Medical Aid Effectiveness in Africa and its impact on poverty for people with

disabilities in Uganda

Angelos Evangelou, Waynflete Studies, Economics

Magdalen College School, TT 2013

1

Acknowledgments

I would like to thank Dr Trudy Owens not only for explaining everything to me while in Kampala but also for her giving me the chance to work with such an excellent team of professionals and allowing me to have the opportunity to handle primary data. All data in this study has been given to me by Dr Owens and I am very grateful.

I would like to thank Mrs Beverly Eldridge for her constant guidance, even when the tunnel was at its darkest she showed me the light.

Furthermore, I am grateful to Dr Andrew Rathmell for the time he gave me and the scope he added to my project.

Most importantly I am grateful to the participants of the study, who were welcoming and kind. I shall never forget being mistaken for “Dr Evangelou”, an experience I thoroughly enjoyed. Suffice to say I did not correct them...

2

Contents

Acknowledgments.................................................................................................................................2

Introduction:..........................................................................................................................................4

Purpose of the Research:.......................................................................................................................4

Significance of the study:.......................................................................................................................4

Rationale for the Research:...................................................................................................................5

Background Literature:..........................................................................................................................5

Prevention versus Cure:........................................................................................................................6

Research Questions:..............................................................................................................................8

Methodology:........................................................................................................................................8

The Sample:...........................................................................................................................................8

Results and Follow Up:........................................................................................................................14

Conclusion:..........................................................................................................................................16

A Final Thought:...................................................................................................................................18

Bibliography:.......................................................................................................................................19

Appendix A: Map of Uganda................................................................................................................20

3

Medical Aid Effectiveness in Africa and its impact on poverty for people with

disabilities in Uganda

Introduction:

This paper will focus on how effective medical aid is in improving the incomes and other economic

factors such as employment of people who have disabilities in Uganda. The route taken to approach

the study's questions will include analysing part of the data gathered in the summer of 2012 in

Kampala Uganda, Mungo Hospital, by a joint team of economists and medical professionals as part

of a disability project. The overarching point this paper will be addressing is how primarily incomes

change when individuals are given medical equipment and how this improves factors such as: quality

of life, mobility, dependence on others and employability. The essay will question the actions of the

state in relation to individuals with disabilities and will further look to what possible improvements

could be made to enhance the lives of such individuals.

Purpose of the Research:

The overarching aim of the research is to determine how effective medical aid is in improving the

incomes and other economic factors of people who have disabilities in Uganda. The research will

primarily explore how the socio economic statuses of those with disabilities are shaped by medical

intervention. The socio economic status will be defined for the purpose of this paper as an index of

a number of indicators: income, employment prospects and family demographic characteristics.

The study will focus on the effects of medical aid in relation to two sets of outcomes: (i) income; (ii)

participation in employment. The use of questionnaires completed by the whole sample will review

income by looking at pre and post aid salary; and employment by looking at the dependence on

family assistance.

Significance of the study:

As well as contributing to the already existing literature on the relationship between income and

disability, the study is hoping to identify some of the underlying issues in Polio/Disability policy in

Uganda and is aiming to identify implications for policy and practice for future aid programmes.

Furthermore the economics of the medical aid component of the study could act as a model for

future research in different developing African countries.

4

Rationale for the Research:

Uganda suffers from a collection of various diseases and has a very high road mortality rate,

exceeding 7000 deaths a year with 24.7 people per 100,000 dying on the roads1. Undoubtedly, this

leaves many with debilitating injuries. The country further more suffers from a high level of polio,

and although Uganda had been declared polio free in 20062, outbreaks coming from neighbouring

countries have left its population vulnerable. Notable outbreaks include the Wild Poliovirus (WPV),

which struck in 20103. Recently fresh waves of polio vaccinations have been undertaken. As late as

2010, only 55% of 1 year olds had been vaccinated4 and there is still a sizeable proportion of citizens

who have not been given any medical support. Moreover the 1991 ‘Population and Housing Census’

has revealed that 1.2% of the population are disabled 5 (however this percentage is considered to be

higher by experts).

