Health budget cuts: Tough times ahead for the healthcare system

Peter Eceru

The budget for 2023/24 has increased to Shs52.7 trillion reflecting a 16 percent increase from Shs45.59 trillion in 2020/21. 
However, in spite of the increase in the overall budget, the available discretionary spending available has remained almost the same. This is occasioned by increased payment of debts. This implies that there is a direct knock on the service delivery expenditure. Health service delivery expenditure is one of the areas that has had a cut. 
The health expenditure has about a 5 percent drop in funding in the coming financial year. This is in stark contrast with East African neighbours Kenya and Tanzania who have increased health financing by 14 percent and 8 percent respectively. It should be noted that for the case of both Tanzania and Kenya, this allocation is complemented by public health insurance.
The reduction in budget allocation for health means that Uganda will not be able to meet its commitments including reduction of maternal mortality, Universal health coverage among others. For example, the biggest cause of death for mothers while giving birth is loss of blood which accounts for 41% of maternal deaths. 
To reverse the number of maternal deaths and achieve the Sustainable Development Goals target of having 70 deaths per 100,000 we need to invest in blood collection, processing and distribution. Safe blood and blood components are critical in the prevention and treatment of Malaria, Anaemia, morbidity and mortality reduction, promotion of Maternal and Child Health and provision of blood for victims of accidents and emergencies.  Currently, Uganda needs 450,000 units of blood annually but the budget available can only enable it to collect 300,000 units of blood leaving an unmet need of 150,000 units of blood. 
The 2023/24 budget for blood collection and processing has been cut to 22 billion shillings from 23 billion shillings.  In the current financial year, the government allocated 23 billion shillings for blood collection, processing and distribution. This is a very worrying situation for a country like Uganda with one of the highest teenage pregnancy rates at 25 %- the highest candidates for blood transfusion.
The health system has for the larger part been characterised with labour disputes arising from poor working conditions and poor pay for the different categories of health workers. The latest is the current failure by the government to pay Senior house officers and medical intern students. The payment for both senior house officers and intern’s students was all agreed with the government through a negotiated settlement. While the Minister of Finance indicated that provision of 22.6 billion shillings to cater for arrears for the senior house officer and medical interns for the financial year 2022/23, government has not deliberately planned for the SHOs and intern students in the 2023/24. 
The government in the current financial year has established a new staffing structure for health facilities, unfortunately the filling of the newly created structure has not been catered for in the new budget.
It is important to note that not all investment in health will generate maximum benefits for the health sector. Over the years the government has invested heavily in the construction of new health facilities. This has significantly improved the number of people leaving within 5 kilometers of a health facility to 591% on average. This means that the challenge of accessibility has substantially been dealt with. Investments must now be directed towards functionalising and improving the quality of services in the available health facilities
On drugs, the government made a modest increase in allocation to National Medical Stores for procurement of medicines and supplies. However, this increase will have no significant impact on drug stock outs in public health facilities. While there is a funding deficit of about She240 billion, the government has only made an additional allocation of Shs74 billion in the 2023/24 budget. 
This will be lost out in forex exchange losses given that Uganda imports about 90 percent of its drugs in dollars. The shilling is anticipated to lose value against the dollar, implying that Uganda will be able to procure less drugs for the same amount compared to what the same amount it would have procured last year.  Our commitment to deliver quality public health care is in doubt. Government must therefore take deliberate action to actualise a national health insurance scheme to cater for additional resources for health service delivery. Other countries in the East African community have established health insurance schemes as complimentary financing options.
Mr Peter Eceru is the program Coordinator for Advocacy at The Center for Health Human Rights and Development.