Unlike many countries in sub-Saharan Africa, Uganda made significant economic gains over the past 15 years. But there still are critical challenges, particularly in the health sector. The U.S. Agency for International Development (USAID), a major donor in health in Uganda, reports on its USAID Uganda website that over 60 percent of the country's population does not have access to clean drinking water and that 55 percent of the population lives on less than the equivalent of one United States dollar per day.

Many Ugandans cannot afford to be seen by a doctor in a country where there are as many as 27,000 people per doctor. Additionally, while most physicians are located in urban areas the vast majority of Uganda's population lives in rural areas. As a result, nurse aids, nurses, midwives and clinical officers provide the majority of the health care services.

A high population growth rate (2.9 percent) is also affecting health issues in Uganda. If the rate of population growth remains unchecked, Uganda's population of 21 million will double in 24 years. Other health sector indicators are:

• Total Fertility rate stands at 6.9;
• Less than 20 percent of married women use contraception;
• Maternal mortality is 506 per 100,000 live births;
• For every 1,000 live births, 81 infants under age one die;
• Less than 40 percent of children under the age of two have been immunized for the six killer diseases;
• Thirty-eight percent of children under the age of four are undernourished; and
• Life expectancy is just 42 years.

Despite these challenges, Uganda is making headway in changing some of the age-old beliefs and practices. The DISH Project interventions helped to increase contraceptive prevalence among women in 12 districts from 12.6 percent in 1995 to 18.6 in 1997 and 20.3 % in 1999; helped to increase condom use for AIDS prevention among men from 27 % to 38% in 1997 and 40% in 1999, according to DISH Evaluation Surveys 1999, Measure Evaluation Project and Pathfinder International.