Whereas the government has set out to use public-private partnerships (PPPs) to ensure universal health coverage, research has revealed that the deal never translated into increased access or equitable treatment for the poor.
This is one of the findings of a research that was carried out by Initiative for Social and Economic Rights (ISER), an NGO, to establish whether health, finance and development policies are translating into the provision of services that guarantee the rights of Uganda’s vulnerable populations.
The report titled, “Achieving Equity in Health: Are Public-Private Partnerships the Solution?”, concludes that investing in public healthcare where most of the poor go for treatment would make more sense than investing in an arguably risky private project.
The report was released a month after Parliament approved a proposal to issue promissory notes to the tune of Shs1.3 trillion to Finasi/Roko Construction Special Purpose Vehicle (SPV) Ltd to finance the construction of the proposed International Specialised Hospital of Uganda at Lubowa, in Wakiso District.
“There is no evidence that strengthening the private sector results in better health outcomes for the poor and rural communities. If anything, evidence has shown that private for profit is unlikely to deliver better health outcomes for the poor people and exacerbates inequalities, resulting in the rich being able to access better healthcare and the poor excluded,” the report reads in part.
The report also pokes holes in the arguments that private sector-led health facilities are more efficient than public health facilities. The research also indicts the regulatory framework for PPPs, describing them as “weak and piecemeal”.
Laws such as the PPP Act, 2015, PPP Policy Framework 2010 and the National Public Private Partnership in Health Policy 2012, the document says, create overlapping and contradictory obligations.
According to the report, no specific methodology that would ensure economic analysis, fiscal affordability, risk identification and transfer, value for money, assessment for human rights compliance were followed during the formulation of the laws.
Government’s funding to the health sector over the last several years, the report says, has oscillated between 7 and 9 per cent of the National Budget, standing at 7.4 per cent this financial year and 6.4 per cent the previous year, all of which is way below the 15 per cent that African Union countries committed to in the Abuja Declaration.
The report indicts government for failure to fulfill its promise to improve healthcare for the poor and geographically isolated.
“Instead, it relies on mostly foreign donor and religious PNFPs [Private Not For Profit organisations] to provide essential services. Sometimes, the government provides significant funding to PNFPs to service an area in lieu of establishing public facilities,” it says.
ISER calls on government to increase the budgetary allocation to the health sector and work with Parliament to improve the PPP laws. Government, the reports says, should cease looking at the private sector as its substitute.
“Public private partnerships cannot compensate for a weak State and require the State to maintain a strong and consistent stewardship role,” it says.
The document also called on MPs to refrain from approving PPPs without following legally defined procedure, allocate more funds to the health sector and pass a national insurance scheme to allow for equitable access to health care. ISER also called on donors to invest in the public health sector.