The Ugandan government has made substantial steps forward in the provision of rights for those

with disabilities, with the Constitution of the Republic of Uganda – 19956, preventing active

discrimination for all members of society. Further plans have been established, notably the “National

Community-Based Rehabilitation (CBR) Strategic plan 2002-2007”7 which plans to integrate those

who have disabilities with the rest of the community. However, other Non-governmental

organisations (NGOs) such as the National Union of Disabled Persons (NUDIPU) have fought for the

rights of those with disabilities since 19878, by establishing a central office in each region of Uganda.

There is unfortunately much more work to be done, especially in the post-care provided to those

who have either contracted the disease or suffered a seriously debilitating injury.

Background Literature:

Two areas of literature will be addressed to cover the needs of this paper: the concepts of disability

and aid. Disability is conceptualised as being one of two: either mental or physical. For the purpose

of this study, there is a complete emphasis on the physical. In the broad sense of what causes

physical disability, three main things are prominent: the prevalence of infectious diseases (such as

polio), the high number of traffic accidents and the conflict that ensues both on a national level and 1 World Health Organisation Statistics: Uganda (2007)2 Unicef, ‘Two million Ugandan Children Targeted for Polio Immunisation’, www.unicef.org, 18/11/2010, Web., 27/12/20123 World Health Organisation, Technical Advisory Group on Polio Eradication for the Horn of Africa Countries – 8th Meeting Report, 6/9/2012, p2.4 World Health Organisation, ‘Uganda, Country Statistics’ www.who.int, Web, 24/12/2012. 5 Uganda Country Profile, Employment of People with Disabilities: the Impact of Legislation, (March 2004), p3.6 Uganda Country Profile, Employment of People with Disabilities: the Impact of Legislation, (March 2004), p5.7 Uganda Country Profile, Employment of People with Disabilities: the Impact of Legislation, (March 2004), p10.8 Uganda Country Profile, Employment of People with Disabilities: the Impact of Legislation, (March 2004), p12.

5

a tribal one. This study will focus more on the issues that infectious diseases bring and also to an

extent the effects of traffic accidents that primarily effect lower limbs. The second area of literature,

aid, is conceptualised as being in the form of one of three things: Financial aid, military aid and

medical aid. This study will concentrate on medical aid and predominately the dispensation of

crutches and Knee-ankle-foot orthosis (KOFOS) support. The use of Medical aid can come from

charities, non-governmental organisations, world organisations and research funded projects. The

study will highlight the work of research funded projects. Intervention as a method for offering

medical aid can be evaluated by two different designs, either by a Randomised Controlled Trial (RCT)

where there is completely random allocation of the treatment to individuals, or through a Quasi-

experimental design which does not involve randomised allocation, normally due to ethical

concerns. This study uses a RCT because it "involve[s] the random allocation of eligible individuals or

entities to each of two or more treatment conditions"9 and is therefore the most rigorous design

used in medical trials that allows the exploration of causal relationships. In the greater context of the

question, there has been surprisingly little similar work published on the subject. There appears to

have been a much greater emphasis placed on the effect of medical aid on conflict resolution and

the powerful effect it can have stabilising volatile states. This is highlighted by famous reports such

as” Who Gives Foreign Aid to Whom and Why” by Alberto Alesina and David Dollar10 . This lack of

closely relevant literature makes this particular study exciting as it looks to break new ground in the

field of developmental economics.

Prevention versus Cure:

There has been a global drive to eradicate polio highlighted with the inception of the United Nations

Foundation: Polio Eradication Initiative, that since 1988 has reduced “the number of polio cases by

99%”11. In the long term, it is overwhelmingly clear that vaccination and education about the disease

are clearly much more cost effective in dealing with polio. However, this project was focused on

dealing with those who had already contracted the disease.

