal networks among health providers at the district level, the redistribution process requires a strong initiative from the centre and the political leadership of the district.

Motivation and special benefits to retain staff in remote areas

Evidence shows that inadequate staffing at some peripheral health units is partly a result of lack of accommodation and adequate remuneration. It is therefore, recommended that, the redistribution of health providers should be matched with a motivation strategy that can keep health providers in remote areas. The motivation strategy can include special benefits for accommodation and a risk service allowance. The national strategy for motivating civil servants working in the remote districts of Kalangala, Moroto and Kotido can be emulated by other local government for application to their respective health sectors. This will enhance accessibility to prompt treatment and support supervision in remote areas.

Capacity building

Existing capacity building programmes in both districts target mainly the public health facilities for malaria control. The in-service training of nursing aides was a positive approach to enhance case management of malaria and other related health services. The in-service training of nursing aides should in future also include management skills of planning, monitoring, budgeting and providing support supervision to CDDs. Evidence shows that whereas some NGO health facilities had benefited from district capacity building programmes for malaria control, the private for-profit sector had not been considered.11 Capacity building for the private for-profit sector should include; a clear understanding of the profile of the private providers involved in malaria control; a clear understanding of the available capacities and skills of health providers employed in the private sector providing malaria control services; a clear identification of required skills for malaria control and planning in the private sector; and a community based training strategy for the private for profit sector. Support supervision should also be extended to the private for profit sector in malaria control. Besides, the training of CDDs, PDCs and CORPs in malaria control, other community resource persons such as Traditional Birth Attendants (TBAs) should also be considered. The TBAs can be instrumental in providing IPT to pregnant mothers at community level. A recent study of the HBMF/M strategy in Uganda by Batega, (2003) also recommended that the 11 Several studies agree that the private for-profit sector contributes about 70% of the home treatment of malaria. It is therefore plausible to argue that the consideration of the private for profit anti-malarial distribution channels for capacity building will go along way in enhancing quality and prompt malaria treatment at community level.

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spouses of CDDs should also be considered for training in presumptive diagnosis and treatment of malaria for the under 5 year old children12.

Close collaboration with private sector

Evidence from the study findings show that both districts lack the capacity to provide large scale sustainable community-based health education about malaria control, for reasons already discussed above. Three related recommendations are put forward to supplement the existing health education initiatives. First, a wider coverage medium of communication should be considered by both districts. That is the use of local FM radios. It is more effective in terms of coverage, it requires little labour input and is relatively affordable. Though the central government line ministry (MoH) runs several malaria alert adverts, the languages used are selective. The use of local area FM radios will enhance and supplement central government efforts in providing health education about malaria control. Secondly, health education about malaria control should be mainstreamed at the district and sub-county levels, like in the case of HIV/AIDs education. Local government should carry out advocacy campaigns among Local Council I and IIs to encourage them to include health education about malaria control in all their community activities. Lastly, village councils should be encouraged to hold health promotion competitions about malaria control in order to raise awareness and stimulate interest in malaria control at village level. 12 Batega (2003), show that the HBMF/M pilot district of Kumi and Kiboga 6 out of the 7 male CDDs interviewed/observed were being assisted by their spouses in dispensing the Homapak (anti malaria package brand name). Consequently, a more proactive approach to have spouses trained was recommended by that study.

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References

Amonoo, L., Ebarhim, G. J., Lovel, H. J., & Ranken, J. P. (1994). District Health Care: Challenges of Planning, Organization, and Implementation in Developing Countries, MacMillan: London. Batega, D.W. (2001) The Challenges of Primary Health Care Delivery in Tororo District, Uganda, L’ Afrique Orientale, Annuaire 2001 pp: 314-338. Batega, D.W. (2003). “Home based management of fever/malaria strategy in Uganda: A sociological analysis of accessibility acceptability and compliance”, Kampala: WHO-country office, Kampala. Collins, C., and Green. (1994). “Decentralisations and primary health care: Some negative implications in developing countries” in International Journal of Health Services Vol. 24 No.3 pp: 459-479. Hutchinson, P. (1998) Equity and Access to Health Care: The Effects of Income, Access and Gender, Kampala: The World Bank Mission, Uganda. Isabirye, H and Wendo, W. (1998) . “Management of Malaria in Rural Rukungiri District” (Unpublished dissertation), Kampala: Child Health and Development Centre, Makerere University Kampala. Kalisa, M. W. (1997). A Study of Malaria Control Policy in Hoima District, Kampala: Ministry of Gender, Labour and Social Development, Uganda. Kostanjesk, N. (1997). District health management under the decentralised system: a study of Tororo District. Kampala: German Development Service (DED), Uganda. Kullenberg, L. & Porter. D. (1998). “Decentralisation and Accountability: Recent Experiences in Uganda”, United Nations Capital Development Fund (UNCDF), Kampala.

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Langi, P. & Oryema, L. (1994). Malaria situation in Apac, Kabalore, Kampala and Rukungiri Ministry of Health Uganda, Kampala. Makanga, K. (1997). Malaria control methods used by the community in Ndeeba, Kampala,(Unpublished dissertation), Makerere University, Kampala. Makerere University (2000). Decentralisation and Human resources Demand In Uganda: A perspective of the Districts, Makerere University, Kampala. Makumbi, I. (1994). Basics of decentralisation and its Implications to the Health Sector in Uganda, Uganda Medical Bulletin, MoH Uganda. Mills, A. (1990). “Decentralisation: Concepts and issues - A Review in Mills et al (eds), Health Systems Decentralisation: Concepts Issues and Country experiences, Geneva: WHO. MoH. (2000). Health Sector Strategic Plan 2000/01 –004/05, MoH. Kampala, Uganda. MoH. (1999). National Health Policy. MoH, Kampala, Uganda. MoH. (1998). National Malaria Control Policy. MoH, Entebbe, Uganda. MoH. (1993-1996). Planning Unit Reports, 1993-1996, MoH. Entebbe, Uganda. Muzaale, P. and Birungi, H. 1997. The Evaluation and Application of the Concepts of Community Participation, Community Management, and Enabling Governance in Uganda, Makerere Institute of Social Research – Kampala. Musgrave, R.A. (1993). Who Should Tax, Where and What?” in McLure, C (ed) Tax assessment in federal countries. Canberra: Center for Research on Federal Financial Relations, Canberra, Austrian National University. Najjemba, R. (1998). Management of Childhood Illness at Peripheral Health units in Mbarara District, Uganda (Unpublished dissertation). Kampala: Institute of Public Health, Makerere

University, Kampala. Okello, O. F. (2001). Knowledge, attitudes, and practice towards malaria and use of treated bed nets in Uganda, Kampala: Commercial Markets Strategies (CMS) Project – USAID, Kampala, Uganda. Rondenille, D.A. Nellis, J.R. & Shabir, C.G., (1983) Decentralisation in Developing Countries: A Review of recent experience in developing countries, Washington D.C: World Bank. Silverman, J. (1992). Public sector decentralisation: economic policy reform and sector investment programs. Washington D.C: World Bank Technical Paper No. 188, Africa Technical Department Series. State. A. (1993). The Control of Malaria in Uganda: A Study of Perceived Causes and Home Treatment of Malaria in Kabalore District, Kampala: (Unpublished dissertation), Makerere University, Kampala. The 1995 Constitution of Republic of Uganda, Entebbe: Government Printer, Entebbe. The Local Government Act (1997). Entebbe: Government Printer, Entebbe. Twebaze. D. (1998). Mothers Perceptions, Recognition, and Treatment of Childhood Malaria at Community level (Unpublished), IPH – MUK, Kampala. Uganda Bureau of statistics (2001). Uganda Demographi and Health Survey 2000/2001, Claveton: Maryland, USA. A Survey of Wanyama, S.K. (1997), Community Drug use in Rakai District, (Unpublished dissertation) Kampala, Institute of Public Health, Makerere University, Kampala. WHO (1988). The Challenges of Implementation: District Health Systems for PHC, Geneva: WHO, Geneva. World Bank (1993). World Development Report: Investing in Health, Washington D.C: World Bank.

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Rethinking the Enduring Nature of Poverty: A Cultural Perspective to Poverty Debate Eria Olowo Onyango*

Abstract There are general characteristics normally used to depict poverty, for instance; deprivation, powerlessness, vulnerability, marginality, and helplessness. But these characteristic features are rarely drawn from the cultural knowledge specific to a given society. In addition, the way the poor themselves view poverty is never located within their own culture in terms of behaviour and aspirations regarding their life. This paper therefore argues that poverty is made manifest in the poor peoples interactions as they engage the world around them and to understand it, society specific cultural factors ought to be taken into consideration.

1.0 Introduction

to the world’s poor. This is because the different notions of what poverty is can only be made relevant when it is analysed within the socio-cultural space of the poor. This makes it important for scholarship on poverty to first define what cultural standards have been used to identify and problematise poverty within a given society. Hence, if understanding poverty calls for studying the various cultures of the poor, then it is important to begin by knowing what culture means.

Among the numerous problems humans face in the world today, poverty stands out as one of the most enduring. This has not been because of neglect, but poverty strikes as one of those social problems that manifest great diversity both in form and its impact. The fundamental problem in the understanding and tackling of poverty first and foremost stems from the heterogeneity that characterises human life and then, the various ways through which different people conceptualise poverty. Various attempts to define what poverty exactly is have demonstrated this heterogeneity, as they tend to reflect the different standpoints depending on the socio-cultural background of the affected people. However, it is important to note that the occurrence of poverty the world over causes a global concern that calls for action both from the local as well as macro levels. But in understanding poverty, just like human beings whose dynamism poses great difficulty in scholarly work, there is need to undertake a serious look at the would-be taken for granted processes that make life meaningful

2.0 What is culture?

In development discourse, debate on the concept of culture is not new, and several definitions taking a sociological or anthropological approach have been used to define it. This concept, often used as an analytical tool, was first used by the anthropologist Taylor who defined it as “that complex whole which includes knowledge, beliefs, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society.” In this definition, Taylor demonstrates that culture is an aggregate construction involving many diverse phenomena, i.e. knowledge,

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* Author is an Assistant Lecturer and PhD candidate. e-mail:[email protected]

See Taylor in Barfield (1997), The Dictionary of Anthropology, Blackwell, London. 67


beliefs, art, morals, law, customs and other capabilities that are specific to a distinct group, it is associated with them and is received by all those born in that group as tradition. Culture in this sense in shared within a society or group, passed on from generation to generation within the group, and that is why it is a complex whole. Many anthropologists now distance themselves from the idea that discrete human groups have a distinct, bounded set of identifiable ideas, beliefs, or practices, and they argue that claims for such sets of bounded ideas, beliefs or practices are too often made by suspect nationalist movements. They continue to challenge the notion that culture is fixed, bounded, and unchanging. The argument here is that human groups, however defined, are shifting, and uncertain, and people belong to many competing categories, often involving power and subjugation. People work actively upon what they have received in order to respond to change their cultural inheritance. Therefore, culture should be viewed as knowledge that flows and spreads differentially. It is distributed on and in people as a result of their experiences (Barth, 1995). Culture is not static, bounded and unchanging for that matter. This is because the materials that constitute culture such as knowledge, beliefs, morals, etc are not static either, they are constantly being generated and recreated as they are induced by peoples experiences; of each other, of events, and of the objectifications of the experiences of others (Barth, 1995). So if we are to understand why people behave differently from what we know or expect, then it is because their experiences continuously induce them to recreate and reconstruct the elements of what is called culture. In other words, it is recognising the fact that each person is a unique individual carrying a unique repertoire of cultural

understanding and beliefs. Each individual, even in a small-scale society, carries a portion of his or her ‘culture’ and views that culture from a unique social and semantic position. This is because of the dynamism that characterises human social life. Thus, this paper conceptualises poverty as a social problem that is contingent within the dynamic process of social life. Poverty conceptualised within this dynamism therefore requires understanding the nature and form of the social processes that constitute the life of the poor before it can be placed in the theoretical and intellectual debates. It is important to note that culture underpins human behaviour out of which poverty is made visible and understandable to the poor themselves. This means that the notion of what poverty exactly is can only be made understandable within the knowledge base of the concerned people.

2.1 Cultural conceptualisation of poverty

In this section, poverty is conceptualised from the perspective of the poor people. The main objective is to show that when poverty is conceptualised from the culture or knowledge of the poor, there exists a lot of variations. It calls for putting poverty in the context of the cultures of a particular society of the poor to gain better insights in the nature and form of poverty as understood in a given society. The starting point is a general reflection of the way poverty can be conceptualised, and then a specific case material drawn from a study of the Banyole in Eastern Uganda is used to illustrate how poverty can be conceptualised for the cultural perspective. Culturally defined, poverty is an elusive term whose definition may vary from society to society. Poverty has been most effectively viewed as relative deprivation, based on inequality. It is a product of the way in See Barfield (1997, 372) on the cultural definition

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Rethinking the Enduring Nature of Poverty: A Cultural Perspective to Poverty Debate

which inequality is constructed in different cultural and also political contexts. These cultural contexts, however, differ depending on the society one is dealing with – it is this that draws a lot of variations from the different cultures, making the concept highly controversial at times. Therefore, poverty must be studied in the context of the society in question, taking into account the knowledge systems used to understand social life. Although there may be some form of general characteristics depicting poverty, such as deprivation, powerlessness, vulnerability, marginality and helplessness, these features must be drawn from the unique repertoire of cultural knowledge specific to the society concerned. That is to say, the way the poor understand poverty must also be located within their behavioural patterns and aspirations as they map their life world. It would be erroneous to begin listing these general characteristics of poverty cited above as part of cultural factors depicting poverty. Hence, what determines the ‘cultural factors’ of poverty are those issues made manifest in the poor peoples activities and interactions as they engage the world around them. It is therefore not possible to determine apriori what is considered cultural factors used to define poverty. Among the Banyole in eastern Uganda, poverty is conceptualised from the perspective of social relations. It is related directly to an individual’s ability to forge social networks that are used to fight what they consider to be poverty. A popular Nyole saying that expresses this goes thus, Poverty, (obutahi) is like a wild animal, when it comes to grab you and finds you with a brother, you will be safe… [A popular Nyole Maxim]

The Nyole word obutahi (meaning poverty) actually means being without people, and of poverty, concentrating on elements of inequality and deprivation as key components in poverty definition. He concurs that the cultural definition of poverty is very controversial.

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when they speak of someone being without relatives or who has lost a child, brother, sister, etc, they talk of s/he being poor. Their understanding of the term poverty, makes sense from the perspective of human relationships, and more so from the fact that one must have people. Therefore people are the potential for good life, progress and also potential resources without which one risks plunging into poverty. The above portrayal of the term poverty does not mean that the Nyole are oblivious to the market forces and political economy in general. They are not static, change in perceptions and continue to cope with the changes that take place in the market economy, but this is done from the perspective of their own understanding of the world around them. A typical Nyole household unit has a man, his wife or wives and children. But by extension children from his brothers and sisters may also be part of the household. The household is part of a bigger unit known as the lineage. A lineage comprises several households emanating from one grandparent. The Nyole are patrilineal, and lineage is traced from the male line. Every one among the Nyole belongs to only one clan, and several lineages are grouped together to comprise a clan. One is born into a clan and cannot belong to more than one clan. The clans are exogamous – that is, one cannot marry from his/her own clan or that of the four biological grandparents. Every one in the clan is considered a relative, and people of the same clan refer to one another as a brother / sister, or parent / child (depending on the generation) regardless of the genealogical closeness or There are over 200 clans in Bunyole, and a person is born into a particular clan which he or she cannot change. And when it comes to marriage, one must look to another clan whose members have no relations with his clan. In this way they extend their social networks to other clans.

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remoteness. Members of the same clan treat one another with mutual respect, maintain social and economic solidarity – in the form of reciprocal obligations towards fellow clansmen whenever they are in need of help. The clan identity is partly built around a totem (normally an animal or a bird) and marriage rules, which stipulate who should not be married. A relationship of marriage that is established by any member of the clan becomes a matter of concern for everyone in the clan i.e. all the clan members automatically become related to the family and clan in which the member has picked a wife. These relationships among others involve respect, reciprocity, and generosity, for example, offering gifts in terms of assisting one another when there are problems such as famine, ritual, disease or death. Thus, from the foregoing, there exists two social network systems; first, the intraclan network where members of the same clan look onto one another as a brother or sister, and compels everyone to meet fellow member’s needs. Secondly, the inter-clan network set up by the marriage relationships, where the two clans whose members have had a marriage, play reciprocal roles in lifting up whoever is in need or hardship. The members of a particular clan feel it is their duty to ensure that everyone in the clan is taken care of, in terms of food, shelter, land, spiritual reverence to the clan spirits, and what is considered good behaviour. In case one member is considered economically well to do, for example one having many cows, good harvest of rice or millet, or got a prominent job in government, they talk of it being a blessing to the clan. Such a person is then obliged to help any one in the clan who may need social or economic assistance. Likewise, when a member of the clan is in dire need of assistance, the other members can fundraise

to help. So material or economic gain by one member is treated as an achievement for the whole clan, something that they should all be proud of. It is essential therefore to understand the dynamics of these processes that structure the Nyole livelihood before defining poverty in a manner that conforms to their situation. By referring to having no people as poverty, it is clear that the Nyole are talking about a multiplicity of interconnected processes that people perform in their daily engagement with the world around them. These processes involve activities consummated in an environment structured as an ecological and social milieu – which can only be understood by delving into their culture. The above argument illustrates how the livelihoods of the poor people are structured within their own knowledge, and their own conceptualisation of the environment around them. Hence, it is through their culture that they draw survival strategies to enable them cope with whatever kind of problem they may meet in their lives. Therefore, poverty as a problem is conceptualised within the cultural framework and also approached using the culturally set safety nets in any given society. For instance, in the case of the Nyole cited earlier, where poverty is conceptualised as being without people, the clan structures are set in such a way that one should have “people” even without biological or genealogical connections – that is why a clansman is a ‘brother’ just in the same way as a biological brother. The interactions between clansmen are also structured along mutual co-operation, solidarity, and reciprocity. This is done to provide opportunities to everyone to have ‘people’ and hence checking instances of poverty.

