Performance of Uganda’s health Sector; Can increased financial allocation improve service delivery?

A woman in labor rested in the delivery room of the hospital in Arua (photo credit: NewyorkTimes)

Uganda’s human development especially the health sector is ranked 20th on the continent  at a score of 70.3 in the Mo Ibrahim Index of African Governance 2015. To her credit, Uganda’s health sector has  registered improvements over the last four financial Years ( 2013/14- 2016/17), including the expansion of provider networks, abolishing of patient user- fees, sustained management of HIV patients amongst other achievements.

Despite the progressive markers, improvements have been unevenly distributed with a clear and persistent urban-rural gap.Though health related gender outcomes such as access to maternal health care have improved, they are slowed down by worrisome indicators like high fertility rates.

While a healthy citizenry is paramount for  the socio-economic stability and sustainable development of Uganda, this is not a product of the health sector alone, but also improved sector  financial allocation,  sector prioritization in the national budget and effective policy implementation.

What is Uganda’s health sector  financial Stand?

Uganda’s health sector remains significantly under-funded, mainly relying on private sources of financing especially out-of-pocket spending, thus making it difficult  to attain sector targets.

At less than 10% of its budget to health care, public spending on health is less than the 15% agreed upon in the Abuja Declaration by heads of African states.The current funding of US$ 27 per capita per annum expenditure on health care is far below the US$ 44 per capita recommended.

In principle, a good health financing system raises adequate funds for health in ways that ensure people can use needed services, and are  also protected from financial catastrophe or impoverishment associated with having to pay for them.

Generally, the health status of Ugandans remains poor, characterized with a low level of life expectancy and a high level of mortality undermining the efforts and investments for social and economic development.

Health sector allocation for the last Four financial years

Financial Year Amount allocated  % on the national budget Status
2013/2014 1,142.83 8.60% Moderate
2014/2015 1,197.80 8% Moderate
2015/2016 1270.8 7% Reduced
2016/2017 1.385 7% Low

Relationship between  health budget and  sector allocation  for the last four financial years ( Data  Source :CSBAG ,MoFPED)

In FY 2013/2014 and 2014/2015, the health sector received  approximately 9% of the national budget. In the period, a reduction of maternal mortality rates  was seen i.e from 168 per 100,000 in FY 2012/13 to 146 per 100,000 in 2013/14 . This was attributed to  recruitments  i.e deployment of midwives and other health workers, availability of medical equipment to health facilities and  60% health units having enough medicine.

Despite the moderate financial allocation, Local Government health services financing was inadequate. Financing of primary prevention initiatives at the district level was minimal thus leaving Civil society Organizations to fill gaps. Further still, recurrent budgets under the  Primary Health Care (PHC) grant still show limited improvement.

In FY 2014/2015 – 2015/2016,  sectoral budget allocation  was reduced from 8% -7%. At 7%,  nine hospitals  were constructed with World Bank support equivalent to US$ 52 million. i.e Moroto, Mityana  Nakaseke, Kiryandongo, amongst others. Ten (10) ambulances for Kampala metropolitan area were procured by the Ministry of Health contributing to a reduction in continued Maternal Mortality Ratio through implementation and distribution of Emergency Obstetric Care (EmONC) lifesaving medicines.

Projections for 2017/2018 Health  Sector Performance.

In FY 2017/18,  continuous implementation of a plan to accelerate investments in maternal, newborn and child health  is underway.This proposes five strategic shifts reflecting a paradigm shift in the reproductive, maternal, neonatal, child and adolescent health(RMNCAH) agenda. i.e targeting areas with highest number of deaths, increasing access for high burden populations,placing emphasis on evidence based high impact interventions,  amongst other plans.

Whereas, the Ministry of health has outlined good proposals to advance the health standards of Uganda’s citizens, achievement is doubtable if the  health sector budget is reducing financial year after another. With a limited budget allocation, the ministry has little to deliver.

Though the burden of maternal and perinatal deaths was addressed at policy level by launching and beginning Implementation of a reproductive health maternal, newborn and child health (RHMNCH) sharpened plan 2013 to accelerate reduction of maternal, newborn and child mortality; sectoral priority to attract, recruit and retain staff to offer Maternal and Newborn care services could remain on paper due to continuous sectoral cuts.

Going Forward

Prioritization health sector financing in the national budget is key for implementation of the sectoral plans, ensure universal health coverage and improve service delivery for the betterment of Ugandans health services. Adequate financing of the health sector will provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective and ensure that the use of these services does not expose the citizens to financial hardships who mainly depend on 2 dollars a day for survival.

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About Joy Namunoga

Joy is a US Department of State alumni for the Community solutions Program 2016. She was a Policy Fellow at Sunlight Foundation in Washington DC and presently,the Advocacy officer for Anti-Corruption Coalition Uganda, where she empowers citizens to actively and sustainably demand transparency and accountability from public and corporate officials. Join Joy in envisioning a world where transparency and accountability exists.
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