One way of thinking about the aim of this research is by locating it within a recognised framework of

preventative services versus remediation. The social scientists identify levels of prevention and one

would hope that vaccination against polio or education about road safety is offered in Uganda as the

first level of prevention to all citizens (universal provision). Offering medical equipment as part of an

9Boruch R, Snyder B, DeMoya D. The importance of randomized field trials, (1999), Report P-648-D for the American Academy of Arts and Sciences, Harvard University p.410Alesina, Alberto and David Dollar. "Who Gives Foreign Aid To Whom And Why?," Journal of Economic Growth, (2000), v5(1,Mar), 33-63.11 http://www.unfoundation.org/what-we-do/campaigns-and-initiatives/polio-eradication-initiative/

6

intervention can be located at the fourth level (rehabilitation) as it targets people who have already

suffered a form of disability (see figure 1).

Base Level: Identifies needs in the general population for whom universal services are provided. This refers to the needs for housing, income, education, employment and health care.

First Level: (UNIVERSAL) Targets vulnerable groups and communities through programmes such as vaccination.

Second Level: (EARLY RISKS) Addresses ‘at-risk’ areas to prevent risk escalating and minimise the impact of problems. Third Level: (SERIOUS RISK) Addresses the recurrence and further escalating of problems

Fourth Level: (REHABILITATION) addresses a diverse group of issues. (from: Hardiker, Exton and Barker 1996)

7

1. Primary preventionUniversal services

2. Secondary prevention

Targeted at deprived communitiesor populations

3. Tertiaryprevention

Preventing the recurrence of

problems

4. RehabilitationAddresses

diverse group of

issues

Targeted provision for populations who are already experiencing risk i.e. polio

sufferers

Concerned with preventing the recurrence and further

escalation of existing problems for families who already

experience multiple problems.

Targeted at ‘at-risk’ areas.The aim is to intervene as early as possible after the identification of risk. This type of intervention is targeted to prevent risk escalating and minimise the impact of their problems.

Occurs prior to the onset of a problem. Takes a broad public health approach, building ‘resilience to risk’ and developing ‘protective factors’ such as vaccination and education to tackle emerging problems.

Figure 1: Levels of preventative work

Research Questions:

In this study, the focus is placed in two main research questions:

(i) Does a prosthetic given to a patient with a chronic disability like polio or other lower limb

disability, produce any significant benefit in the short and medium term?

(ii) Does the provision of assisted devices for walking, many years after the development of polio

produce any qualitative health, economic or happiness benefits to the individual or family?

Methodology:

Through the help of local disability charities and organisations such as Uganda National Action on

Physical Disability (UNAPD) and the National Union of Disabled Persons (NUDIPU), 3000 patients

with lower limb disability were sought out and approximately 10 % were randomly selected (n =

348). The project then assessed the patients and looked at factors such as socio-economic variables

and physical condition through an extensive series of questionnaires and medical tests12. Following

this 233 were treated by receiving a combination of medical equipment and some basic instruction

in how they should use this equipment for the greatest effect. They then undertook more

questionnaires and they repeated the same physical tests as before. They were then contacted 3

and 6 months later and underwent telephone interviews and questionnaires to gather information

on how their lives had changed. These same people will then be assessed again in July 2013 when

the project returns to Kampala. Furthermore, on returning to Uganda the sample will be greatly

extended to see larger patterns in the general populace.

The Sample:

The RCT that was implemented in June 2012 had 233 patients with disabilities treated (intervention

group) and 115 control tests (control group). The control group will receive the same treatment in

June 2013 (delayed treatment). Of the original sample, 138 males and 95 females were in the

intervention group, and 64 males and 51 females were in the control group. In the sample 58% of

participants were males and 42% females whilst their average age was 40 years. In terms of income,

the sample was poorer than the average urban population, earning £122/305,000 UGX a month in

12 To be published later in the year

8

comparison to the average £384/960,000 that workers earn in Kampala. In contrast, they are not

poorer than the national average13. Table 1 shows some key sample characteristics and compares

them against the Ugandan National population and urban population characteristics.

Table 1: Sample statistics compared to the Ugandan National population and Urban population Disabled sample Uganda National pop. Uganda Urban pop.