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Rethinking the Enduring Nature of Poverty: A Cultural Perspective to Poverty Debate

3.0 Conclusion

The solution to any problem always lies right at its roots. Tracing the roots of poverty requires understanding the stock of knowledge distributed among the poor, which includes studying their real life experiences and how it informs their perception of poverty. To understand their culture, anyone can learn this by living with them, talking to them, and tracing the processes of life as they occur in their daily lives. It is after learning the intricacies involved in the poor people’s lives that one can relate them to the other national and global forces. Market forces and economic growth for instance are all forces that operate within the complexities that characterise the life world of the poor. But without looking at the culture of the poor, the development efforts as well as poverty reduction strategies misses the “bulls eye” in capturing the real life world of the poor. Bibliography Barfield, T. (1997). The Dictionary of Anthropology. Oxford: Blackwell, Oxford. Barth, F. (1992). Towards Greater Naturalism in Conceptualising Societies in Kuper A. (ed.) Conceptualising Society (PP. 17 – 33). Routledge: London. Chambers, R. (1997). Whose Reality Counts? Putting the Last First, Intermediate Technology Publications: London.

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Gans J.H. (1970). Poverty and Culture; Some Basic Questions About Methods of Studying Lifestyles of the Poor, in Townsend P. (1970),(ed.), The Concept of Poverty, Hienemann: London. Gordon & Spicker (ed.) (1999). The International Glossary on Poverty, Zed: London Keesing, R.M.& Strathem A. J. (1998). Cultural Anthropology:A Contemporary Perspective, Harcourt Brace: Orlando, Florida. Linton, R. (1940). Acculturation, In Linton (ed.) Acculturation in Seven American Tribes. Gloucester: Mass. Lipton, M. (1977). Why Poor People Stay Poor: A Study of Urban Bias in World Development, Temple Smith: London. Mammo, Tirfe (1999). The Paradox of Africa’s Poverty: The Role of Indigenous Knowledge, Traditional Practices and LocalIinstitutions. The Case of Ethiopia, The Red Sea Press: Eritrea. Sen, Amartya (1999). Development as Freedom. Alfred A. Knopf: New York. Wilk, R.R. (1996). Economies and Cultures, Foundations of Economic Anthropology, West View Press: US. World Bank, World Development Report, 2000/01; Attacking Poverty. WB, Washington DC. Whyte S.R. (1997). Questioning Misfortune, the Pragmatics of Uncertainty in Eastern Uganda. Cambridge: London.

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Livelihood Patterns and Social Change: Implications for the Rural Youth in Uganda* Andrew Ellias State

Abstract This paper explores the broad ways in which the local social networks of rural youth construct, sustain, and negotiate livelihood strategies in rural areas of Uganda. My findings help to clarify the relationship between social networks and socio-cultural and political structures that shape the construction of youth’s livelihood strategies and inform poverty reduction efforts at the local level. I find that friendship networks are becoming more important than kinship networks in youth’s livelihood strategies. By studying how largescale processes of social change, such as the commercialization of agriculture, patterns of migration, and government development programmes, shape forms of capital in the three districts of Kyenjojo, Kayunga, and Bushenyi, I attempt to uncover the various ways in which particular youth livelihood patterns are shaped by broader processes of change.

Introduction

reproduce particular livelihood strategies, given the opportunities and barriers experienced by the local communities in Uganda. This paper contains data obtained by interviews specifically concerning youth’s resilient livelihood strategies and their changing social networks. Interviews were very rich sources of information and gave an indication of what is to expect at local levels. The definition of “youth” differs from country to country and organization to organization. The Uganda government’s national youth policy defines “youth” as “all young persons, female and male, aged 12 to 30 years. This is a period of great emotional, physical and psychological changes that require societal support for a safe passage from adolescence to full adulthood.” The national youth policy statement emphasizes the heterogeneity of the youth as a category of the entire society. The “definition does not look at youth as a homogeneous group with clear-cut age brackets”, the policy statement

This paper is based on research interviews conducted in Uganda in the summer of 2003 targeting officials in Kyenjojo, Bushenyi, and Kayunga districts. District officials (technical and political) were interviewed in order to lay a foundation to situate large-scale changes that have taken place and are currently still ongoing that affect rural youth’s social networks and livelihood patterns and strategies. This was the first phase of a broader project on social capital networks and rural livelihood strategies. This study sheds light on youth’s livelihoods by documenting how local social capital networks help organize, structure, and * This paper has greatly benefited from comment by the Ron Aminzade salon group. It was also presented at the African Studies Association Annual meeting in Boston city in 2003. This study was made possible with funding from the College of Liberal Arts, University of Minnesota under Graduate Research Partnership Program (GRPP). † Andrew Ellias State obtained a PhD from the University of Minnesota, USA in 2005 and currently teaches in the Department of Sociology at Makerere University. For correspondence:e-mail. [email protected].

See Uganda Government. 2001. “The National Youth Policy: A Vision for the Youth in the 21st Century” Kampala, Ministry of Gender, Labour, and Social Development. 72

Livelihood Patterns and Social Change: Implications for the Rural Youth in Uganda*

argues, “but rather as a process of change or a period of time where an individual’s potential, vigour, adventurism, experimentation with increased risks and vulnerabilities show themselves in a socially meaningful pattern.” The policy statement also acknowledges the unique experiences and youth patterns of life in Uganda today that are forced to take on family roles and responsibilities while as young as 12 years. The statement says, “… prepare and empower the youth to be able to take on socio-cultural, economic, civic, political and adult roles and autonomy. It also reflects the reality on the ground that the family and extended kinship ties loosen due to the different factors. Many young people by the age of 12 years have assumed adult responsibilities.” This definition differs in many ways from the manner in which other world organisations take the youth to be. For instance, the United Nations (UN) defines the youth as persons between 15-24 years while the Commonwealth Youth Programme takes a youth to be 15-29 years. For me, I take these definitions to be indicators of what youth’s livelihoods in rural Uganda are today. Given that children as young as 12 years take up adult roles and responsibilities in the light of the circumstances enumerated, then examining youth’s livelihood strategies become a legitimate area of inquiry in academia. There are contradictions, however. The national youth policy mentions youth as defined by age from 13-30 yet the majority of the youth are between ages 15-19 years. Since the majority of the youth live in rural areas, and that by the age of 25 years many have already started their own families, I will, in this paper, take the youth as those in age ranges of 17-24 years of age. I am also aware that livelihood strategies and patterns in rural areas have recently been a subject of debate in development literature. The majority of studies have focused on rural poverty (Hume 2003; Hulme and Shepherd

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2003; Ellis and Bahiigwa 2003; Bird and Shepherd 2003), rural diversification (Ellis 2000), rural employment (Bryceson 1999, 2000), and rural development (Chambers 1984, 1995, 1997).Others have looked at migration and livelihood patterns (De Haan, Karen and Ngolo 2002, Jacobsen 2002) but few have addressed the impact of large-scale changes, including migration, democratization, and capitalist developments on the forms and types of youth’s livelihoods in rural areas. This study explores youth’s livelihood strategies and patterns in rural Uganda by focusing on the patterns and dynamics of youth network relations that exist within three carefully selected rural areas and how recent large-scale changes have affected complex livelihood strategies. By interviewing local, technical, and political leaders in the three districts of Kyenjojo, Bushenyi, and Kayunga, I begin to map out how political, social, and cultural changes have shaped youth’s livelihoods. By focusing on the structure of multiple networks within a community, this study goes beyond past studies of development that concentrated on economic assets (Ellis 2000) but ignored the role of cultural, political, and social capital in shaping livelihoods and their capacities. In addition, youth’s strategies have for the most part, not been at the centre stage yet the youth form a large percentage of the population. My task is to map networks of political, social and cultural co-operation among people in rural Uganda. I apply social network analysis to assess how rural youth interact in day-to-day activities. Using data collected from in-depth interviews, I explore how capitalist development, state formation, and migration processes alter livelihood patterns in Uganda.

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Youth in Historical Perspective in Uganda

For almost four decades since Uganda attained independence in 1962, there has not been any clear, coherent and allembracing youth policy, with the exception of the 2001 youth policy, to guide and ensure sustainable youth development. The youth, as a category, have been organizing on their own and the few times when youth issues have come on the national agenda they have been mainly organizational-based and reactive to prevailing circumstances. Such moments were as far back as in the 1960s when government established a youth desk in the Ministry of Culture and Community Development. It also established several youth organizations such as the National Union of Youth Organization (NUYO) that targeted out-of-school youth between the ages 13-30 years, the Uganda Youth Development Organisation (UYDO) in the 1970s and the National Union of Students of Uganda (NUSU) that targeted youth in secondary and tertiary institutions. The Young Farmers Union (YFU) targeted inand out-of-school youth between 10-25 years (National Youth Policy 2001). The majority of such organizations that operated at the national level were politically motivated and were bound to be abolished in the event of a regime change of such as the one 1971, 1980, and 1985. Important to note here is that these organizations mainly targeted elite youths in schools and university and were mostly run by the educated and had headquarters in areas urban. The rural youth rarely got a chance to be involved. In fact, each of these youth bodies did not even See Uganda Government. 2001. “The National Youth Policy: A Vision for the Youth in the 21st Century” Kampala, Ministry of Gender, Labour, and Social Development. Also see Chekwot, Hisali, and Odongo. 2003. “Report of the National Policy Inventory/Data Bank.” The Parliamentary Commission: Parliament of Uganda.

have a unified coordinating line ministry for administrative purposes but fell under the mandate of different ministries. The NUYO was under the Ministry of Culture and Community Development, the YFU was under the Ministry of Agriculture, while NUSU was under the Ministry of Education. There were also a few youth nongovernmental organizations (NGOs) that supplemented government efforts in organizing the youth such as the Boy Scouts and Girl Guides movement, Young Men’s Christian Association (YMCA), Young Women’s Christian Association (YWCA), the Boys and Girls Brigade and the St John’s Ambulance services, all of them modelled on the British system with some religious undertones. All these bodies aimed at character-formation and inculcating religious values in the youth. Therefore, while the 1960s saw dynamic youth programmes in Uganda, the strengths of these programmes were dependent on the government’s investment and NGOs. They mainly focused on a broad range of social and economic needs of the youth and were rural-focused and provided opportunities for the most disadvantaged out-of-school youth. Youth services and programmes, like most sectors, lagged behind during the period of economic mismanagement and civil strife in Uganda from 1971 to 1986. The school system was not sustainable, the educated lost value in the community, if they were able to survive the killing engineered by authorities in government, and the youth joined informal trading en masse. Terms like magendo (informal trading or illicit trade), bayaye (street thugs), street children/youth, cropped up in Uganda’s vocabulary. Many youth dropped out of school to do magendo and education lost meaning. A number of them joined armed struggles and acquired the name of kadogos (child soldiers). Rural-

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urban migration of the youth increased, as did the new illnesses like the human immunedeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) that surfaced in this turbulent period. The worst hit categories were those in the age ranges of 1230 years. The youth became household heads in circumstances where AIDS or the armed struggles claimed adults. Hence, the youth not only lacked attention by the government but were also made to seek livelihoods within their own social networks by disease. They could not even rely on their kin and relatives networks since their roles and importance had diminished (see Atekyereza 2001 on how such families are still identified in terms of dead parents and not the living – youth). They are traumatized not only by the disease but also by their inability to provide for the family. This affected the authority of parents and relatives towards guiding youth’s future. This general breakdown of social, economic and political fabric of society meant a loss of the support system that sustained youth programmes in the decade of the 1960s. Manipulation of the youth by some politicians also created suspicions towards government-instituted youth bodies. This led to the change in the way the youth were organized. This came in 1986 when the National Resistance Movement (NRM) assumed control of government. Since the struggle to liberate from tyrannical rule heavily depended on the youth, the NRM government made a radical departure in organizing the youth. A Youth Affairs position headed by a commissioner became a department in the Ministry of Youth, Culture and Sports. Youth mobilization became part of the all-embracing government and membership was by virtue of Ugandan citizenship and being aged 18-30 years, Currently, there is a minister of State in the Ministry of Gender, Labour, and Social Development directly overseeing youth affairs.

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and not by registration or belonging to a society. To actualize the status of the youth, a National Youth Council Statute passed through Parliament in 1993, paving the way for the election of youth representatives from the grassroots to national legislative level. Whereas the new government (NRM) put in place structures to empower the youth socially and economically, such endeavours have not been accompanied by sufficient resources. Though a number of measures are in place, such as the skills and enterprise development programmes, the Youth Enterprise (Credit) Scheme (YES) under the Ministry of Gender, Labour and Social Development, these efforts target particular youth groups such as university graduates who have put a lot of pressure on the government to give them start-up capital. Since the government also lacks the infrastructure to implement and monitor the success of such programmes, funds given in such ventures are misunderstood as political gifts for helping in the political campaigns and repayment becomes a big issue which no politician is ready to raise. In any case, as I noted earlier, only a few end up benefiting from such programmes, usually started as a political pronouncement, by the time they reach the implementation stage. Today, youth have seen many organisations and community-basedorganisations (CBOs) emerge. Many of them are indigenous because the youths are mobilising their own social networks and end up doing a commendable job, which independent of government’s effort. In the same manner, government policy has changed from a centralised to a decentralised system of providing services. The local authorities are now providing delegated services that were previously centralised government duties and responsibilities, including youth services.

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Thus, this study examines youth’s social networks and livelihood strategies at a time when there are many large-scale changes taking place, including the decentralization of services to the local level. I aim at highlighting how the large-scale changes have affected how youth organise especially those in rural areas where services and opportunities are not easily accessible.

I. Research Questions 1) Theoretical Questions Numerous large-scale changes, such as the commercialization of agriculture, democratization, and population migrations, have shaped rural youth’s routine choices regarding pursuit of their livelihoods. The puzzle here is that, given all these changes − large and small − what are the values and practices shaping the youth’s social networks as they develop solidarities to better their livelihoods? What is the role of the family versus friendship networks in the accumulation of social capital that enable youth to advance with their own livelihoods, given these changes? My argument is that large-scale changes have altered network relations and connections, thereby changing youth’s livelihood strategies in rural areas. The viability and quality of life of contemporary rural livelihood patterns are, in large part, determined by the manner in which network connections and relations operate. Larger social forces, such as the state, capitalism, and demographic patterns, systematically restructure these connections and relations. Hulme and Shepherd (2003), in an attempt to explain chronic poverty, argue that despite the limited knowledge available to scholars, hundreds of millions of people live in poverty with poor livelihoods. I attempt to connect livelihood patterns and social change by looking at how youth have adopted varying livelihood strategies provided by this social

change and how such strategies rely on certain types of capital to attain improved livelihoods. I also examine the similarities and differences between three districts that emerge as migration, capitalist developments and democratization shape youth’s livelihood strategies. 2) Empirical Questions Documenting youth’s social network relations and the different activities they are currently involved in helps us explain their livelihood strategies. These activities include small rotating credit associations and self-help activities that help them remain focused and devise ways to survive. The number of these types of activities has increased dramatically in recent years. The growth of these activities, which are not kinship-based, suggests that the youth are more likely to cooperate with their peers and friends rather than with traditional relatives and elders. Changing network patterns include the declining influence of elders over youth’s decisions and hence the increased reliance on their network connections with schoolmates, friends, and acquaintances. Relatives get the respect they deserve as elders but do not influence livelihood patterns of the young because friends increasingly shape their interests. The question is why is this the case? My answer highlights different time horizons among the young. According to my interview data, relatives and clan-mates in the village, in most cases, think in terms of survival and the present or past while the young think more in terms of investment in the future. Thus, friends influence youth’s future strategic planning because of changes in interests and aspirations wrought by new opportunities created by capitalist development, government decentralization, and migration. Social networks at village level are a form of social capital. For example, network relations and connections help individual

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youths when they fall sick, or when their loved ones pass away. They can easily cash in on the network connections to solve problems. For example, the youth often work together in groups to solve their most pressing needs, such as constructing a house, getting married or even paying school fees for their younger siblings. I am aware, however, that as much as the social networks are important in determining livelihood patterns in a given area, they can undermine it as well. The youth seem to get attraction to one another because of shared interests and the opportunity to plan things with friends. Friendships form a nucleus around which youth’s livelihood strategies revolve. Today, their marriage networks cut across ethnicity and religion, especially when it is between Christian religious denominations. Various state policies and programmes have been implemented since the late1980s aimed at addressing declining rural livelihoods. These have contributed enormously towards fostering particular livelihood activities today, including cash crop production for export, liberalized economies leading to increased farm prices, diversified production and livelihood patterns and easy access to health care units through opened-up rural roads as a result of the decentralized service delivery. An important part of the economic context is the implementation of structural adjustment policies (SAPs) in Uganda. The implementation of IMF/World Bankengineered structural adjustment policies (SAPs), such as privatization, liberalization, and increased production for export, aimed at reducing poverty and setting the country onto a development path desired by donor countries and international institutions. Such policies affected the adoption of particular livelihood patterns in contradictory ways. On the positive side, liberalization policies have encouraged some to diversify into new

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crops, such as vanilla. On the negative side are those who have sunk further into poverty and had difficulty surviving as subsistence producers (see State 2005 on the negative and positive consequences of SAPs). The majority of the beneficiaries of those neo-liberal policies, which have involved cost-sharing and cuts in health care and social services, were not the youth but the well-off. During the implementation of SAPs, the majority of programme that affect youth livelihoods either were cut back or did not form part of the top five priority areas, which include promotion of health care, universal primary education, agriculture and the environment, the road and communication sector, and water and sanitation. These included the education, health, road networks and jobs. By conducting in-depth interviews with the youth, political leaders and administrators in the three districts, I sought information about what activities the youth were engaged in owing to the scarcity of resources and attention. Faced with this dilemma, the youth in rural areas found it cheap and easy to pool resources, both tangible and intangible, from among themselves in order to construct their livelihoods. For example, Kayunga Youth Association deals in motorcycle and bicycle transport and Bushenyi Development Association deals in saving and credit within their own resources. II. Logic of Case Selection Uganda provides an important case for the study of how large-scale changes are affecting youth livelihood strategies because it has experienced important political, economic, and social changes in recent years. The economic changes noted above concern the shift to the neo-liberal policies of free trade, privatisation, and exportoriented production. Political changes include a movement from a dictatorship to a single-party democracy. Together with

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such changes, there have been a lot of policy shifts. Since 1986, when President Museveni assumed power, the position of the vulnerable segment of the population, such as the women, the disabled and the youth, have been at the forefront of governmentimplemented programmes and policies. A key policy meant to foster democracy and grassroots participation is decentralisation. This policy has allowed for the devolution of power, responsibilities, functions, services, and resources to local and regional levels. With decentralisation and the promulgation of the constitution of 1995, and the enactment of the Local Government Act of 1997, local governments were supposed to prepare comprehensive and integrated development plans and incorporate the plans of lower levels of government. For the first time, districts implement their plans depending on the availability of funds. The development goals at the district had to follow national development goals, for instance universal primary education, improved health care and roads, agricultural development, etc. In addition to these economic and political changes, Uganda has also witnessed important demographic change in the form of international and interregional migration. There have been both international and in-migrations to all three districts. Among the international migrants are the Rwandese and Sudanese migrants who came because of political persecution in their own countries. Kyenjojo and Kayunga seem to have more of these than Bushenyi because of the land shortages. The Rwandese migrants were mainly pastoral communities and preferred to settle in one particular county favourable for cattle rearing (i.e. Bbaale in Kayunga and Kyaka in Kyenjojo). The in-migrants into Bushenyi and Kyenjojo districts are mainly from Kabaale district (the Bakiga ethnic group) while the Kayunga inmigrants came from eastern and northern

Uganda. The large-scale migration patterns have proved a greater challenge today in Kyenjojo district than it has in other districts because politicians have been quick to exploit ethnic differences for their own gain. The study covered three locations. These locations were chosen because they represent varying characteristics, which have implications for youth’s social network relations. A comparison of these three districts with historical, economic, political and demographic differences, and certain similarities, allowed us to explore the impact of these differences on rural youth’s livelihood strategies. A) Bushenyi District Bushenyi is a district in southwestern Uganda. Carved out of the then Ankole district, it became a district in 1974. Bushenyi district (originally called West Ankole district) has a total land area of 3949 sq. km a population density of 187 persons per sq. km and a total population of 738,355 people (UBOS 2002). The main source of livelihood is farming, including growing crops such as bananas (matooke), beans, coffee, finger millet, cassava, sweet potatoes, tea, and passion fruit. There is also dairy farming that is changing and expanding with exotic animals. Bushenyi has five counties (administrative units, each headed by an Assistant Chief Administrative Officer – ACAO). Two counties (Igara and Sheema) practise highly specialised production for export to urban areas like Kampala and outside Uganda. Compared to the other districts, which are also predominantly agricultural, the commercialization of agriculture, especially the use of modern methods of farming, is more advanced in Bushenyi district. There was a widespread perception among those interviewed in the other districts that Interview with the District Population Officer Ibid.