Average earnings (UGX)

Average HH monthly income 145869(1) 303700 660000

Average individual monthly

earnings 304823 302500(2) 660200(3)

Marital status

married 44.5 65.9 57.8

divorced/separated 14.4 7.4 8.2

never married 25.6 18.9 29.1

widowed 8.6 7.8 4.9

Education

no schooling 1.44 17.3 6.6

some or completely primary 33.91 51.4 30.5

some or completely secondary 46.26 25.3 44.8

above secondary 18.39 5.9 18.1

Employment status

wage employed 36.74 23.6 -

self-employed 63.26 76.4 -

Source: Uganda National Household Survey, 2009/10

Notes: (1) Average of midpoints of 5 income ranges, with highest value 225000 UGX.

(2), (3) Average monthly income of hh (head per household)

Table 2 shows the frequencies of the sample demographic characteristics with reference to individual and cumulative percentages.

13 Uganda National Household Survey, 2009/10.

9

Table 2: Frequencies of sample characteristics

Total sample Treatment Control

Freq

. Percent Cum.

Freq

. Percent Cum.

Freq

. Percent Cum.

Gender

female 146 41.95

41.9

5 95 40.77

40.7

7 51 44.35

44.3

5

male 202 58.05 100 138 59.23 100 64 55.65 100

Total 348 100 233 100 115 100

Age range

20 < 5 1.44 1.44 3 1.29 1.29 2 1.74 1.74

20-30 72 20.69

22.1

3 53 22.75

24.0

3 19 16.52

18.2

6

30-40 100 28.74

50.8

6 68 29.18

53.2

2 32 27.83

46.0

9

40-55 115 33.05

83.9

1 75 32.19

85.4

1 40 34.78

80.8

7

55 > 56 16.09 100 34 14.59 100 22 19.13 100

Total 348 100 233 100 115 100

Marital status

married 134 38.51

38.5

1 94 40.34

40.3

4 40 34.78

34.7

8

married polygamously 21 6.03

44.5

4 14 6.01

46.3

5 7 6.09

40.8

7

divorced/separated 50 14.37

58.9

1 30 12.88

59.2

3 20 17.39

58.2

6

widowed 30 8.62

67.5

3 25 10.73

69.9

6 5 4.35

62.6

1

never married 89 25.57 93.1 54 23.18

93.1

3 35 30.43

93.0

4

cohabitating 24 6.9 100 16 6.87 100 8 6.96 100

Total 348 100 233 100 115 100

Job status

wage employed 97 27.87

27.8

7 69 29.61

29.6

1 28 24.35

24.3

5

self-employed 167 47.99 75.8 99 42.49 72.1 68 59.13 83.4

10

6 8

unemployed 28 8.05

83.9

1 21 9.01

81.1

2 7 6.09

89.5

7

unpaid family worker 5 1.44

85.3

4 4 1.72

82.8

3 1 0.87

90.4

3

student 13 3.74

89.0

8 9 3.86 86.7 4 3.48

93.9

1

sick/unable to work 34 9.77

98.8

5 28 12.02

98.7

1 6 5.22

99.1

3

retired 2 0.57

99.4

3 2 0.86

99.5

7 - - -

volunteer 1 0.29

99.7

1 - 0.43 100 1 0.87 100

. 1 0.29 100 1 0.43 100 - -

Total 348 100 232 100 115 100

Education

no education 5 1.44 1.44 2 0.86 0.86 3 2.61 2.61

primary 118 33.91

35.3

4 81 34.76

35.6

2 37 32.17

34.7

8

secondary 161 46.26

81.6

1 105 45.06

80.6

9 56 48.7

83.4

8

post-secondary 64 18.39 100 45 19.31 100 19 16.52 100

Total 348 100 233 100 115 100

Religion

catholic 111 31.9 31.9 73 31.33

31.3

3 38 33.04

33.0

4

protestant 98 28.16

60.0

6 67 28.76

60.0

9 31 26.96 60

Muslim 77 22.13

82.1

8 52 22.32 82.4 25 21.74

81.7

4

Pentecostal 43 12.36

94.5

4 27 11.59

93.9

9 16 13.91

95.6

5

7th day Adventist 12 3.45

97.9

9 9 3.86

97.8

5 3 2.61

98.2

6

traditionalist 2 0.57

98.5

6 2 0.86

98.7

1 - -

none 1 0.29 98.8 1 0.43 99.1 - -

11

5 4

other 1 0.29

99.1

4 - - 1 0.87

99.1

3

orthodox 2 0.57

99.7

1 2 0.86 100 - -

. 1 0.29 100 - - 1 0.87 100

Total 348 100 233 100 115 100

Perceived hh wealth

very poor 24 6,9 6,9 13 5.58 5.58 11 9.57 9.57

poor 96 27,5934,4

867 28.76

34.3

329 25.22

34.7

8

never have quite

enough55 15,8

50,2

941 17.6

51.9

314 12.17

46.9

6

can manage to get by 131 37,6487,9

382 35.19

87.1

249 42.61

89.5

7

comfortable 37 10,6398,5

628 12.02

99.1

49 7.83

97.3

9

rich 5 1,44 100 2 0.86 100 3 2.61 100

Total 348 100 233 100 115 100

Table 2 shows the frequencies of a number of demographic characteristics of the sample. This is

presented as total and also for each group (treatment versus control). Even though the study

utilised an RCT design, it is important to check whether there are any statistically significant

differences in the demographic characteristics of the two groups.

From Table 2 it can be seen that a large proportion of the participants are married (39 %) whilst

6% are involved in polygamous marriages. Furthermore 14% are divorced or separated and a high

percentage (26%) has never married.

In terms of employment 28% are wage employed meaning that they have a regular monthly

salary while 48% are self-employed. Although 10% of the sample are too sick to work, only an

additional 8% of the sample are unemployed. This can be seen in figure 2.

12

Out labour force Unemployed Self employed Wage employed

0

10

20

30

40

50

60

70

80

Figure 2: Employment Outcomes (%)

With reference to levels of education around a third have completed primary school (34%) which

in Uganda lasts for 7 years whilst another 46% have been to secondary school which lasts from 3-5

years. In terms of higher education 18% have moved on to further study after secondary school.

Only a tiny percentage (1%) has received no education whatsoever.

The majority of the sample reported being religious with 32% of them being Catholics, 28% being

Protestants, 22% Muslims and 12% belong to the Pentecostal Church. The remaining sample was

composed of Traditionalists, Orthodox Christians, Seventh Day Adventists and other minority

faiths.

Finally, the perceived household wealth varied greatly with 38% reporting that they ‘have enough

to get by’16% saying that ‘they never have quite enough’; 28% reporting to be ‘poor’ and 7%

stating that they are ‘very poor’. Only 10% said they were ‘comfortable’ living off their income,

and a small 1% reported that they were ‘rich’.

The comments presented about Table 2 focus on the sample as a whole. However, it is important

to note any statistical differences between the two groups, even though the study utilised an RCT

design, and this is reported in Table 3. As it can be seen from Table 3 there were no statistical

differences between the groups. The p values all exceeded the alpha value of 0.05 (p = Significant

at the 0.05 level). To do this a t-test has been employed which “assesses whether the means of

two groups are statistically different from each other. This analysis is appropriate whenever you

want to compare the means of two groups, and especially appropriate as the analysis for the post

test-only two-group randomized experimental design”14) has been included. Furthermore, the

smaller the p-value is the more statistically significant it is. 14 “The T Test”; http://www.socialresearchmethods.net/kb/stat_t.php (25/02/13)

13

Table 3: Differences between groups on a number of key demographic characteristics

T-test

H015: diff = mean(control) - mean(treated)=0 P-value

gender 0.526

age 0.334

mar status 0.351

job status 0.130

education 0.662

schooling 0.758

religion 0.623

earnings 0.278

eq. household income 0.856

satisfaction with life 0.337

perceived wealth 0.991

15 (H0 = null hypothesis, meaning that there will be no difference between the two groups)

14

Results and Follow Up16:

Contact was first re-established with patients and controls straight after the tests in June and then in

November 2012 (4 months on). Out of the 348 people who first took part in the Project, 187 people

who received treatment and 81 controls responded. The results will be presented in the following

order: 1st wave and 2nd wave:

1 st Wave: June (straight after treatment was received -donation of aid)

Table 4 charts the feelings of the participants of the project (in percentages) after June when they

first received/did not receive the treatment.