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Bushenyi is a relatively “well-to-do” and “progressive district” in terms of livelihood patterns compared to the other two. The major ethnic group in the district are the Banyankole, who have enjoyed political “goodwill” from the central government since independence and whose livelihoods have been able to surpass other districts in Uganda (Bonger 2000). The people of Bushenyi took advantage of the political capital accorded to it by different regimes. Hence, the district offers a good comparative case with respect to social capital networks and livelihood patterns. Migrations here took place in the late 1960s and early 1970s. Now there are no new migrants simply because there is no more vacant land to settle. The first migrants were usually allocated land near forests and game reserves where the indigenous people felt no need to settle or felt they would buffer the security zone. B) Kyenjojo District Kyenjojo district has two counties (Mwenge and Kyaka) and 13 sub-counties (14 subcounties including the town council) with a total population of 380,440 (Census 2002). Mwenge county has the highest number (about 269,367) whereas Kyaka has about 111,173. These are all farmers, with over 95 percent of the population living in the rural areas. The district has two zones, the one with a higher altitude zone covering Mwenge county and the semi-arid zone covering Kyaka county. The semi-arid areas favour beef production – for both local consumption and for commercial purposes (mainly beef cattle). It is also favourable for coffee and cassava growing, which are drought-resistant crops, and groundnuts that grow well in light soils. Mwenge county, with high rainfall, favours tea growing, Interview with the District planner Interview with the District Planner, District Coordinator of Production/Agriculture and CAO

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which is a major livelihood activity in the area. There is also cultivation of bananas, millet, beans, and horticultural crops. Thus, the major livelihood activity, subsistence farming, mainly depends on ecological zones. Similarly, the district has a banana/ coffee farming system where the major crops grown include robusta coffee, bananas, maize, finger millet, beans, potatoes and cassava. In general, the main crops grown are tree crops, root crops, cereals, legumes, fruits, and horticultural crops, with subsistence farmers practising intercropping but with a few specialising in one crop system (such as the growing of tea, coffee, and cassava). With the liberalisation of the economy, the vast tea plantations have been revived. Unlike coffee that is grown on smallholder household plots, tea plantations are mainly owned by the multinational companies and individual property owners. Many of these owners are returning Ugandans of Asian origin. This, therefore, implies that people living near the plantations earn their livelihoods through wage labour. It is important to note here that the indigenous settlers often despise working on tea plantations because their livelihood patterns depended on nomadic pastoral activities until about 1891 when their cattle were almost wiped out by cattle disease. Thus, the Bakiga migrants and Rwandese refugees, rather than the Batooro, dominate the plantation wage labour. There are, however, outgrowers who use the indigenous Batooro wage labour rather than the migrants. In all, the majority of people in Kyenjojo depend on subsistence farming rather than on wage labour. There are district similarities in that each of the districts is divided into zones and almost engaging in one livelihood pattern, mainly agro-based, or another. Kyenjojo District Local Government Three Year Development Plan, 2001/2 – 2003/4, p.10.

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Kyenjojo has a relatively homogeneous population due to settlement of the Batooro. Though there are migrants into this district, they were probably not significant enough to affect the social networks of the youth and their livelihoods, though in some places it could. It is also relatively a new district (carved out of Kabarole district in December 2000 by an Act of Parliament). The district, while still under Kabarole district, was among the first districts to decentralise. C) Kayunga District Unlike other districts, the Kayunga district sources of livelihood differed in many respects. The district has two counties of Bbaale and Ntenjeru. Like Kyenjojo district, it was created in December 2000 out of Mukono district by an Act of Parliament. The district is located about 70kms east of Kampala City. It is found in the central part of the country – the Buganda kingdom. It has a total land area of about 1810 sq. km and lies between 1000-1200m above sea level. It is generally flat with no remarkable hills. Like other districts along the equator, Kayunga district has a tropical climate in the south (Ntenjeru county), where the rainfall pattern is bi-modal (having the first rains in March-May and the second season occurs in September-December). The dry seasons span July-August and January-March with an evenly distributed rainfall pattern. The northern part of the district (Bbaale county) is characterized by the savannah type of climate (it is part of the cattle corridor). The county experiences two seasons (a dry and a wet season) and the rains are not evenly distributed. This, therefore, affects the livelihood patterns in the district, with Bbaale county specialising in livestock farming while Ntenjeru county specialises in crop farming. Similarly, because of the climate, Bbaale county less highly populated than Ntenjeru county.

Generally, like other districts in Uganda, the majority of the people in all the districts are engaged in peasant production as a source of livelihood. The majority are involved in the growing of potatoes, cassava, maize, etc. They are peasant producers who sell coffee and food products to cater for their needs such as school fees, health care, clothing and food. In view of this, the district has attempted to come up with strategies for improving the people’s sources of income. It has introduced cotton growing on a large scale, mobilising 3,000 acres, out of which the farmers have already received seeds for 700 acres, and the Cotton Development Authority (CDA) has promised to provide the balance for planting for this season. Currently, there is a government effort to restock as a way of empowering especially the pastoral communities. Kayunga and Bushenyi districts have come up with initiative of distributing improved or imported goats in an attempt to ensure that those in goat production produce good-quality goats that can fetch more income. There are also many other small ways in which people make a living, such as operating a bicycle or motor cycle taxi, starting up a private school, etc. Thus, the youth exploit their social capital networks as they get along with their livel. Multiple sources of livelihood have been adopted in order to lessen the impact of the vagaries of nature. The government’s decentralisation policy has been very instrumental in providing am opportunity for rural producers and dwellers to adjust to new livelihood patterns through provision of services such as extension services, improved seeds, etc. compared to Bushenyi and Kyenjojo, Kayunga also has two zones with one dry and suitable for pastoral activities (Bbaale county) and another densely populated and agricultural (Ntenjeru).

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III. Large-scale Change and Liveli- hood Strategies The changing individual, friendship, and community networks The most significant research finding in this study was the discovery that youth in all the three districts depend more on friendship networks rather than on relatives. Respondents in the three districts reported that networks based on one’s friends were more important in an individual’s livelihood strategies than networks based on clan-mates, village-mates or relatives, though some respondents cited relatives as being there all the time since they are attached to a person by blood compared to friends.10 One respondent from Bushenyi district summarized friendship patterns as “Nibagira ngu, omushaija ashaka omukanwa ka mutahiwe!” (A man survives through the mouth of his friends!). In other words, a wise person should listen carefully and learn from what the other person has to say. He argued that they had not benefited from their relatives and that whatever they had, was achieved through friendship networks. Ordinary people believe you cannot be an island unto yourself. They believe in supporting one another. The respondents were of the view that a person may be very bright or have certain technical skills and knowledge but may lack start-up capital for a business. Similarly, a person learns good behaviour from friends, something which creates unity among the people. One interesting idea mentioned was that friends help in raising bride price and making wedding preparations for the youth. One respondent summarized this as follows: You see they say that if you cannot admire, then you cannot progress. Therefore, through admiring definitely you keep changing some 10 Interviews conducted targeted district political and administrative staff. My next study explored village and community levels and compares the data collected with district officials’ responses.

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of your traits and behaviours. I have also learnt not to get annoyed very fast and not to make decisions when I am annoyed (Bushenyi district administration official).

Friendships are more effective than blood relations with respect to accumulating economic and social capital. Respondents argued that it is very hard to find a relative who is interested in your achievements and development. However, friends normally encourage you to progress in life. A respondent said: As a person (speaker), I have achieved what I have and who I am because I have made friends at different levels right from where I come from, i.e. village level, up to my office. At the office level, where I am the head of the council, friendship is very important and required for me to identify problems because people cannot tell me their problems unless I avail my self and people can easily access me to discuss and resolve our problems (Kayunga district local leader).

Therefore, the changing network patterns include the waning role of elders in influencing youth’s decisions, hence youth rely more on their network connections with school-mates, friends, and acquaintances. Social networks at the village level are a form of social capital, for example the network relations and connections help individual youth group members when they have problems such as relatives falling sick, payment of school fees, or when they lose a loved one. They can easily cash in on the network connections that they have in order to solve such problems. In fact, the government has not fully aided these ventures by meeting the needs of vulnerable people in the community. For example, the youth work together in groups to solve their most pressing needs such as constructing a house, getting married or even paying school fees for their younger siblings. They do not collect, say 20 million shillings, like civil servants, but contribute a few hundred thousand shillings, depending on

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their income. However, some respondents were of the opinion that, much as the social networks are important in determining livelihood patterns in a given area, they can undermine it as well. It is important to note that attraction to someone is based on certain traits within a person that appeal to the individual who feels attracted. Friends can plan and have common strategies. Among the common traits that cut across ethnicity, race, gender or religion and that unite different people, families, and communities are marriage networks. At the local level, there are people who collaborate financially or organize themselves into groups such as burial groups e.g. “Mwezikye” Let’s bury one another and “Baano mukabbi” (Your friends in problems) in Bushenyi. At the district level, civil servants have also started organizing their own staff associations. One example cited was an association called Bushenyi Investment Group (BIG) that started in 1996 to which each member contributes one hundred thousand shillings every month. It has 14 members, and every month two people get a round contribution of $300 and about $100 remains in the association’s coffers. Now, they have started giving out loans to other people outside the association at an interest (initially 10 percent but now 5 percent). A majority of respondents in all three districts said they usually discuss business-related topics whenever they are with friends. Others reported that friends usually consulted them on how to make good proposals for their projects and even on how to succeed in life, and how to make good decisions in business. At the district level, quite a number of youth come to seek advice from their experienced peers at the district, especially professional advice, such as youth mobilisation in community development. One respondent from Kayunga district,

quoting a reknowned African writer: Chinua Achebe, summarised this thus “If you washed your hands and fingers very well, you could eat at the same table with the Prince and Princess”. This could imply that when one behaves well, then he/she deserves better treatment. However, some friends are not genuine and exploit the goodwill of others or act as free-riders. Some youth seek friendship because they want something and disappear immediately they have achieved what they wanted. Similarly, some relatives and clan-mates are envious of other youth’s development and become destructive through witchcraft. There was a consensus that relatives typically place greater demands on one’s resources if one is successful. Apparently, people have learnt from others how to survive in life. One young respondent said: So you find – your own relatives, clans, village-mates – those ones normally prefer to suckle from you (laughter), are what we have seen. However, your friends want to benefit from your knowledge and to adopt it in order to develop themselves. I take that to be more important than your own relatives, who only befriend you for their own benefit. Yes (laughter) Another young respondent reported: “Sometimes relatives pull you down because it is very hard to get the kind of attachment like the one you have with friends.”

Youth Group Dynamics and Livelihood Strategies

From the discussions and interviews, group dynamics become noticeable in all the three districts. For example, there are very many community-based organizations (CBOs). While examining youth groups, their constitutions, their formation patterns, and the ambition they have, one realizes that there is some form of informal organization right from the lower to higher levels.

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Participation in such activities depends on age structure that ranges from 18-60 (the most productive age category), which also indicates networking outside youth groups. This acts as a coping mechanism for the youth against poverty. People identify a problem and then combine efforts to solve it. Among the many initiatives by the government and donor agencies to facilitate these groups is the provision of funds to care for people living with HIV/AIDS. Several youth and women groups have come up with good proposals on how best to cater for the orphans, the sick, and the widows. There are also development-oriented groups, with some having been named after the particular livelihood activities they are involved in, e.g. a group of women involved in crop husbandry will name their group after a particular crop. However, there is a general outcry that the plight of HIV/AIDS victims has been turned into a business, with so many NGOs (both local and international) making a fortune out of them by pretending that they are caring for them (see the Monitor editorial, 27 October 2003)11. There are many micro-finance groups that help in the group dynamics called kusikiraana (pull or help each other) where people pool resources in the form of cash or physical items, say in the case of building a home or communal labour (see Ghazali 2003). In the fishing areas (Bushenyi and Kayunga), there were campaigns against the use of destructive fishing methods that deplete the fish stock. Co-operation exists 11 The paper quotes one of the HIV/AIDS patients, Maj. Ruranga Rubaramira as saying, “Many people have turned us into commercial projects. We are now objects of trade. We are not an industry, we are human beings.” This was at a gathering of more than 155 people living with HIV/AIDS in Kampala on 25 October 2003 to chart a common position ahead of an international HIV/AIDS conference. He is also quoted as saying that there are over 2,500 projects so far.

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among the youth and they have formed formal groups called co-operative societies, especially those involved in fish-processing and fish-mongering. Women have also formed their own groups and started accessing loans from the micro-finance institutions. This kind of co-operation has served as an incentive to motivate the youth to seek improved livelihoods. District authorities work hand in hand with local youth communities. In the past, whenever a government official went to the landing sites, anglers would run away. However, this has changed because people are aware that officials provide extension services as well as enforcing the law. There is constant communication with the local communities and district authorities are now trying to use local leadership called Gabunga at landing sites for mobilization. The Gabunga is an informal landing site leader who ensures that there is harmony and use of proper fishnets. In most cases, the Gabunga owns most of the boats at the landing site. The local government in Kayunga is now trying to take advantage of this development and change the Gabunga institution into Beach Management Committees so that they are able to look after a wider area. For instance, if the landing site is located within the agricultural areas, they have to be keen on what happens in the area. The District Fisheries Officer said: We are now going to have elections for the institution unlike in the past where the Gabunga was a person who owned many boats or the one who started the landing site or owned the land around the landing site.