Table 4: Initial 1st wave responses of participants with reference to changes in life Change in life and different domains from June

Strongly got worse

Got

worse Remained the same

Improve

d Strongly improved

Life overall

Treatment 0.53 4.28 26.2 67.91 1.07

Control 0 9.88 61.73 28.4 0

Income

Treatment 2.14 14.97 68.98 13.9 0

Control 2.47 24.69 67.9 4.94 0

Education

Treatment 2.15 1.61 89.78 5.38 1.08

Control 2.47 1.23 86.42 9.88 0

Family relations

Treatment 0 1.60 67.91 27.81 2.67

Control 0 0 55.56 41.98 2.47

Social relations

Treatment 0 1.07 55.08 39.57 4.28

Control 0 0 56.79 39.51 3.70

Health

Treatment 0 4.81 43.32 49.20 2.67

Control 0 7.50 63.75 26.25 2.50

16 Although the results collected are assumed to be accurate, the effect of “Social Desirability Bias” a phenomenon where those completing questionnaires or interviews will report inaccurately “in order to present themselves in the best possible light... Social desirability can affect the validity of experimental and survey research findings”; http://www.psychologyconcepts.com/social-desirability-bias/

15

Table 4 shows the means of the main variables reported by the participants through a series of

interviews and questionnaires completed by most of the treatment and control group. It is worth

noting that these data were collected immediately after treatment, which means that not enough

time has been given for the potential effects of the treatment to materialise. Taking that into

consideration from the figures in Table 4 it can be seen that 68% of patients in the treatment group

reported that their “life overall” improved whilst in the control group only 28% did so.

In terms of income 68% of the treatment group reported that their income remained the same,

whilst similar patterns can be seen for education, family and social relations.

Strongly got worse

Got worse

Remained the same

Improved

Strongly improved

Figure 3: Representation of income for treatment group

However, the most pertinent statistic is that of health where 49% of the treatment group reported

an improvement in health whilst only 26% of the control group did so. This difference in percentage

on the other hand is important to note because with increased health comes better mobility and the

ability to perform duties and work. This would lead to an expectation that with time, these health

benefits could transform into employment opportunities and quite possibly higher earnings. This will

most likely best be seen in June 2013 or even further on when patients have had more time to earn

better wages or find new employment.

Table 5 presents the tests of the differences (by using T-tests) in data between June and November

by comparing the responses of the participants in a number of variables (satisfaction with life,

earnings, leisure time, independence, and personal health preventing leisure time). Due to the fact

that a 4 month window is a more realistic period of time to show any changes in the data, the

comparison of these results can be seen as much more useful. Data was collected from both the

16

Income of treatment group (June 2012)

treatment and control group. From the original 348 sample, 187 treatment and 81 control

participants responded

Table 5 – Means of selected variables in wave 1 and wave 2 for treatment and control Treatment Control

June NovemberT-test

(p-value) June November

T-test (p-

value)Satisfaction with life 3.28 3.81 0.0013 3.5 3.87

0.1352

Earnings (income) 11.85 11.78 0.620011.4

5 11.760.175

5

Leisure time 2.4 2.55 0.0079 2.36 2.36 0.9407

Personal health preventing leisure time 2.56 2.19 0.00 2.37 2.36

0.9154

Independence 0.41 0.44 0.5057 0.47 0.480.864

4

From Table 5 it can be seen that participants in the treatment group reported a significant increase

in the areas of ‘satisfaction with life’ and ‘leisure time’ when compared to the responses of the

control group. However, data collected on ‘independence’, ‘personal health preventing leisure time’

and ‘earnings’ reveal no significant change. There appears to be a link between increased mobility

and enjoyable leisure time. People who received treatment reported statistically increased life

satisfaction between June and November (p = 0.0013) than the control group.

Conclusion:

This study aimed to explore the benefits that prosthetics could bring to patients with chronic

disability in the short and medium term. In addition, it aimed to explore the economic benefits to

the individual patients. As the last phase of the RCT is to be concluded in summer 2013 the paper

cannot comment on the overall effects of the intervention. However, it can identify some

preliminary results. The results of the T-test have demonstrated that an intervention of this type in

this environment has not yet led to an improvement in income (p = 0.6200) as can be seen in the

analysis of the follow up data (June to November 2012). However, the participants in the treatment

group reported a statistically significant difference compared to the control group about their levels

of ‘satisfaction with life’ (p = 0.0013 in contrast to p= 0.1352).

17

Although the treatment of patients did not appear to help those with disabilities come into greater

income, this might be revealed with further analysis later in the year. However, even if this was to

be the case, the process was expensive (large research team, prohibitive transport of equipment

costs and foreign accommodation), and so it could be deemed that prevention is more efficient and

cheaper than the cure. As stated in the section ‘Rational for the Research’ of this essay, Uganda

suffers such disability problems due to Polio, which has still has not been completely eradicated. Aid

might be more used more appropriately if funds were spent on the IPV vaccine, a drug with a 99%

effectiveness and with very limited side effects. The move to embrace vaccination programmes and

school teaching has strengthened, backed by important NGOs and charities such as the Gates

Foundation and UN aid programmes. Moreover, the unrivalled success of vaccination has led to the

deployment of immunisation to more volatile countries such as Afghanistan, showing that this is

clearly considered the best way forward.

A year later (June 2013), the same team of researchers are preparing to return to Uganda to

complete the study. Dr Owens, an Economist from the University of Nottingham, has written an

unpublished Research Brief summarising the key points from the initial results. From the five areas

she reported on it is worth highlighting the area ‘knowledge of disability rights and institutions’ as

greater awareness of social welfare and services not only leads to a reduction in social stigma but

opens up pathways for disabled people to take on new challenges that they never knew were

available before. The knowledge that can be gained from these organisations has the possibility to

increase the earning power of men and women. As it can be seen from Figure 4 the levels of

disabled people who have knowledge about disability institutions does not even always exceed the

50% mark. Therefore in placing new strategic policies forward it is worth considering the role of

education and the gap that sincerely needs to be filled.

0

10

20

30

40

50

60

70

Non-Disabled

Disabled

Figure 4: Knowledge of Disability Institutions (%)

18

A paper written by De Neve and Oswald (2012) looked at the impact of happiness (life satisfaction)

upon income by using a sample of siblings. It reported that increased life satisfaction led to

increased income. Although this paper had neither an African focus nor any data from developing

countries, it opens up a window of thinking as to whether the current findings from the study in

Uganda (life satisfaction for the treatment group) are actually more important than initially thought.

As De Neve and Oswald17 posit to policy makers: “the existence of these mechanisms raises the

possibility that a happier society may be one that intrinsically generates high incomes for its

citizens”. This means that the Ugandan study might have a deeper relevance than purely just being

an intervention.

A Final Thought:

The process of not only writing about a project, but also experiencing things such as

collecting data, interviewing patients, undertaking medical examinations and most

importantly learning about the pressure that comes hand in hand with a task of this nature

was an unforgettable experience. It is for this reason that I believe that this essay is firmly

grounded in the reality of the present Ugandan disability crisis. This essay has forced me to

step back and look at the project from a different perspective, allowing me to more easily

delve into the hard facts and to forget the more personal and human effect that an

experience of this nature has on you. The study has certainly made me more passionate

about an issue that was already of importance to me, it has opened up the area of

developmental economics, inspired me to consider inequality of opportunity around the

world and made me appreciate the tools at our disposal.

17 Jan-Emmanuel De Neve and Andrew J. Oswald “Estimating the influence of life satisfaction and the positive affect on later income using sibling fixed effects” (2012, LSE)

19

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Appendix A: Map of Uganda

18

18 www.nationsonline.org

21