Deep in the villages, there are small groups of about 10-20 youth who do communal work together and assist each other through joint gardening activities like weeding, harvesting, etc. There are also women groups who come together to access loans from micro-finance institutions and they originate from all tribes

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or ethnic groups. Their organizational success solely depends on performance and other values such as honesty and trustworthiness rather than tribe or ethnicity. Therefore, one can argue that there are youth networks that go beyond ethnicity, age, and gender divisions within the communities where this study was carried out. The Youth, Decentralization and Livelihood Changes The day-to-day implementation of government programmes in districts is under the decentralization system. Districts have a low tax base and so revenue is low. The amount of income they mobilize directly from the people in the form of taxes and licenses is low but the demand for development needed in districts is broad and enormous. Therefore, the major source of funding is the central government that receives funds from donor agencies through grants that it sends to the districts. The funds from the centre benefits a cross-section of sectors, e.g. community development, production (agriculture, veterinary services, entomology, and fisheries), education (construction of classrooms and teachers’ houses, payment of teachers’ salaries, roads (rehabilitation and improvement of the road network), health services (construction of health service units). Some of the funds remain at the district to implement the general monitoring and supervision activities. Funding from the central government has a standardized formula, i.e. based on how many students are enrolled in school and population served. However, for districts that have more centrally located ministers, the services may not necessarily depend on such variables but on political patronage or use of political connections. Decentralization is important in changing livelihood patterns and in poverty alleviation. There are several avenues

through which the central government implements the decentralization programme including Local Government Development Programme (LGDP), Poverty Alleviation Program (PAP) to improve delivery of extension services, Universal Primary Education, and Functional Adult Literacy Education (FALE). These programmes have an impact on youth’s livelihood patterns. It is difficult to implement services provided by the central and local government without donor funding. With decentralization, services originally offered by the central government were transferred to local governments by granting them more powers, functions and resources to implement them while the local ones were strengthened. However, the central government retained key functions such as security, police, central prisons, defence (the armed forces and internal security), and secondary education. There is increased transparency and accountability, and increased follow-up by the beneficiaries themselves, though there is talk of pervasive corruption. The local government development grants have an element of capacity-building grant for the local staff. Grants that come into the districts, such as the Plan for the Modernization of Agriculture (PMA) and other conditional and non-conditional grants, come from the centre. Most of these programmes aim at empowering the communities and therefore improve their livelihoods. With decentralization, many government powers were devolved from the centre to lower governments, and now that the programmes are near, the people do not have to suffer with unnecessary delays and excessive bureaucratic requiremens. Through decentralization, the communities have also been involved in participatory planning where they supervise the community projects. This, in a way, has created a sense of ownership and sustainability of new initiatives. The

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local governments are supposed to be a link between the central government and the local communities. However, with the clientele-patronage system developed around political positions, those who benefit are the few highly connected individuals who have links with those who matter or possess resources, who are in most cases usually the elite in the community. The central government, through the Programme for Modernization of Agriculture (PMA), sends funds to local government development programme. The funds go to the sub-county and parish levels with clear guidelines to focus on key areas like roads, farm improvement, water and sanitation, agricultural extension, and primary education. As noted earlier, participation is selective by age and level, with the exception of the affirmative action laws introduced by the government that give women particular positions at every level. The only problem is that at a higher level, the decisions made tend to be associated with elite interests rather than popular demands at the grassroots level. Resources Allocation and Political Patronage To all systems of government all over the world, the political aspect of resource allocation is very important. While allocating resources, say to schools, the districts look at enrolment, distance from one school to another, etc. Districts have various committees that help in the allocation of resources. These committees advise the politicians on what is available and what areas are in need of resources. Thus, the allocation process follows specific guidelines though decisions made are politically. District councils take collective decisions. Political patronage may be at a collective level because district councils make decisions, for example priority areas of intervention get budget allocations

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first. District councillors are free to bargain for better deals for their constituents, but to say that one area is favoured over the others is false. Respondents reported that all areas in districts get equal treatment in terms of resource allocation since councillors come from different constituencies, but not all categories of the population benefit equally, with certain groups, such as the women, youth, and the disabled receiving less resources. District councillors lobby for facilities because they are accountable to the people or the electorate. Even areas that never supported the winning candidate get equal treatment. The district council operates through sectoral committees that synchronize plans for the year. Thereafter, the district authorities organize a budget conference where donors and opinion leaders discuss the budget. After drafting the budget framework paper, a draft is prepared and passed on to different sectors. Since the people’s representatives get budget proposals during the budget conference, there is no way certain areas would lag behind on the basis that people did not support a certain leader. On the other hand, political patronage is not completely absent because the majority of projects at district and national levels are political programmes. These are political programmes based on the president’s campaign manifesto that in the end become government policies. Districts are required to follow national priorities while implementing local development policies and programmes. District-level political patronage is visible when it comes to recruitment of staff and job allocation. District leaders would want to recruit a person born in the area. Similarly, campaign managers are favoured on the District Tender Boards (DTB). Patronage resources mostly benefit one particular ethnicity, the youth, political allegiance, region and religious

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affiliation. This reinforces the class, gender, ethnic and generational hierarchies. For example, one respondent had this to say about political leaders influencing decisions on the appointment of district staff: …That if there are about 3 or 4 people you know. I can even talk to District Service Commission (DSC) and say if any one of these is to get a job, then they should give it to so and so. Whenever you say that, people [officials] take you seriously. Generally, political patronage is there. I do not refuse that one though I am a politician. After campaigning for you, people expect rewards from you. You do not have money but you can give a top job. When there is a tender for the road, you can usually say please, if that man has all the qualities, may be you can give him. With that, a bit of influence comes in from politics.

There are different reactions as to whether political patronage played a big role in the allocation of scarce resources, which in turn affected the livelihood patterns and strategies of the youth. The majority of the respondents thought that with bottomup or participatory planning, political patronage is less important in the kind of strategies the youth adopt. They argued that the way to avoid such a scenario is by enhancing the capabilities and capacities of the communities through involving them in the process of making development plans that act as a basis for allocating local government funds. The Local Government Act requires that representatives, including those of the youth, must make decisions on the prioritization and allocation of funds. In fact, the district councils and the councillors are the planning authorities under decentralization. In addition, there is the technical planning committee composed of departmental heads. The technical planning committee coordinates planning-related activities for purposes of fulfilling functions of planning in the Local Government Act. The planning units implement district plans

on behalf of the district council based on the budget drawn up on a participatory basis. Likewise, the sub-county council is the planning authority at the lower levels of government headed by the sub-county chief but the youth have only one representative who may not alter the decisions made. The problem with such a system is that the youth, who constitute part of the vulnerable segment of the community, even though there are affirmative action policies in place for them, usually find themselves outside the decision-making framework. As earlier mentioned, the lack of regard for the youth based on generational differences affects what they get. My interview data indicates that policy-makers associate the youth with the Ministry of Labour, Gender, and Youth. In terms of allocation of resources, the ministry is under-funded and is only remembered when there is a National Youth Day. Even though the affirmative action includes youth, they are normally left out just because of the perception that they are not worthy and do not form part of the priority areas. IV. Conclusion This paper has shown that the youth in the three areas in Uganda engage in different activities for their livelihood. The majority of the youth’s livelihoods are outcomes of network relationships with their peers or friends rather than with their relatives or kin. There are differing theoretical and practical conceptions of youth’s livelihood patterns yet there is a gap between what has been identified and how much of what has been identified can be explained. The greater part of the explanations focuses more on tangible economic assets and fails to acknowledge the importance of intangible assets such as the social capital network connections, especially friendship networks. My study also indicates that there are numerous large-scale

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changes, such as changing farming modes, the democratization process, and population migrations that affect and shape rural youth’s livelihoods at the grassroots level. The puzzle here that needs further investigation is that given all these changes – large and small – what are the changing values and practices shaping youth’s social networks as they develop solidarities to better their livelihoods? What is the role of family versus friendship networks in the accumulation of social capital, given these changes? Are the youth today still a useful category of society that cannot be ignored, given the advent of multiparty politics in Uganda?

References

Atekyereza, Peter (2001). Critical Factors for Family Studies Analysis in Uganda: A Case Study of Changing Family Forms and Functions PhD Thesis. Linz: Department of Policy and Development Research, Johannes Kepler University. Bird, Kate and Shepherd, Andrew (2003). “Livelihoods and Chronic Poverty in Semi-arid Zimbabwe” World Development 31 (3): 591-610. Bonger, Tenkir (2000). “Resources, Poverty and Human Development in Rural Uganda” Africa Development 25(3 & 4):31-73. Bryceson, Deborah (1999). “African Rural Labour, Income, Diversification and Livelihood Approaches: A Long Term Development Perspective” Review of African Political Economy 80:171-189. Bryceson, Deborah (2000). “Disappearing Peasantries: Rural Labour Redundancy in the Neo-Liberal Era and Beyond”, pp. 299-326 in Disappearing Peasantries? Rural Labour in Africa, Asia and Latin America, edited by Deborah Bryceson, Cristobal Kay and Jos Mooij (Eds.) London: Intermediate Technology Publications.

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Chambers, Robert (1984). Rural Development: Putting the Last First. London and New York: Longman. Chambers, Robert (1995). Poverty and Livelihoods: Whose Reality Counts? Brighton: Institute of Development Studies at the University of Sussex. Chambers, Robert (1997). Whose Reality counts? Putting the first last, London: Intermediate Technology. Chekwoti, Caiphas, Eria Hisali and Lalobo Odongo (2003). Report of the National Policy Inventory/Data Bank, The Parliamentary Commission: Parliament of Uganda. De Haan, Arjan, Karen Brock and Coulibaly Ngolo, (2002). “Migration, Livelihoods and Institutions: Contrasting Patterns of Migration in Mali” Journal of Development Studies 38(5):37-58. Ellis, Frank (2000). Rural Livelihoods and Diversity in Developing Countries. London: Oxford University Press. Ellis, Frank and Bahiigwa, Godfrey (2003). “Livelihoods and Rural Poverty Reduction in Uganda” World Development 31(6):997-1013. Ghazali, Suriati (2003). “Kut (Informal Rotating Credit) in the Livelihood Strategies of Urban Households in Penang, Malaysia” AREA, 35 (2):183194. Hulme, David (2003). “Chronic Poverty and Development Policy: An Introduction” World Development 31 (3): 399-402. Hulme, David, and Shepherd, Andrew (2003). “Conceptualizing Chronic Poverty” World Development 31 (3): 403423. Jacobsen, Karen (2002). “Livelihoods in Conflict − The pursuit of Livelihoods by Refugees and the Impact on the Human Security of Host Communities” International Migration 40 (5): 95-123 2002.

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State, Andrew Ellias (2005). A Comparative Study of Social Capital Networks and Livelihood Patterns and Strategies in Bushenyi, Kibaale, and Kyenjojo Districts, Uganda, unpublished PhD Dissertation: University of Minnesota. The Monitor newspaper editorial (2003). 27 October 2003.

Uganda Government. 2001. The National Youth Policy, Kampala: Ministry of Gender, Labour and Social Development. Uganda National Bureau of Statistics (UBOS)(2002). The 2002 Uganda Population and Housing Census Main Report, Entebbe: UBOS.

DEPARTMENT OF SOCIOLOGY FACULTY OF SOCIAL SCIENCES MAKERERE UNIVERSITY The Department of Sociology is one of the 4 departments under the Faculty of Social sciences with over 2000 students offering various subject courses. The Vision of the Department of Sociology is to enhance excellence in training high-level human resource that relevant to both local and international needs and generate sociological knowledge directed towards understanding society, social relations and problem solving at intellectual, policy and practical levels. The Mission of the Department of Sociology is to use the methods, philosophy and literature of Sociology and Social Anthropology to equip students with sound sociological understanding and problem solving analytical skills relevant to societal development of Africa and the world. Objectives of the programmes in the Department are: 1) To foster quality teaching that equips students with the sociological knowledge and analytical skills about society that is beneficial to the student’s career in Sociology. 2) To promote quality sociological research and output generation that will enhance understanding of society, social relations and problems. 3) To provide academic, policy and practical guidance on social scientific knowledge that enhances problem-solutions to societal needs and problems or dilemmas. 4) To provide a solid foundation upon which students may progress to graduate studies in Sociology, Criminology and Social anthropology and other related disciplines. 5) To network with academic and actors working on development in still developing countries as well as service occasional students from the region and abroad plus other University programs. The Department started teaching a revised curriculum beginning with the 2007/2008 intake that is more practical and relevant to today’s societal needs. The curriculum competes favorably on the international scene in the three areas of specialization i.e. General Sociology, Criminology and Social Anthropology and African Studies. The department also runs two Graduate programs, i.e. MA in Sociology (since 1997) and MA in Rural Development (starting 2008/09). The average completion rate for the MA in Sociology is currently at 74.7%. Admission of student for PhD by research is also available. Further inquiries can be directed to: The Head, Department of Sociology Faculty of Social Sciences Makerere University P. O. Box 7062, Kampala Tel: 0414-540650 0782-309276 Email: [email protected] Vol. 8 No.2, December 2007 ________________________________________________________________________

Fighting Corruption in Uganda: 1986-2006 Steven Arojjo Obbo Ofumbi

Abstract This article discusses Uganda government’s fight against corruption from 1986 to 2006. It analyses the focus of Uganda’s anti-corruption approach, and shows that the current anti corruption efforts mainly utilise the legal, market and political approaches. For the legal approach to be effective, the laws need to be reformed. The societal approach needs to be promoted. This will enable the population take keen interest in fighting corruption. The private sector and civil society organisations are major players in the fight against corruption. This needs to be reflected in the government action taken to deal with corruption.

Introduction

strong and have been cited as important determinants of bureaucratic corruption. Individuals who become successful in the public sector or the exchange economy are expected to share the benefits with their extended family and their ethnic cleavage. Thus, a civil servant may engage in corrupt activities in an effort to meet personal obligations to members of his family or ethnic group (Alam 1989, Gould & Mukendi 1989).

This paper analyses the measures put in place to fight corruption in Uganda in the period 1986-2006. The paper highlights why corruption is an issue in developing countries. The paper defines and theorises corruption and various anti-corruption measures. Strategies for fighting corruption are discussed including their shortcomings. Uganda government’s responses to corruption are discussed in detail with specific reference to the office of the Inspector General of Government (IGG), The Local Government’s Act of 1997 (amended 2001), The Leadership Code, The Ministry of Ethics and Integrity, Local Councils and the privatization policy. The role of Civil Society Organisations (CSO) and the private sector in the fight against corruption are also highlighted. In the majority of developing societies, individual rights are often subordinate to the rights of the group or social cleavage. As a result, loyalty to the ethnic group is considered more important than individual rights or personal accountability. In Africa, these particularistic attachments are quite ___________

Defining Corruption

While there is no universally agreed definition of corruption, the definition provided by Klitgaard, MacLean-Abaroa and Parris (1999) will be adopted for this study “Corruption means the misuse of office for private gain. The office is a position of trust, where one receives authority in order to act on behalf of the institution, be it private, public, or non-profit”. Unlike other formulations which emphasise the misuse of “public office for private gain” this formulation demonstrates that corruption can occur not just in the public sector, but in any of the three major governance pillars – government, the private sector or civil society (United Nations-HABITAT & Transparency International, 2004:10-12).

1 Lecturer in the Department of Sociology, Makerere University. For correspondence E-mail: sarojjo@ ss.mak.ac.ug

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As there is no universally accepted definition of corruption, likewise there is no universally valid typology of corruption. All forms of corruption, however, are based on the potential conflict between the individuals’ professional and personal interests. Summaries of the most common forms of corruption are: bribery, embezzlement, theft and fraud, and extortion (Transparency International, 2004:11). The magnitude of corruption is often described as ranging from “petty corruption” to “grand corruption.” The phenomenon of corruption is very often a result of prevailing socioeconomic and governance conditions in a country. Factors such as poverty, scarcity, and lack of access to basic services, lack of information, overly bureaucratic institutions, particularistic tendencies that propel individuals to share benefits of holding public offices to abuse the office and low incentives for civil servants come together in various permutations and combinations to Probably the most common form of corruption, bribery is the giving of some form of benefit to unduly influence some action or decision on the part of the recipient or beneficiary. The person soliciting the bribe may vary from money or other valuables to less tangible benefits such as inside information or employment. Bribes may be paid on a case-bycase basis or as part of an ongoing relationship. The most common strategy for countering bribery is to criminalise it, often with an exclusive focus on cases involving public officials Extortion involves coercive incentives such as the use of threat of violence or the exposure of damaging information. Petty corruption can involve the exchange of very small amounts of money or minor favours by those seeking preferential treatment, the employment of friends’ etc. Grand corruption involves the distortion or corruption of central functions of government such as legal, economic or policy- making, the development and enactment of legislation, or judicial independence. The end result of grand corruption can be the loss of confidence in governance, rule of law and, in extreme examples political stability.

give rise to corruption. In Uganda corruption is viewed as widespread in the civil service due to the inadequacy of salaries paid to civil servants especially the non-senior ones (Public Service Review and Reorganisation Commission, 1990). Government has therefore set out to drastically cut down the size of the civil service. The reasons for this is to enable the remaining civil servants earn more. The government has been raising the salary of civil servants even if it has not reached the level of what has been called a “living wage”.

Theorising corruption and anticorruption

Klitgaard, MacLean-Abaroa and Parris (1999), argue that individuals tend to engage in corruption when the risks are low and the rewards high. Based on this assessment, they propose a simple heuristic formula for analysing the tendency for corruption to exist: C=M+D–A Corruption = Monopoly + Discretion – Accountability In explaining this formula, they state that corruption tends to flourish in situations where officials have a monopoly power over a good or service, unlimited discretion in deciding access and where there is no accountability. But at the same time societal ethical standards, play a big role in reducing corruption by acting as a deterrence.

Strategies for Fighting Corruption

The literature on fighting corruption identifies four types of strategies to minimise or eliminate corruption. They include societal, legal, market, and political strategies (Gillespie and Okruhlik, 1991: 80). Societal strategies place emphasis on the determination of a common standard of morality against which corrupt behavior can be measured. Vigilance by members of society and education to make it relatively costly for

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Fighting Corruption in Uganda: 1986-2006

individuals to engage in corruption is also emphasised (Dobel, 1978; Etzioni-Halevy, 1979; McMullan, 1961). Bureaucratic behavior can be constrained effectively by the law. Special commissions of inquiry or special prosecutors can be chosen to investigate individuals and groups accused of corruption; and, where the evidence gathered points to corruption, the judiciary system can judge and punish the guilty according to national laws (Ali, 1985). Market-related strategies for fighting corruption are based on the belief that there is a relation between the structure of the market and the incidence of corruption. The prescribed remedy is less government regulation and greater reliance on markets for the allocation of resources. Such an approach, however, appears to emphasise the manipulation of outcomes within existing rules instead of proper reform of the rules. The fault is not with the market, but with the rules that regulate the market. Since rules define market outcomes, greater reliance on markets for the allocation of resources without reforming existing rules will have little effect on outcomes, including bureaucratic corruption. Unless there is effective reform of the socio-political rules within which the market functions, incentives for opportunism will remain and corruption will continue unabated (Tilman, 1968). Political strategies for fighting corruption emphasise the decentralisation of the public sector. It is argued that corruption arises from the concentration of power in the hands of a few politicians and bureaucrats, and that a process, which provides citizens with greater access to public institutions, will significantly minimise opportunities for corruption within the country. Under this approach, an effective anti-corruption program is expected to emphasise political deregulation and the subsequent expansion of opportunities for citizens to participate

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in governance. Social scientists and policymakers who favor administrative reform as a way to minimise the incidence of corruption support increasing the legal compensation of bureaucrats in order to reduce the chances that civil servants will seek extra-legal income (Dobel, 1978; Gillespie and Okruhlik, 1991; Nas, Price, & Weber, 1986).

Rationale for Anti-corruption

The impetus for anti-corruption can be provided primarily by political exigency rather than by genuine interest in the efficient functioning of the nation’s political and economic institutions. In several countries, including those in Africa, post coup commissions of inquiry are usually designed to discredit the ousted government and help incoming elite gain recognition and legitimacy. Incumbents also use anti-corruption programs to help them stay in power and continue to monopolise the supply of legislation and the allocation of resources. An incumbent leader faced with deteriorating economic and social conditions and a challenge from opposition parties or groups may initiate a campaign to fight corruption within his/ her administration. The aim of this would be to direct attention away from existing problems and the government’s inability or unwillingness to provide effective solutions for those problems. Whether or not anticorruption initiatives are used for political exigency and how often are determined by several factors including “the personal values of the head of state, challenges from a counter-elite and popular discontent arising from socioeconomic conditions” within the country (Gillespie and Okruhlik 1991:82). In several African countries, politicians regularly use anti-corruption campaigns to help them stay in power. Anti-corruption programs can be used to discredit members of a previous regime, to destroy the

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reputations of leaders of the opposition, and to improve support among the population for the incumbent regime. Even if a government seriously and honestly wishes to fight corruption, existing approaches suffer from at least one obstacle: their success depends on the effectiveness of the counteracting agencies. In Africa, anticorruption programs depend primarily on the police, the national judiciary, and the press, and assume that those agencies are appropriately constrained by the law and are free of corruption. In addition to the fact that few African countries have a press that is independent and free of government, very high levels of corruption are not acted on by the police and national judiciary systems of most African countries. As a result, an anti-corruption program backed by those agencies is unlikely to be effective. Many anti-corruption programs are based on the manipulation of behaviours within what are inefficient rules and as a result, are unlikely to be effective. The stakeholders in the anticorruption fight have increased. The private sector and CSOs today are key players in the fight against poverty. The first step in an effective anti-corruption program is to select appropriate new rules in conjunction with all the stakeholders, making sure that the new social contract is capable of generating the outcomes desired by society. This requires investment in sensitisation and/educational programmes.

Government’s response to corruption

When the National Resistance Movement (NRM) came to power in 1986, it promised a fundamental change as opposed to a change of guards. The elimination of corruption was one of the most important concerns of government. “Corruption emerged not merely out of economic greed but also from the necessity of political survival since the basis of continued support for the politicians

was generally based on patronage sustained by the continuous flow of favours to one’s followers. The awarding of contracts which, before independence, was a monopoly held by colonial officials, was the first eye opener to the favours that can be bestowed by holders of public office” (Tumwesigye, 1995:87). But as Katorobo adds, the scope for corrupt behavior expanded when the number of public enterprises grew, local government centers were destroyed and power centralised. Machinery for inspection and supervision broke down and accounting and enforcement of morality virtually collapsed (Katorobo, 1995:19). As observed earlier, the political response to corruption was its inclusion among the top ten issues to be tackled by the NRM. Government basically used two approaches, anti corruption legislation and the establishment of the office of the IGG in 1986, which was charged with the fight against corruption and abuse of office. It was also charged with fighting human rights abuses. This last mandate was withdrawn in 1997 when the Human Rights Commission was introduced. The 1995 Constitution strengthened the office of the IGG by making it more independent and at the same time vesting the office with powers of arrest and prosecution.

Functions of the office of the IGG

The functions of the office of the IGG earlier spelt out in the IGG Statute 1988 part III section 7 (1), (2) and (3), was superseded by the Inspectorate of Government Act 2002. The Act mandates the IGG to investigate any breaches in the rule of law, corruption, abuse of office, occasioning injustice and neglect of duty by persons in public office. To fulfill the above mandate, the IGG is vested with the power to enter and search any premises and may cause prosecution to occur.

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Table: 1 Cases handled by IGG by calendar year Year 1996 1997 1998 1999 2000 2001

Number of Number of Completed New Cases Cases 848 586 1148 740 2944 2449 3318 2811 4809 4236 3294 3428

Number of Prosecutions

Number of Court Cases Resolved

Number of Convictions

6 31 47 100

0 6 8 20

3 1 6

Source: Annual reports to Parliament of the Inspectorate of Government (1996-2001). Some may be cases carried forward from the previous years. In only a small minority of cases do investigations lead to prosecution. The small number of cases prosecuted, resolved in court and convictions secured points to a problem in the rules/laws. Much as there are new legislation in place to deal with corruption, they are apparently not satisfactory in as far dealing with corruption is concerned.

In 1998, the IGG carried out the first National Integrity Survey covering all the 45 districts of the country at that time. The aim of the survey was to establish a benchmark in the fight against corruption. The survey revealed that seven forms of corruption were known by the households to exist in their districts. The most notable of these was bribery. In the same year Transparency International carried out a survey to produce a Corruption Perceptions Index, covering 85 countries, listed Cameron, Kenya and Nigeria, Tanzania and Uganda in the lowest 15% (Botswana, Mauritius, Namibia and South Africa were in the upper half – least corrupt – of the survey).

Table: 2 Household knowledge about forms of corruption Forms of Corruption known Bribery Embezzlement Fraud Nepotism/tribalism Misuse of official vehicles/ equipment Neglect of duty Diversion of funds Don’t know No answer

No. (%) households 13118 (71) 4012 (22) 522 (3) 3407 (19) 392 (2) 879 (5) 494 (3) 1454 (8) 1490 (8)

Source: Cockcroft and Legorreta, 1998 The small number of forms of corruption that can be identified by the people indicates that other forms of corruption can pass as uncorrupt. The forms of corruption listed by the IGG’s office include many more forms of corruption like, over-invoicing or underinvoicing, payment of salaries to non-existent workers (“ghost workers”), payment for goods not supplied or services not rendered (“air supply”), undercharging of taxes and duties on exports and imports involving false classifications, false declarations and false tariffs; purchases of goods and services at inflated prices, “ten percent commissions”, improper payments, misappropriation of public assets, the removal of documents from case files or even the disappearance of whole files, court decisions in which awards for damages of very large sums of money do not correspond to the injury

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actually suffered, or the indefinite number of adjournments of hearing of cases or of given judgments (Ruzindana, 1995). The other forms definitely exist; the difficulty though is that they are often outside the purview of public perception. It is in these lacunae that political corruption and grand corruption are to be found. Both service workers and households were asked about how much corruption they thought existed in public service. It emerged that households think that higher levels of corruption exist in the public service than do service workers. Seventy percent of the households (n=12038) said that there was “very much” corruption as opposed to 37% (n=571) of service workers providing the same response. Most of the service workers, 56% (n=865) said that corruption in public services was “somewhat” corrupt. Only 26% (n=4464) households agreed with this view. Table: 3 Knowledge about IGG activities among households who have heard of the IGG Activity Investigates allegations of corruption Educated the public Stops corruption Encourages corruption Advises, empowers people Nothing useful Don’t know/not able to answer

No. (%) households 1780 (37) 38 (1) 242 (5) 9 (0.2) 423 (9) 11 (0.2) 2371 (50)

Source: Cockcroft and Legorreta, 1998 The 2003 Integrity Survey revealed that the number of people with knowledge about the IGG had risen from 32% to 70% overall. This shows that a lot was done to bring the true role of the IGG to the public. This should hopefully help in empowering the people to utilise the services of the IGG and also to reduce the cynicism about the role of the IGG. But despite this improvement, accurate knowledge about

how to file complaints on corruption with the IGG was still a problem. While most of the respondents knew of the IGG, only a minority said that they knew how or where to report cases of corruption. Only 21% of the respondents knew the correct procedure to report corruption cases and less than 5% had personally reported a case. The low level of reporting could be an indication of the difference in conceptualisation of corruption existing among the population. This points to the need for education/sensitisation of the population on what constitutes corruption in the Ugandan context. In order to deal with corruption successfully, there is need for the stakeholders to contribute to the exercise. In relation to this, both the households and service workers interviewed said that the following areas need to be addressed by both central and local governments: sack/discipline corrupt workers, prosecution, better pay and conditions for workers, training and supervision. The responses with regard to what communities can do to deal with corruption, showed that most of the respondents support reporting cases of corruption, especially service workers 72% (n=1146) as opposed to households 48% (n=8739). Since most service workers support the reporting of corruption cases, it offers a firm basis for the enactment of legislation that facilitates and protects whistle blowing. At the same time the small number of people who advocate reporting of corruption cases can be viewed as a sign that the societal approach to dealing with corruption still requires much work. The populace can also be seen to lack a grasp of the magnitude of corruption.

The importance of legislation against corruption

Laws against corruption are critical for several reasons. The first and foremost is that

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laws signal the determination of a society to fight corruption. Second, laws help to prosecute those who are corrupt when such people are caught. Third, such legislation is useful to the extent that laws can aid in minimising corruption through deterrence or help in apprehending criminals through cooperation. Fourth, many persons choose to be law-abiding, even when enforcement seems unlikely; this is true, in particular, of some transnational corporate groups, which require their branches and subsidiaries to obey all laws, even those widely ignored (Schroth and Sharma, 2003). This significance not withstanding, it begs the question: to what extent are African countries using such laws to fight corruption? The Local Government’s Act 1997 gives the Auditor General the mandate to audit the accounts of every Local Government Council and administrative unit. The Auditor General also has the power to appoint an auditor to act on his/her behalf. The Act further empowers his/her office to carry out surprise audits, investigations or any other audit considered necessary. Using the Auditor General’s reports, the Public Accounts Committee (PAC) conducts public hearings in which officials who have been implicated in corrupt activities are put to task. Since the PAC does not have the powers of a court of law, the judiciary takes over with the prosecution of cases. The Auditor General plays an important role in the inspection and audit of government transactions and submission of reports to parliament for action. In 1992 the Leadership Code of Ethics was enacted and it required the annual mandatory declaration of assets, incomes and liabilities by public officials. The Code also criminalises corruption, private use of public information, influence peddling and abuse of power. The code stipulates the legal sanctions that may be applied to a public official who is found to have violated it.

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In all countries, there is a Leadership Code, whether written or unwritten. This is because corruption can only exist with the connivance, even if passive, of the political leadership and the public. Therefore, it can only be eradicated when both the political leadership and the public make a concerted effort not to tolerate it. The Leadership Code is one of the means binding leaders to behave themselves. Leadership codes not only serve the purpose of committing leaders not to be corrupt but also help the public not to tolerate any form of corruption. The Leadership Code in existence in Uganda provides for the annual declaration of income, assets and liabilities by the leaders. It gives a minimum standard of behaviour and conduct for leaders with regard to gifts and benefits in kind, and with regard to conflict of interest, contracts and tenders in which a leader may have an interest, and with regard to the use and abuse of public property. The Code also gives the legal sanctions that can be taken against a leader who violates its provisions (Ruzindana, Workshop Proceedings 1995). One of the appeals of decentralisation is that it is viewed as engendering accountability. Part of the reason for embarking on decentralisation therefore was the hope that corruption would be dealt a blow. In the pre-decentralisation era, each line ministry responsible for the particular sector determined financial transfers. The amounts allocated to each district tended to be a product of the negotiating powers of the district officials at the ministry headquarters. With financial decentralisation, that has changed, with two important changes emerging. The central government allocations to local government’s inter-governmental transfers are now governed by objective criteria. Secondly, the Ministry of Finance, Planning and Economic Development (MFPED) now transfers local government

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funds directly to the accounting officer of a district. This new method has resulted in the sealing of loopholes hitherto used by the corrupt between MFPED, line ministries and the districts. “Ghost workers” have been spotted and eliminated. But corruption has tended to be “localised” in the sense that it now finds expression in the corrupt award of contracts and tenders at the district level, which often results in the provision of substandard services. A new Ministry of Ethics and Integrity was established in 1998 under the office of the President. The Minister of State for Ethics and Integrity was given the mandate to propose new or reform existing laws against corruption. The minister is also charged with monitoring the observance of ethics and integrity within government institutions. Given the fact that the Uganda Law Reform Commission is to “study and keep under constant review the laws of Uganda with a view to making recommendations for their systematic improvement, development, modernisation and reform” (Uganda Law Reform Commission, 2000:xiii), the mandate for reforming laws related to corruption should be vested in the commission. The privatisation policy of government is in part intended to divest the state of the responsibility of shouldering commercial enterprises. This has been done to stop government wastage in supporting nonperforming enterprises, reduced to this state by plunder of officials in charge of them. The plunder aside, these enterprises also provided employment as rewards for politicians and their relatives. This way of running public enterprises only helped the flourishing of corrupt practices. But “discriminating and corrupt privatisation have been common because political leaders have wanted public companies to be divested to their favoured clients. Privatised enterprises may no longer serve as patronage vehicles, as did earlier

parastatals, but incumbent governments want them to be in the hands of political loyalists rather than political opponents, partly because this may help them consolidate their political control” (Tangri and Mwenda, 2001:132). The local council structures represent a shift in the basis of authority exercised by local administrative leaders. When the present government came to power, there were already other organs like the local administrative line-up from the sub-parish to the county chiefs playing similar roles as those of the new Resistance Councils (RCs). That not withstanding, the RCs were firmly established and in the Resistance Council Statute of 1986, their roles vis-à-vis other state organs were defined. It is important to note that the emergence of the Resistance Council also represented a shift in the basis of authority exercised by the leaders in these administrative structures. Hitherto, the offices held by such leaders were on the basis of appointment. In the RC structure, however, leadership was through elections. The RCs therefore represented a change in two ways. First, by democratising the process of decision making at the grassroots through the participatory approach in decision making. In the second sense, the RCs marked the decentralisation of major decisions affecting the local communities. The resultant impact of the above has been greater civil involvement in matters of public concern. The Local Council courts handle civil and customary cases while criminal cases are forwarded to the police. This partnership in dealing with the issues which concern local communities, involves local nonGovernment Organisations (NGOs) like Action For Development (ACFODE) and the Federation of Women Lawyers (FIDA). In the pre-decentralisation era, almost all local governments spent money without approved budgets. The process of budgeting

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and expenditure was known to only a few. This made it hard to evaluate budget performances and it was equally hard to detect unauthorised expenditures. With the financial decentralisation in force, all councils are required to approve their budgets. The requirement to have budgets drawn and endorsed by councilors, local government appointed officials and the centre (ministries of Finance, Local Government and others) has enabled all the key players to know what has been agreed on. The above in return makes it possible for them to monitor and evaluate the financial management and budgetary performance of local governments. No African country has, or ever had, a law intended to criminalise foreign bribery (Schroth and Sharma, 2003). No African country is a party to any of the antibribery conventions, although 14 countries recently signed, and may in time ratify, the SADC Protocol against Corruption. The Organisation of Africa Unity (OAU) produced a draft Convention on Combating Corruption at the end of 2001, which was adopted in 2003 as the African Union Convention on Preventing and Combating Corruption. The convention aims to promote mechanisms to fight corruption in the public and private sectors, to facilitate cooperation among state parties, and to coordinate the The Paragraph 66(1) of the Nigerian Corrupt Practices and Other Related Offences Act No. 5 of 2002 comes closest to attempting to criminalise foreign bribery, but in general the offences defined in Sections of the Act require some involvement of a Nigerian government entity or public official. The aim appears to be the prevention of bribery of Nigerian officials while travelling outside the country. Republic of Angola, Republic of Botswana, Democratic Republic of Congo, Kingdom of Lesotho, Republic of Malawi, Republic of Mauritius, Republic of Namibia, Republic of Seychelles, Republic of South Africa, Kingdom of Swaziland, United Republic of Tanzania, Republic of Zambia, Republic of Zimbabwe

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policies and legislation relevant to corruption (Webb, 2005:12). The Convention’s scope is broad and covers active and passive bribery, influence peddling, illicit enrichment, and concealment of proceeds derived from corrupt acts. Its requirements are extensive and appear to be binding. States parties “undertake to” adopt legislative and other measures to establish the Convention’s offences, strengthen national control measures to ensure the setting and operating of foreign companies in their territories are subject to the national legislation, establish independent national anti-corruption authorities, pass laws to protect informants and witnesses, and punish those who make false and malicious corruption reports. As of November 2004, only 4 of the 53 states had ratified the Convention. It requires 15 ratifications to come into force. The African Union Convention is comprehensive on paper and is largely phrased in mandatory terms. However, its expansiveness may actually deter countries from ratifying it and the lack of follow-up mechanism enables countries to delay or avoid implementation (Webb 2005).

The Role of Civil Society in the Fight Against Corruption

Civil Society Organisations are important players in the fight against corruption. This is mainly in the establishment of mechanisms for the public awareness campaign on corruption. Transparency International has played a significant role in mobilising action and support against corruption in Uganda. Transparency Uganda’s primary goals is the fight against corruption, the forging of a partnership with mainstream government agencies charged with fighting corruption like; the Vice President’s Office, Office of the IGG, the Auditor General, the Office of the Director of Public Prosecution and the Director of the Criminal Investigations

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Department. The aim of this partnership is to strengthen support and understanding by the public in the fight against corruption. It is also meant to enhance transparency and accountability in the conduct of public affairs and public procurement. Transparency Uganda holds an annual anticorruption week in which recommendations are made and progress monitored. In one of such evaluations, drama was identified as an effective tool of disseminating the anti-corruption messages. Since 1997, the organisation has staged drama productions alongside the seminars that have proved even more popular. Transparency Uganda, Fredrich Ebert Foundation and United States Agency for International Development (USAID) signed a contract in 1997 with the aim of producing drama productions of the above nature. The spread of civil society culture in Africa remains the key factor that could stem the tide of corruption. This could be done through representing its members in government, exerting external pressure, through demonstrations, lobbying and civil disobedience. In addition, these institutions can help spread the values of democracy and citizens sensitised to civil and political rights. The call to support civil society in Africa should not be perceived as contributing to the weakness of the state and thereby making it incapable of fighting corruption. Empowering the civil society will actually enhance the state through the improvement of state-society relations that in turn make it easier to tackle corruption. Activating the interest groups and promoting the participation of social groups are key steps in strengthening of the state (Rahman Hamdy Abdel, 2001:186). Civil society needs to be better organised and equipped to hold governments to higher

standards of transparency and accountability. Civil society organisations also need to have internal checks and balances to avoid excesses, a basis they will need to advocate for the same in government.

The private sector’s role

For the last decade or so, African countries have made efforts to attract Foreign Direct Investment by designing and implementing reform policies. Foreign Direct Investment forms an important part of Uganda’s development, totaling to US $ 0.96bn (19% of GDP) at the end of 2000 (Bank of Uganda, Uganda Investment Authority and Uganda Bureau of Statistics, 2004). The private sector is rapidly expanding in most of Africa after the introduction of privatisation. Almost all African countries now have investment codes. Corruption, however, remains a problem to contend with in many African countries including Uganda. A 2003 study on private sector investment and investor perception established that the major hindering factors to investment were: foreign exchange trends, inflation, interest rates, tax administration, bureaucracy/corruption, access to credit, tax policy, incentives, international commodity prices and domestic competition (Bank of Uganda, Uganda Investment Authority and Uganda Bureau of Statistics, 2004:5). Svensson (2000:4), observes that Ugandan firms typically have to pay bribes when dealing with public officials whose actions directly affect the firms’ business operations. Such dealings cannot easily be avoided when, for example, exporting, importing or requiring public infrastructure services. The data revealed that more than 80% of the firms need to pay bribes during a typical business year. Corruption has negative effects on the levels of both foreign and domestic investments. Investors will ultimately avoid environments where corruption is rampant because it increases the cost of doing business

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and undermines the rule of law. Corruption is also often associated with a high degree of uncertainty, something that always drives investors away (Sullivan and Shkolnikov, 2004:4). There is no doubt the private sector has a responsibility to combat corruption. The private sector must set an example by establishing fair and transparent practices as the way of doing business. Ethical behaviour and transparent processes should not be the exception, but the rule. A successful market economy cannot be built on a fractured foundation, which is why the private sector must play a critical and prolonged role in addressing the issue of corruption. The basic way for the private sector to be involved is through the establishment of fair and transparent processes. These processes include among others, corporate governance and business ethics. In addition, the private sector must demand accountability by those who don’t follow the rules, regardless of whether they are members of government or corporate Chief Executive Officers (CEOs.) Business associations are the glue that cements the private sector movement towards market reforms. Because of this, they are key players in the establishment of measures that combat corruption. Associations can accomplish what individual companies, regardless of their size, cannot and because of this they offer the best chance for the private sector to achieve success. There are several ways the associations can address the issue of corruption. First of all, business associations can demand that government sign and enforce the OECD anti-corruption convention and subsequent legislation. They can put the government on notice that those choosing not to follow these rules will be held accountable in the court of public opinion or the court of law.

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Second, the associations play a key role in serving as information sources for government, the media, and the public at large. Associations have access to volumes of information on the effects that corruption has on a society as a whole. The government can use this information as a resource instead of looking at business associations as an adversary. Third, business associations play a critical role as “watch dogs” of government’s movement towards fairness and transparency. Government must be aware that its actions are being monitored and that the “light of public opinion” will shine on their actions. Business associations must shine the spotlight on every corner of government and into the private sector as well. An area where this could be done is tax education of the public so that tax payers know the criteria for assessments. Forth and one of the most important roles of business associations in the battle against corruption are their continual support of increased private sector reforms. It is no secret that corruption is bad for business. This being the case, the faster market reforms take place, the more corruption will be reduced, since one of the main causes of the corruption is the un-level playing field caused by unfair and non-transparent practices. Finally, business associations must do everything possible to establish ethical behaviour as a societal norm. To this regard, the associations themselves must be above reproach. They must set the highest standard for the activities as an example for their members, government, the media and society as a whole.

Conclusion

In the fight against corruption, much emphasis has been placed on the need for public watchdog bodies. However, laws

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that provide opportunities to the corrupt need to be changed. The social approach in fighting corruption needs to be promoted. Anti- corruption efforts will get nowhere if the population is not agreed that it is a problem and they can do something about it. Civil society organisations and the private sector play a key role in social and economic engagement. They need to be involved in the fight against corruption first by setting up internal mechanisms that close all opportunities for corruption. Secondly, they need to proactively engage government with the aim of legislating and more importantly acting against the corrupt in high places.

References

Alam, N. S. (1989). Anatomy of Corruption: An Approach to the Political Economy of Underdevelopment, American Journal of Economics and Sociology, 48 (4): 44158. Bamidele, O. (1999). Combating Corruption and Economic Crime in Africa – An Evaluation of the Botswana Directorate of Corruption and Economic Crime, International Journal of Public Sector Management, Vol 12, No 7,(604-614). Bayley, D. H. (1966). The Effects of Corruption in a Developing Nation, The Western Political Science Quarterly 19(4): 719-32. Cockcroft, A & Legorreta, J. (1998). National Integrity Survey: Uganda, CIET International, Kampala. Dobel, J. P. (1978). The Corruption of a State, American Political Science Review, 2 (September): 1958-73. Gould, D. J. & Mukendi, T.B. (1989). Bureaucratic Corruption in Africa: Causes, Consequences and Remedies, International Journal of Public Administration, 12 (30): 427-57. Gullespie, K. & Okruhlik, G. (1991). The Political Dimensions of Corruption

Cleanups: A Framework for Analysis, Comparative Politics 24 (1) 177-95. Katorobo, J. (1995). National Integrity System in Uganda, in Petter Langseth and Fiona Simpkin (eds), Integrity Workshop in Uganda II Final Workshop Proceedings. Klitgaard, R, MacLean-Abaroa, R, & Lindsey P. H. (1999). Corrupt Cities: A Practical Guide to Cure and Prevention, the World Bank & Institute of Contemporary Studies, Oakland, California. K2 - Consult Uganda (2003). Final Report: Second National Integrity Survey, Vol 1. Mbaku, M. J. (1996). Bureaucratic Corruption in Africa: The Futility of Cleanups, Cata Journal, Vol 16 No. 1 (Spring/Summer 1996). McCord, M. T. (n.d) The Role of Business Associations, Civil Society and Media in Addressing Corruption, Center for International Private Enterprise, Washington D.C. McMullan, M. (1961). A Theory of Corruption, Sociological Review, 9 (2): 181-201. Ministry of Public Service and Cabinet Affairs (1990). Public Service Review and Re-organisation Commission, Kampala. Nas, T. Price, A. & Weber, C. (1986). A Policy-oriented Theory of Corruption, American Political Science Review, 80 (March): 116-117. Rahman, H. A. (2001). “Africa in the 21st Century: Prospects for Political Development”, in Olugbenga Adesida and Arunma Oteh (Eds), African Voices: African Visions, The Nordic Africa Institute, Uppsala. Ruzindana, A. (1995). Combating Corruption in Uganda, in Petter Langseth and Fiona Simpkin (eds), Integrity Workshop in Uganda II Final Workshop Proceedings. Sullivan, J.D. & Shkolnikov, A. (2004).

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Combating Corruption: Private Sector Perspectives and Solutions, Economic Reform Issue Paper, Center for International Private Enterprise. Svensson, J. (2000). The Cost of Doing Business: Firms’ Experience with Corruption in Uganda, Africa Region Working Paper Series No. 6, The World Bank. Tangri, R & Mwenda, A. (2001), Corruption and Cronyism in Uganda’s Privatisation in the 1990’s, African Affairs, 100:117133. Tilman, R. (1968) The Emergence of Clack Market Bureaucracy: Administration, Development and Corruption in New States’, Public Administration Review 28 (September-October): 1437-44. Tumwesigye, M. B. (1995). The Role of the Inspector General of Government,

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in Petter Langseth and Fiona Simpkin (eds), Integrity Workshop in Uganda II Final Workshop Proceedings. Uganda Law Reform Commission (2000). A Study Report on Rape, Defilement and other Sexual Offences, Publication Number 1. UNDP (1995). Human Development Report, 1995, New York: Oxford University Press. UN-HABITAT (United Nations Human Settlement Programme) and Transparency International (2004). Tools to Support Transparency in Local Governance. Urban Governance Toolkits Series, Nairobi: UN-HABITAT. Webb, P. (2005). The United Nations Convention Against Corruption: Global Achievement or Missed Opportunity? International Journal of Economic Law, Vol 8, No. 1.

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Victimisation Among Urban Citizens And Some of their Implications: an Analysis of the 2000 International Victim (Crime) Survey in Urban Kampala, Uganda Mathias Ssamula*

Abstract The international crime victim survey was conducted in five administrative divisions of urban Kampala namely, Rubaga, Kawempe, Makindye, Nakawa and Central Kampala. The survey interviewed 1,000 respondents aged 16 years and above. It aimed at collecting and analysing data on the crime situation in urban Kampala by establishing the victimisation rates in order to inform policies of crime prevention and control. Respondents were asked to relate incidents of crime, which had happened to them over the last five years and over a one year period prior to the conduct of the survey. The findings indicate that victimisation was most prevalent in the 16-34 age bracket. Respondents had been victims of personal theft, attempted burglary, burglary with entry and assault/threats. Theft from car had the least victimisation rates over the past five years. Over a one year period, respondents had been victims of consumer fraud, corruption, personal thefts, burglary with entry, theft of car and theft of motorcycle. Victimisation over crimes against the person is concentrated mostly in lower residential areas than in other areas whereas victimisation over property crimes is predominant in the upper and middle class residential areas. Apart from sexual offences, more men than women are victimised over property crimes and crimes against the person.

1.0 Introduction

For a long time, the only available information on crime and criminal justice was through official records of reported/registered cases and/or suspects and charged, tried and sentenced offenders. This data involves the administration of criminal justice or at most, the citizens’ action in terms of reporting incidents to the police. Such information is important in determining the volume of and ____________ * Mathias Ssamula is currently a member of

staff of Department of Sociology, Makerere University. This study received financial support from the Netherland Ministry of Justice and United Nations Crime Institute (UNICRI), Rome. Direct all correspondence to [email protected] 102

filtering in criminal justice administration activities. There is no measure of this information effectiveness in terms of criminal activities that take place but are unknown to the administration. Nor does it provide any indication of the propensity of citizens to report incidents, or give useful information on the repercussions of victimisation and attitudes towards crime and criminal justice. Official criminal justice records reflect the logic of sustained and self-referential system of justice and administration thereof with offenders as prime clients. The lack of information on the “darkfigure” and citizens’ direct contact with crime and criminal justice administration prompted the initiation of surveys of victims of crime which provides citizens’ first hand

Victimisation Among Urban Citizens And Some of their Implications

experiences with crime and criminal justice. Victimisation surveys help to illuminate the victim side of the offender-victim relationship indicating the characteristics of individuals who are most likely to have offenses committed against them and, the interpersonal or social dynamics of criminal incidents, among others. Furthermore, these surveys provide valuable information on the extent of criminality, in that they uncover crimes that have not been reported to the police as well as violations known to the authorities. In essence, “A victim survey is a way of measuring the crime rate without making use of police records.” Offenses that are not reported to and those not recorded by the police, are also taken into account. Victim survey(s) give an alternative comparative perspective to statistics of offences recorded by the police and other law enforcement agencies. This study therefore asked respondents to state the number of times they had been victims of property crimes and crimes against the person over the past five years and one year period before the conduct of the survey.

1.1 Objective

The survey aimed at collecting and analysing data on the crime situation in urban Kampala by establishing the victimisation rates in order to contribute to information relevant to policies of crime prevention and control.

2.2

Methods and Materials

This was a one-round survey and the respondents were identified within the household. A two stage sampling procedure was followed to select the study population. During the first stage, a residential address (house, flat, etc) was selected using the systematic random sampling method. In the second stage the respondent to be interviewed was selected by determining the dates of births of all persons in the households who

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were aged 16 years and above, and then interviewing the one whose birthday came soonest after the date of the interview. The sample size of urban Kampala was 1,000 respondents. Male and female interviewers were used and a letter of introduction explaining the objectives and importance of the survey was given to each fieldworker with instructions to show it and to read it aloud to the respondents. The introduction letter stressed that all information would be treated confidentially. Interviewers were trained by the research coordinator on the objectives of the survey, the specific administrative procedures, to interview the occupants of the main house or dwelling on a stand, the interviewing procedure, the handling of sensitive questions, completion of the questionnaire and how to deal with multiple questions. The Statistical Package for Social Scientists (SPSS/PC) data entry software package developed by the United Nations Crime Institute (UNICRI) was used for data processing together with the main tables drafted by UNICRI thus ensuring a high degree of uniformity.

1.0

Findings

2.1 Description of the sample The total sample size of the victim survey was 1,000 respondents, out of which 494 (49.4%) were males and 506 (50.6%) females. The largest number of respondents, 498 (49.8%) were residing in low class residential areas while 306 (30.6%) were of middle class and 192 (19.2%) were of highclass residential area. Four respondents were not classified.

United Nations Crime Institute based in Rome, Italy

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3.0

Prevalence - Victimisation Rates

3.1 Victims of specific forms of crime in the past 5 years and over one year period Respondents had been victims of one or more forms of crime in the past five years and over one year period prior to the conduct of the survey. Over the past five years, personal thefts ranked highest with 439 (43.9%) victims out of the 1,000 respondents. This was followed by attempted burglary 229 (22.9%), burglary with entry 219 (21.9%) and assault/threats, 184 (18.4%). Theft from car had the least victimisation rates with 130 (13.0%) victims. Victimisation rates over a one year period show that consumer fraud ranked highest with 502 (50.2%) victims, followed by corruption 346 (34.6%), personal thefts 158 (15.8%), and burglary with entry, 62 (6.2%) victims respectively. Theft of car had 3 (0.3%) victims and theft of motorcycle had 4 (0.4%) victims. Theft of car and motorcycle showed the least general victimisation rates. (See tables 1&2 in appendices A&B)

3.1.1 Theft of vehicles

Out of the 1,000 respondents, 20 (2.0%) had their cars stolen in the past five years. Of these 9 (35.0%) were male while 13 (65.0%) were female. The largest number of 10 (50.0%) were residing in middle class areas followed by 9 (40.0%) from high class areas and 2 (10.0%) in lower class areas. On the other hand, out of the 1,000 respondents, 3 (0.3%) were victims of theft of a car over one year. Furthermore, out of 283 motorcar owners, 3 (1.1%) were victims of theft of a car. (See table, 1 Appendix, A) The above findings indicate that car ownership is determined to a large extent by income and residential area status. People with high incomes reside in high class areas and are regarded as rich and own a number

of cars, followed by those in middle class residential areas. This could explain the low victimisation rates in low class areas and high rates in the middle class areas. The fact that more people who reside in high class areas employ security protection measures than those in the middle class areas explains the differences in victimisation rates in those areas. Theft from car registered 130 (13.0%) victims in the past five years and of these the largest number of 80 (16.5%) were male as compared to 50 (38.5%) females. This finding indicates that males more than females fell victims of theft from car. This is because ownership of property, including cars favour men rather than females. Furthermore, most victims 68 (52.3%) were from high class residential areas followed by 48 (36.9%) from middle class and 14 (10.8%) from lower status areas. These people’s cars often have valuables in them which attract thieves to break into. On the other hand, victims of theft from car over the last year were 47 (4.7%) out of the 1,000 respondents. Additionally, out of the 283 motorcar owners, 45 (15.9%) were victims of theft from car. Car vandalism had 62 (6.2%) victims over the past five years of which 33 (53.2%) were female and 29 (49.8%) were male. Out of the 283 car owners, 57 (20.1%) were victims of deliberate car damage in the same time period. This indicates that females are more susceptible to this form of crime than males. Offenders find it easier to attack females because they are considered weaker and an easier target. Most of these victims 31 (50.0%) were residents of high class areas followed by 21 (33.9%) of middle class and 10 (16.1%) from lower residential areas respectively. The above findings indicate that victimisation over property crimes followed a residential status pattern with residents of

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high class areas becoming the most victimised followed by those in the middle and low class residential areas respectively. 3.1.2 Theft of motorcycles Victims of motorcycle theft were 8 (0.8%) out of the 1,000 respondents. On the other hand, out of 112 motorcycle owners, 6 (5.4%) were victims of motorcycle theft in the past five years. This theft happened to 5 (62.5%) females and 3 (37.5%) males. Of the 8 victims of motorcycle theft 3 (37.5%) were residents of high-class areas and a similar number were from middle class and 2 (25.0%) were residents of low status areas. Over a one year period 4 (0.4) respondents were victims of theft of motorcycle. Furthermore, out of 112 motorcycle owners 4 (3.6) were victims of motorcycle theft. It should be pointed out that motorcycle theft was low at the time of the survey than it is to date hence the lower reported victimisation rates in the general population and among motorcycle owners. 3.1.3 Theft of Bicycles Out of the 1,000 respondents, 47 (4.7%) had their bicycles stolen in the past five years. Likewise, out of the 297 bicycle owners, 46 (15.5%) were victims of bicycle theft over the past five years. Of the 47 victims, 25 (53.2%) were male and 22 (16.8%) were female. Those residing in the middle class were 20 (42.6%) whereas 16 (34.0%) were from lower residential areas and 11 (23.4%) were from the upper class. The above findings indicate that people residing in both middle and lower areas stand a higher risk of victimisation over bicycle theft. It also reveals that men own more bicycles than females. This is probably because men use bicycles to ferry goods, while women hire them out for business purposes. Furthermore, out of the 297 bicycle owners, 8 (2.7%) had their bicycles stolen. This proportion is slightly

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lower than what is experienced in the general population. 3.1.4 Burglary with entry Out of the 1,000 respondents, 219 (22.9%) were victims of burglary with entry in the past five years. Of these 108 (49.3%) were male and 107 (48.9%) were female. The largest number of 96 (43.8%) were residing in lower class areas, 76 (34.7%) from middle class and 46 (21.0%) from high status areas. On the other hand, 229 (22.9%) respondents reported that over the past five years, someone tried to get into their houses/ flats unsuccessfully. It appears that people in lower and middle residential areas face a higher risk of being victims of burglary than people who reside in high class areas. This is because the latter group spend more on crime prevention measures such as burglar bars, door locks, etc than the former groups (Naude, 1998; Prinsloo, 1998). In terms of income, it was found that there is more poverty in the lower residential areas than in the high class areas which is a contributing factor to the differences in burglary rates among the three residential areas. 3.1.5 Crime against the person Over the past five years, 152 (15.2%) respondents had been victims of robbery and of these 84 (55.3%) were male and 67 (44.1%) were female. Of these victims, 79 (52.0%) were residing in lower status areas, 39 (25.7%) in middle class and 33 (21.7%) from high status areas. Personal theft had 439 (43.9%) victims. Most of these were victims of picks pockets and of these 223 (50.8%) were male and 212 (48.3%) were female. Of these, 230 (52.4%) were from lower status areas, 146 (33.3%) from middle class areas and 61 (13.9%) from the high class. Poverty is probably the main reason for these differences in victimisation rates.

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A total of 184 (18.4%) respondents reported having been assaulted over the last five years. Of these 81 (44.0%) were male while 102 (55.4%) were female. Furthermore, 30 (16.3%) of these victims were from high class residential area, 52 (28.3%) from middle class and 101 (54.9%) from lower residential areas. This means that the females are more susceptible to attacks/ assaults than males. Out of the 506 female respondents 35 (6.9%) reported having been sexually assaulted in the past five years. Of these, 12 (35.3%) were from middle class areas, 11 (32.4%) from lower status areas and 10 (29.4%) from high class. The above findings indicate that the number of victims of sexual offences is slightly similar in all residential areas meaning that all females are vulnerable irrespective of where they reside. 3.1.6 Consumer fraud and corruption Out of the 1,000 respondents in the past one year, 502 (50.2%) were victims of consumer fraud while corruption had 346 (34.6&) victims. These crimes are regarded as a way of life in Africa since most offenders see it as a way of survival “thus not regarding them as crime(s)”.

3.2 Discussion

The survey findings indicate that respondents in the study areas had been victims of one or more forms of crime in the past five years and over one year period prior to the conduct of the survey. Personal thefts rank highest with 439 (43.9%) victims out of 1000 respondents, followed by attempted burglary, 229 (22.9%), burglary with entry, 219 (21.9%), and assault/threats which had 184 (18.4%) victims respectively. A total of 152 (15.2%) and 130 (13.0%) people suffered a robbery or theft from car respectively. Those who were attacked amounted to 125 (44.2%) followed by car vandalism where 57 (20.1%) out of 283 car

owners had their cars damaged/vandalized. Theft of car had 20 (7.1%) victims in the past five-year period. Furthermore, out of the 297 bicycle owners, 46 (15.5%) had their bicycles stolen 6 (5.4%) out of 112 motorcycle owners had their motorcycles stolen over the last five years. Female victims of sexual offences were 35 (6.5%) out of the total 506 female respondents. Most of the victims of sexual abuse were from middle class residential areas, followed by those from lower class areas and least from high class residential areas. The low rates of reportage could partly be explained by the unwillingness of females to provide information due to shyness and the fact that sexual issues are normally regarded as private and that some cultures consider it a shame to discuss sexual issues with outsiders/strangers. It was found that more males than women suffered the crimes against the person and their property. It was further found that victimisation rates are related to locality of residence. The findings of this paper indicate that the place of residence has much to say as to who becomes a victim and who does not. For example burglary with entry had 96 (43.8%) out of 219 victims residing in lower class areas followed by 76 (34.7%) from middle class and 46 (21.0%) from high status areas. This implies that people residing in lower and middle class areas are more susceptible to victimisation than those residing in high class areas. The results of these analyses are consistent with previous studies that examined victimisation by locality of occurrence (Detis, 1998). Lower income and social status areas generally experience higher rates of criminal victimization than the middle and high class residential areas. This also confirms the findings of Duncan (1997) who pointed out that victimisation surveys reveal that high crime rate areas not only have a high

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rate of victim prevalence, but that a small proportion of the victims may experience more than half of the crime reported. Furthermore, poverty may be a contributing factor to the differences in the victimisation rates occurring in the three residential status areas. For example, out of 152 (15.2%) victims of robbery, 79 (52.0%) were residing in lower status areas, 39 (25.7%) from middle class and 33 (21.7%) were from high status areas. This implies that those in high class areas can easily afford crime preventive measures to avert crime more than those in lower class residential areas. The same thing applies to household income in the different localities. For example, Shannan (1998) points out that during 2004, there was a general pattern of decreasing victimisation rates for persons residing in households with higher incomes. Persons in households with an annual income under US$7,500 were more likely to be victims of robbery and assault than members of households with income greater than US$25,000. This finding places individuals without a substantial income at a higher risk of being victims of crime because they do not have the money to buy crime preventive measures such as installing burglar alarms, etc. With crimes like consumer fraud and corruption which are regarded as a way of life, Cohen and Cantor (1980) and Cohen and Felson (1979) suggest that the rise in the crime rate over the years is partly attributable to the changing lifestyles of the late twentieth century. The strong correlation between the rise in the standard of living and the increased incidence of crime suggests that the situation will not easily be reversed, and the problem can only get worse. Therefore, policies will be needed to reverse this type of scenario.

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3.5 Conclusions: Policy implications

An important feature of the International Crime Victim Survey is that it shows the contours of ‘normal’ victimisation against households. This has implications for preventive policies, especially those concerned with alleviating the commonplace nuisance of crime than with reducing the number of ‘headline’ offences that often appear in police statistics because of higher reporting and recording levels. Findings from the survey have implications for crime prevention and control strategies in that they inform and direct policy-makers and law enforcement personnel as to which areas they should concentrate their efforts in terms of resource allocation i.e. money, personnel and equipment. For example, the findings indicate that personal thefts, attempted burglary and burglary with entry rank among the offences with the highest prevalence. Since there are differentials in the victimisation rates with respect to age, sex and residential areas, a crime prevention policy need to put into account such differentials specific to those characteristics. Furthermore, with attempted burglary and burglary with entry, crime awareness training programmes and increased security/ preventive measures at citizens’ residence need to be emphasised by installing burglar alarms, door locks, special door/window grills, etc. But this implies that people in the lower residential areas should have more income- generating activities to enable them purchase the above items and improve their standard of living. Strategies should also be devised to reduce the rate of crime. In addition, a more appropriate strategy is needed which might result in a more even distribution of the risk of victimisation. Rather than aiming to reduce the overall crime incidence rate by preventing nonvictim from becoming victims of crime, such

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a strategy might be to prevent a person or a household that has already been victimised from being victimised again. As Trichett, A., Ellingworth, D., Hope, TandPease, K (1995) propose that the implementation of such a strategy is a less daunting prospect than many other crime prevention strategies because it is focused on a smaller proportion of people and places. When developing place-specific crime prevention strategies, it is important to go beyond the crime rate when evaluating area differences as this will mask the characteristics that should be taken into account. It is crucial to consider the vulnerable people, residential areas, victim awareness programmes, instituting income generating activities in low income residential areas to empower such residents as well as initiating victim support or assistance programmes when formulating such a strategy. These should be some of the parameters in designing crime prevention measures specific to each crime type. Above all, the communities at risk should be encouraged to participate in all endeavors of crime prevention. Furthermore, crime preventive measures to be designed should put into account the issue of affordability. In a society where most respondents reside in lower residential areas, the preventive measure appropriate would be the use of a neighborhood watch scheme. This measure would be affordable by almost all residents, manageable and cheap. Other preventive measures such as installing special door locks, construction of high fences and, employing security guards would also be preferable but these require a lot of money which only people residing in high and middle class residential areas can afford.

References

Alvazzi del Frate, A. Zvekic, U. and Van Dijk J. J. M. (1993). Understanding Crime, Experiences of Crime and Crime Control, Rome: Ministry of the Interior; Italy. Clinard, M. B and Meir, R.F, (1985). Sociology of Deviant Behaviour 8th Edition, London: Harcourt Brace Jovausvich College Publishers. Cohen, L. E., and Cantor, D., (1980). ‘The Determinants of Larceny: An Empirical and Theoretical Study, Journal of Research in Crime and Delinquency 17, 140 – 59. Cohen, L. E., and Felson, M. (1979). ‘Social Change and Crime Rate Trends: A Routine Activity Approach.’ American Sociological Review 44, 588 – 608. Deakin, J. (2006). Dangerous People, Dangerous Places: The Nature and Location of Young People’s Victimisation and Fear, Manchester: University of Manchester, UK. Detis, T. D. (1998). Urban, Suburban, and Rural Victimisation, 1993 – 98, New York: Bureau of Justice Statistics. Duncan, R. (1999). Peer and Sibling Aggression; An Investigation of Intraand Extra-Familial Bullying, Journal of Interpersonal Violence 14: 871 – 886. Hodder: London. Duncan, C. J. (1997). Victimisation beyond the Metropolis: An Australian Case Study, University of Newcastle: Australia. Hart, H. L. A. (1992). Punishment and Responsibility: Essays in the Philosophy of Law, Clarendon Press; Oxford. Lamb, J. H., and Hindelang, M. J. (1980). Analysis of National Crime VictimiSation Survey Data to Study Serious Delinquent Behavior in Urban, Suburban and Rural Areas. New York: Bureau of Justice Statistics, USA.

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Naude, B. (1998).The International Crime (victim) Survey in Sub-Saharan Africa (South Africa, Uganda and Zimbabwe). Department of Criminology; University of South Africa, Pretoria. Prinsloo, J. H. (1998). Acta Criminologica, Vol. 11, No 1. South African Journal of Criminology . UNISA: Pretoria. Shannan, M.C. (2004). Criminal Victimisation, New York: Bureau of Justice Statistics. USA. Ssamula, M. (1996). International Crime Victim Survey, Uganda a report of Findings. Department of Sociology, Makerere University: Kampala, Uganda. Ssamula, M. (1992). International Victim Survey, Uganda, a Report of Findings Department of Sociology, Makerere University: Kampala, Uganda Ssamula, M. (2000). The International Crime (victim) Survey in Urban Kampala,

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Uganda. Department of Sociology, Makerere University: Kampala. Trichett, A., Ellingworth, D., Hope, T and Pease, K. (1995). ‘Crime Victimisation in the Eighties’ British Journal of Criminology 35, 343 – 59. Oxford University Press: London. Ugljesa, Z., and Alvazzi, A. (1995). Criminal Victimisation in the Developing World, Rome: Unicri Publication No. 55, Rome, Italy. Van Dijk, J. J. M., Mayhew, P and Killios, M. (1991). Experiences of Crime Across the World, Boston: Kluwer Law and Taxation Publishers, Deventer. Van Kesteren, J., Mayhew, P and Nieuwbeerta, (2000). Criminal Victimisation in Seventeen Industrialised Countries, The Hague: Watenscheppelijk Onderzoek en Documentatiecentrum, The Netherlands

APPENDIX, A Table 1:

Prevalence Victimisation Rates 5 Years

Incidence Percentage (based on total sample N = 1000) Theft of a car 20 (2.0) Theft from a car 130 (13.0) Car vandalism 62 (6.2) Theft of motorcycle 8 (0.8) Theft of bicycle 47 (4.7) N = 1000 Theft of a car 20 (7.1) Car owners=283 Theft from a car 125 (44.2) Car vandalism 57 (20.1) car owners = 283 Theft of motorcycle 6 (5.4) motorcycle owners = 112 Theft of a bicycle 46 (15.5) bicycle owners = 297 Burglary with entry 219 (21.9) N = 1000 Attempted burglary 229 (22.9) N = 1000 Robbery 152 (15.2) Personal theft 439 (43.9) Assault/threats 184 (18.4) Sexual incidents 35 (6.9) Source: Compiled from victim survey results, 2000. _________________________________________________________________________ Vol. 8 No. 2, December 2007


APPENDIX, B Table 2:

Prevalence/Victimisation Rates (1 year – 1999

Percentage (based on total sample N = 1,000) Theft of a car 3 (0.3) N = 1,000 respondents Theft from a car 47 (4.7) Car vandalism 18 (1.8) Theft of motorcycle 4 (0.4) Theft of bicycle 9 (0.9) Theft of a car 3 (1.1) N = 283 car owners Theft from a car 45 (15.9) Car vandalism 16 (5.7) Theft of motorcycle 8 (2.7) N = 112 respondents Theft of a bicycle 8 (2.7) N = 297 respondents Burglary with entry 62 (6.2) N = 1,000 respondents Attempted burglary 71 (7.1) Robbery 45 (4.5) Personal theft 158 (15.8) Assault/threats 50 (5.0) Consumer Fraud 502 (50.2) Sexual incidents 6 (0.6) N = 506 females Corruption 346 (34.6) from victim survey results, 2000 . Source: Compiled Incidence

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Ethics in Social Research: The Uganda Context Charles B. Rwabukwali1 Abstract This paper examines the role of ethics in social research globally, but lays particular emphasis on the Ugandan context. It makes a distinction between natural sciences and social sciences, noting that ethics are important to natural sciences but not intrinsic to the discipline. In contrast, ethics are important and intrinsic to social research. Ethics refers to “value conflict situations,” or problems for which no choice seems to be completely satisfactory, hence putting good but contradictory values against each other. Essentially, there are two types of ethics – privative ethics and positive ethics. Privative ethics in research is aimed at reducing pain, misery and suffering, while positive ethics in research is aimed at human pleasure and happiness. The aim of ethics in research is to protect individuals and communities from harm that may be caused by the researcher’s misuse of power and guard against infringement on the rights of respondents. The paper examines the history of research ethics globally since the Second World War and notes that in Uganda the National Council for Science and Technology is mandated to ensure ethical conduct of social science research. Despite this, a number of social science research projects in Uganda, especially with regard to HIV/AIDS research, have been undertaken without much regard to ethics. The paper also examines some of the potential ethical dangers a social science researcher may face and how they may be overcome. Such dangers and pitfalls include, undue pressure on respondents, deception, invasion of privacy, breach of confidentiality as well as lack of informed consent. To overcome these problems, researchers and their institutions of affiliation have special ethical responsibilities in ensuring the protection and promotion of integrity in research, hence the critical need for Ethical Review Committees.

Introduction

Natural sciences are a body of knowledge of interdependent propositions, often laboratory-tested and leading to validated generalisations. Typically, data collection in the natural sciences does not deal with human beings, they only come into picture during the application. This means that in the pure natural sciences, ethics are not so intrinsic to the research endeavour (see, Jesami – www.cehat.org). However, recent developments such as the germ and nuclear warfare, genetic engineering and environmental degradation owing to large

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1 Associate professor in the Department of Sociology, Makerere University. E-mail:[email protected]. ac.ug

scale engineering projects, have intensified discussion on ethics in natural sciences. By contrast, the social sciences deal with human beings and the institutions they create. To quote Jesami (www.cehat.org); “Social research is systematic inquiry into ways in which people, and the social institutions that they create, behave in relation to one another and to their environment”. Ethics is important and intrinsic to social research in fields such as Economics, Sociology, Anthropology, Social Work, Social Administration, Psychology, Gender Studies, Political Science and Public Administration.

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Towards a Definition of Ethics Ethics refer to “value conflict situations”, or problems for which no choice seems to be completely satisfactory; pitting good but contradictory values against each other (Kitchner, 2000). Warwick (1993) seems to agree with this formulation when he says that ethics “Deals with questions of moral goodness or evil and with proper standards for human action” (Warwick 1993:316).

Types of Ethics

The term ‘Ethics’ denotes different things to different people. To Ward, there are two types of ethics – privative ethics and positive ethics (Ward, 1974). Privative ethics in research is aimed at reducing pain, suffering and misery. Much of the research in social work tends to fall in this category. For example, if you carry out a study among juvenile prostitutes on Kampala streets, what are your ethical obligations to those being studied? Is it your duty to solve the problem? The solution to this ethical dilemma, according to Ward, is “Equalisations of Intelligence” (Ward, 1974). Ward’s solution, however, is controversial and raises more problems than it solves. Positive ethics in research on the other hand, is aimed at increasing human pleasure and happiness. Much of the research in sociology tends to be of this nature (Ward, 1974). Examples include, research on economic programmes aimed at general welfare and economic well-being of populations, human rights, rights to food, etc. The ethical dilemma here is how to satisfy in a just manner, natural wants and demands. The solution offered by Ward is to increase the standard of living of the population (Ward, 1974). Again, this is debatable. For purposes of this presentation, privative ethics and positive ethics will be used interchangeably.

Why Ethics?

Ethics deals with questions of moral good versus evil hence all human research have ethical, social and legal undertones, which creates two implications. First, it raises the need to protect individuals and communities from harm caused by the researchers’ misuse of power and guard against infringement on the rights of the respondents. Secondly, it puts the onus on the social scientist to use the best avenues possible in the conduct of social research (Gorad, 2002; Warwick, 1993; Wolff, 2005). Until recently, much emphasis was put on ethical debates on individual autonomy such as informed consent and rights of the individuals. However, ethical concerns must take into account the impact of social science research on society, hence the need for guidelines on how to conduct ethically community social science research.

History of Research Ethics on Social Sciences

The beginning of interest in ethics in social sciences can be traced to the 1940s and 1950s when professional associations in Sociology, Social Anthropology and Psychology formulated codes of ethics to guide research in their respective disciplines. This pressure on the social sciences to self-regulate and evolve their own codes of conduct increased after the Second World War (Ward, 1974). During the 1960s and 1970s, there was increased discussion on ethics among social scientists. In addition, pressure came from below, with respondents showing wariness in providing information and answering endless questions from social scientists. The result has seen most of the associations of sociologists, political scientists, psychologists, social workers, etc., in developed countries formulating and refining their ethical guidelines. Today, several leading universities in the world issue guidelines to protect

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Ethics in Social Research: The Uganda Context

student researchers from being exploited by their teachers.

Social Science Research in Uganda

In Uganda today, there has been increase in social science research in delicate and often sensitive issues affecting individuals and communities, for example, research in sexual behaviour and HIV/AIDS, or research on governance in Uganda. All these types of research raise privacy, confidentiality and cultural issues that are contentious and need careful handling. If mishandled these issues can lead to questionable behaviour or actions on the part of the social scientist. To compound matters, a lot of the research done in Uganda today is sponsored either by donors or commercial market research groups. Often this has resulted in pressure to interpret findings to suit the donor or to make sure that findings are “ideologically correct.” All this makes researchers vulnerable to making unethical decisions. In attempt to avert the above mentioned issues, the National Council for Science and Technology (UNCST) has issued guidelines for good practices aimed at improving quality of research that is ethically grounded. Unfortunately, these guidelines are biased in favour of biomedical research, hence a need for guidelines dedicated to the social sciences and a framework for ethics to guide social science research in Uganda. [(See, Uganda National Health Research Organization, 2000)]. A Framework for Ethics in Social Science Research in Uganda Ethics in social science research involves four stakeholders and the power relations among them. These stakeholders are: the participants or respondents; the researchers and their institutions, the sponsors, and the gate-keepers. The power relationships among these stakeholders is often fluid, and the shifting of power often gives rise to

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ethical problems and is important in shaping people’s perception of the object of research. Emphasis in this paper has been put on the ethical issues involving participants/ respondents. Participants/Respondents The conduct of social research involves some degree of risk to the participant, or respondent or study subject (Black, 1999; Creswell, 1998; Bower and de Gasparis, 1978), which naturally, gives rise to a number of ethical issues. For purposes of emphasis, four areas including undue pressure on participants, deception, privacy, and confidentiality will be highlighted. All these must be attended to by the researcher to ensure an ethically “correct” social inquiry. Undue Pressure/Coercion Ideally, social scientists should conduct their research on participants who willingly and voluntarily agree to participate. However, sometimes participants are unwilling to volunteer participation, and the researcher ends up in a dilemma of either abandoning the interview or cajoling (coercing) the subject to participate. Coercion could, as Bower and de Gasparis (1978), put it, take several different forms including, the provision of gifts, lunch allowance, transport refund, undue use of authority, and threats concerning the consequences of non-participation. The ethical dilemma here is not so much as the payment of these gifts; rather it is when these inducements become excessive. As Rosenthall and Rosnow (1975:199) put it. “the ethical dilemma results from the likelihood that fully informed voluntarism, while it may satisfy the moral concern of researchers, may be contradicted for the scientific concern in the many cases; and experiments must weigh the social ethic against the scientific ethic in deciding which violation would constitute the greater moral danger.”

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However, while it is reasonable to expect the researcher to do his/her best in ensuring that participants willingly and voluntarily engage in his/her study, attempts to achieve this result should not extend into forms of duress (Black, 1999; Creswell, 1998; Mikkelsen, 1995). Deception Warwick (1993) argues that a key obligation of the social researcher is to be truthful. That is, the researcher should avoid lying or deceiving participants in a given study. Deception may take the form of a misstatement of the purpose of a study or the uses that will be made of the results; by disguising of the variables being measured; by a misleading description of the study’s procedure; or by misinformation about its sponsorship (Bower and de Gasparis, 1978). Some have argued that deception can be used in social science research as a strategy to gain co-operation of participants, especially for studies on topics that are sensitive and where there is greater likelihood that members may refuse to participate. Studies on topics, such as abortion or homosexuality, that are deemed to be illegal, are a case in point. On the other hand, some people have argued that complete truthfulness about the purpose of the research is the only viable approach as the use of deception denigrates participants. As in all ethical dilemmas, there is no easy way out. Nonetheless, purposeful deception is a reasonable strategy in research involving sensitive topics, where full disclosure of all information regarding the study may lead to participants refusing to cooperate with the study team. The strategy here is to present general information about the study and avoid going into minute details. Privacy In many countries, Uganda included, the right to privacy is protected by law whereby an individual has a right to be left alone.

Yet, social scientists often approach research subjects as uninvited guests. Indeed, at times researches are regarded as spies by those they seek to study. The question becomes, “should social scientists be allowed to invade people’s privacy in the name of science? The answer depends on whether you think the right to privacy is absolute, as many lawyers tend to think, or whether you think the right to privacy is relative, as many social scientists tend to think. To this end, social scientists have argued that privacy should be seen as “the right of an individual to decide for himself how much of his life, his thoughts, emotions and the facts – that are personal to him – he will share with others” (Frankel, 1976). Moreover, social scientists point out that man is a social animal and hence privacy is incompatible with peaceful co-existence of communities that depend on exchange of information for cooperation. In the final analysis, intrusion into matters that participants would rather keep to themselves is left to the judgment of the researchers. This therefore calls for the critical analysis of the situation in terms of how damaging or sensitive the revelation might be to the person involved, how many others might be harmed and the general public welfare. In short, it boils down to the thorny issue between an individual’s right to privacy and society’s need to know. Confidentiality Protecting the anonymity of informants has long been taken for granted as a fundamental requirement in social science research (Bulmer, 2001). The assumption is that informants will give more truthful answers and act with less inhibition if they are assured that whatever they say or do will be held in confidence. There are, however, two threats to the confidentiality principle in Uganda today.

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At times sponsors of especially market research demand the names of people with certain attributes so that they can sell to them products or provide them with services. Similarly, agencies sponsoring evaluation research may wish to know the wrongdoers among the programme participants so that corrective action can be taken against them. The second threat to confidentiality comes from the courts of law and other governmental bodies such as the security agencies that sometimes issue subpoenas for information about individuals from the records of research designed for other purposes. The easiest way to protect confidentiality and anonymity of informants is to assign numbers or aliases to individuals, instead of using real names. In addition, it may be wise, as Neuman (2000) points out, to develop case studies of individuals that represent a composite picture rather than the individual picture. Thus, the removal and destruction of identifying “fact sheet” information should be routine practice, especially where follow-up interviews with the respondent are not required. Similarly, random response data collection schemes should be used so that analysis of aggregated data can be done without anyone being able to discover how an individual answered a given question (Boruch,1970). Certainly, such procedural safeguards can neither guarantee anonymity, nor do they cover all possible circumstances that confront social science researchers. However, they serve as a “golden” goal that all research, whether quantitative or qualitative, should aim at achieving (Newman, 2000; Pole and Lampard, 2002). Informed Consent Most social scientists would agree that the best way to ensure that the ethical issues discussed above are taken care of is through the use of Informed Consent (Reason and

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Bradbury, 2001; Romm, 2000, Sommer and Sommer, 2002). The informed consent process ensures that the participant’s right to volunteer is honoured. Of course, this by itself does not guarantee safeguards for protecting the rights and welfare of research subjects. At its minimum, the principle of informed consent has been codified into a set of procedures to be applied to individual studies involving human subjects (Weisstub, 1998). The basic elements necessary to ensure informed consent include a fair description of the purposes of the research; a proper identification of the researcher and other personnel associated with the study; an explanation as to how and why the participant was selected; a detailed description of the discomforts, harms, and benefits which can be expected from participation in the study; an assurance of privacy, anonymity and confidentiality for the participant; an offer to answer any questions concerning the research; and the instruction that the subject may change his/her mind at any time and withdraw from the study without suffering any kind of penalty. Given the long list of issues required to achieve informed consent, it is not surprising that some social scientists have found problems in the implementation of these principles. In particular, three problems have been pointed out. First, there may be a conflict between the principle of informed consent and the validity of research findings. For example, prior detailed information about the subject of research may influence the potential subjects’ likelihood of participation and hence result in biased findings. Second, the subject matter under investigation may be too complex for the participant to grasp has been noted in health-related research (Foster, 2001). Furthermore the social scientist himself/herself may not have all information that would be required for

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informed consent before the commencement of the research. For example, the researcher may not be aware before hand that some of the questions on their research instrument will cause embarrassment (Lee – Treweek and Linkogle, 2000). Despite all the above problems in informed consent, participants in a research have a right to know what they are getting into and what the research is all about. It is therefore crucial that social science researchers ensure that participation in their studies is voluntary and that participants understand that they can withdraw their participation at any time, freely, and without fear that they would suffer some harm as a consequence. Responsibilities of Researchers and their Institutions Beyond participants’ rights in social science research, individual researchers and their institutions of affiliation have special ethical responsibilities in ensuring the protection and promotion of integrity in research. It is now universally accepted that institutions, such as universities, which sponsor or house the different types of research, should have formal mechanisms to ensure that their research meets acceptable ethical standards. One such useful mechanism is for the institution to have an Ethical Review Committee. An Ethical Review Committee would ensure that participants are not harmed, wronged or treated as “mere means” or “object” to benefit other, and that their human rights are not violated. (King, et al.1999). Why are Ethical Review Committees Needed? These are needed to ensure independence of ethical review of the proposed research; impartiality in judging the merits and shortcomings of the proposed research, since researchers may overstate the benefits of their research and underplay the risks to

participants; and to obtain an assessment of features of the proposed research by laypersons, nonscientific experts, as well as by scientists (See, Homans, 1991). The Role and Functions of Ethical Review Committees (ERCS) The primary role of the ethical review committee is to apply ethical principles to research proposals to determine that: (a) Risks are reasonable in light of anticipated benefits, i.e. the “beneficence” principle. (b) The process and documentation of informed consent are ethically acceptable, i.e. informed consent is not just a piece of paper, but it leads to genuine respect for persons. (c) Recruitment practices are noncoercive and respect the privacy and confidentiality of potential participants. (d) Equity in the selection of research participants. In addition, ERCs have a duty to monitor research that is already in progress and to develop policies governing specific aspects of research at the institutional, local or national level. Examples of such policies may include, “spousal permission” for enrolling participants in research, involvement of adolescents without parental permission and involvement of persons lacking capacity to consent, for example, the mentally sick, or indeed, the illiterates.

Ethical Responsibilities of Sponsors

Given the poor economic situation that social science researchers in the Third World, including Uganda, find themselves, increasingly much social science research is being funded by donors or sponsors. But as War wick (1993) has pointed out, the reliance on donors for social science research funding raises a number of ethical issues since they can easily influence the methodology, integrity of research as well as the findings.

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The question becomes, to what extent, should sponsors be allowed to influence the design and interpretation of social science research? There are not easy answers to this question. In my view, the way out of this impasse is for national governments to fund their own research adequately. However, the question of funding for research, especially social science research in our country is problematic. For the last five years Makerere University has been getting declining amounts of money for research from government. At the same time, donor funding for research has been on the increase through such agencies as Sida/SAREC, Rockefeller Foundation, Ford Foundation, Carnegie Corporation of New York, etc. As already intimated, this reliance on donor funding comes with “strings attached.” It means that at times we have to conduct research on topics that as nationals we would rather avoid, such as gay and lesbian behaviours. Moreover, donor funded research tends to be multidisciplinary, involving collaboration between local scholars and foreign scholars. In theory, there is supposed to be equality between the local scholars and the international scholars. However, in reality, local scholars tend to be used as “hired hands” or cheap labour. Often the foreign scholars are the dominant group and tend to influence the research process, at times infringing on the rights of individuals and groups. My plea here is that if we must engage in donor funded collaborative research we must insist on genuine collaboration in the design, execution and data analysis stages of the research process. We should insist on water-tight agreements on funding levels, funding source, intended use of the research, publication rights, time commitment of standards of quality required and relations with the donors.

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Consent where gatekeepers are involved

Social science research is done in communities among groups or individuals. In order to access these communities we often require the assistance or even permission of “gatekeepers” such as LC officials. This involves ethical considerations whereby the “gatekeeper” may insist on knowing the names of those being interviewed, hence breaking the confidentiality principle. To ensure ethical conduct where “gatekeepers” are involved, the researcher should: (i) obtain from the gatekeeper permission to conduct research. However, this is not a substitute for obtaining separate and full informed consent from the individual participants. (ii) avoid promising favours to the “gatekeeper”, such as sharing data and information obtained, as a precondition for obtaining research clearance. (iii) be mindful not to harm the relationship between the “gatekeeper” and the research subject in the process of collecting research data. (iv) not expose communities, groups and individuals studied, to harm while publishing and disseminating results of research, for example, by using aggregate data and avoiding mentioning personal names. In short, avoid violating the ethical and cultural understanding of the groups or communities studied.

Summary and Conclusion

This paper has shown that the conduct of social science research, especially in developing countries like Uganda, is replete with ethical dilemmas arising out of conflicting values. The onus is on the researcher to show sensitivity and cultural understanding of the people being studied so as to avoid their cultural and ethical norms. Hence, research participants should

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always be informed of the general purpose of the study, the methods of the study and the sponsorship of the study. Participation of people in social science research should always be on a voluntary and informed consent basis and confidentiality must always be observed. For organisations and agencies that sponsor research, the challenge is to make ethics a part of institutional arrangement and part of research methodology. In effect, research institutions must sensitise their researchers in ensuring that ethics are observed beyond ethical review, that is, ethics must be observed at all stages of research.

References

Black, T. R. (1999). Doing Qualitative Research in Social Sciences: An Integrated Approach to Research Design, Measurement and Statistics, London: Sage Publications. Boruch, R. F. (1970). Deceiving Subjects: The Pollution of Our Environment. American Sociologist (5): 45. pp 15-20. Bower, R. T. and de Gasparis, P. (1978). Ethics in Social Research: Protecting the Interests of Human Subjects. New York: Praeger Publishers. Bulmer, M. (2001). The Ethics of Social Research in Gilbert, N.(ed.) Researching Social Life. London: Sage. Creswell, J. W. (1998). Qualitative Inquiry and Research Design: Choosing Among the Tradition. London: Sage Publications. Foster, C. (2001). The Ethics of Medical Research on Humans. Cambridge: Cambridge University Press. Frankel, L. R. (1976). Restrictions to Survey Sampling – Legal, Practical, and Ethical, in Perspectives on Attitude Assessment: Surveys and Their Alternatives in H.W. Sinaiko and L.H. Broeding, eds. Pp. 54 -67. Champaign, Ill: Pendleton Publications.

Gorad, S. (2002). Ethics and Equity: Pursuing the Perspective of NonParticipants. Winter 2002, Social Science up-date. Issue 39. pp 16 – 20. Homan S, R. (1991). The Ethics of Social Research, London: Longman. Jesani, A.2005. Ethics and Social Science Research in Health. www.cehat.org King, N. M. P., Henderson, G.E. and Stein, J (Eds), (1999). Beyond Regulations – Ethics in Human Subjects Research. Chapel Hill: University of North Carolina. Kitchener, K. S. (2000). Foundations of Ethical Practice, Research, and Teaching in Psychology, New York City, Lawrance Erlbaum Associates. Lee–Treweek, G. and Linkogle S. (2000). Danger in the Field: Risk and Ethics in Social Research. London and New York: Routledge. Mikkelsen, B. (1995). Methods for Development Work Research, A Guide for Practitioners. New Delhi: Sage Publications. Neuman, L.W. (2000). Social Research Methods: Qualitative and Quantitative Approaches (4th ed.) London: Allyn & Bacon. Pole, C. and Lampard, R. (2000). Practical Social Investigation: Qualitative and Quantitative Methods in Social Research, New York: Prentice Hall. Reason, P. and Bradbury, H. (eds) (2001). Handbook of Action Research: Participative Inquiry and Practice, London: Sage Publications. Romm, N. R. (2000). Accountability in Social Research. New York: Plenum Publishers. Rosenthall, R. and Rosnow, R. L. (1975). The Volunteer Subject, New York: John Wiley. Sommer, R. and Sommer B. (2002). A Practice Guide to Behavioural Research

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– Tools and Techniques, Oxford. Oxford University Press. Uganda National Health Research Organisation (2000). Guidelines for the Conduct of Health Research Involving Human Subjects in Uganda, Health Education Printing Unit, Ministry of Health, Entebbe. Ward, L. F. (1974). Applied Sociology. New York: Arno Press. Warwick, D.P. 1993. The Politics and Ethics of Field Research, in Social Research in

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Developing Countries in Survey and Census in the Third World, by Martin Bulmer and Donald P. Warwick (Eds.). London: John Wiley and Sons. pp. 315 – 330. Weisstub, D.N. (1998). Research on Human Subjects – Ethics, Law and Social Policy, New York: Pergamon. Wolff, M. F. (2005). Ethics as Social Practice: Introducing the Debate on Qualitative Research and Ethics, Forum for Qualitative Social Research, Volume 6, No.1 Art. 9. pp 25-30.

DEGREE PROGRAMMES OFFERED IN

THE FACULTY OF SOCIAL SCIENCES The Faculty of Social Sciences of Makerere University offers an integrated programme distinctively devoted to social and behavioural science education. The Faculty runs varied courses leading to the award of Bachelors Degrees, Masters Degrees, and Doctorate Degrees in the following: Undergraduate programmes (a) Bachelor of Social Work and Social Administration - B (SWSA)

Applicants to the B(SWSA) Programme must have either: UCE or its equivalent and at least 2 principal passes obtained at the same sitting of UACE or its equivalent, OR A Mature Age Entry examinations certificate in those subjects relevant to the professional degree course of B(SWSA), OR Diploma in Social Development (including Education, Human Resource Management, Business Studies and Paramedicals) or its equivalent from a recognized institution of higher learning. This course is run as a day programme.

(b) Bachelor of Arts in Social Sciences - BA (SS)

Applicants to the B.A. (SS) programme must have either: UCE or its equivalent and at least 2 principal passes obtained at the same sitting of UACE or its equivalent, OR Mature Age Entry examinations certificate in those subjects one desires to study, OR a Diploma of at least second class from a recognized institution of higher learning. This course is run both as a Day and Evening programme.

Postgraduate Programmes (a) Postgraduate Diploma/Master of Arts Degree in Community Based Rehabilitation (P.G.Dip./MA (CBR) (Deferred)

Applicants to both courses are required to possess an honours degree in Social Sciences or in a related field or its equivalent, plus at least two years’ experience in the field of social services institutions, including medical, educational and vocational institutions.

(b) Master of Arts Degree in Gender Studies - MA (Gender Studies)

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Admission is on the basis of both academic and work experience, as follows: At least a good second class honours degree in any discipline from a recognized University; and A minimum of two years of working experience.

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(c) Master of Arts in International Relations and Diplomatic Studies - MA (IRDS)

Applicants should have an Honours Degree in Social Sciences or a related field, or its equivalent from a recognized university; and, practical experience in diplomacy and related fields.

(d) Master of Arts Degree in Public Administration and Management - MA (PAM)

Applicants should have obtained an Honours Degree or its equivalent in any discipline from a recognized University. Applicants without a prior degree in the Social Sciences should have either two years of administrative and managerial experience or a postgraduate diploma in Public Administration, Human Resource Management or any other relevant administrative field.

(e) Master of Arts in Social Sector Planning and Management - MA (SSPM)

To qualify for admission, candidates must be holders of a BA degree in Social Sciences or in a related discipline, of an Upper Second Class of Makerere University or its equivalent from a recognized University. Candidates with a Lower Second Class degree may also be considered for admission if they furnish sufficient evidence that they have experienced academic growth since graduation.

(f) Master of Arts in Sociology

Applicants should have obtained a good Honours degree in Sociology and Social Sciences, or its equivalent from any recognized university. Applicants with relevant qualifications from related disciplines in the humanities and sciences, including those with a background in health, and applicants practising in related fields who possess demonstrated research or management experience of at least two years, will also be considered.

(g) Doctor of Philosophy (Ph.D) Degrees

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The following are eligible for the degree of Doctor of Philosophy in the Faculty of Social Sciences: Any Master of Arts of a recognised Institution of Higher Learning of not less than two years’ standing. A Bachelor of Arts of a recognised Institution of Higher Learning of not less than three years’ standing whom the Senate has specially exempted from the Master’s examinations. A graduate of any other recognized Institution of Higher Learning who has been admitted to the status of Master of Arts in the Institution of Higher Learning, and who has held the qualification by virtue of which such admission has been granted for not less than two years; or who has been admitted to the status of Bachelor of Arts in the Institution of Higher Learning and has held the qualification by virtue of which such admission has been specially granted for not less than three years and has been specially exempted by the Senate from the Masters’ examination.

Applications are received when the Academic Registrar has called for them. A Faculty Handbook with more details about these programmes can be collected from the Faculty. Further inquiries can be directed to: The Faculty Administrator Faculty of Social Sciences Makerere University P.O.Box 7062, Kampala Tel: 0414-545040, 0712-545040, 0712-808640 Email: [email protected]

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