While women comprise 52 per cent of Uganda’s population, a typical woman continues to grapple with critical health issues that are only slightly addressed by the current budget support to the health sector. A glance at the national budget for financial year 2021/2022 doesn’t emphasize the health rights and wellbeing of women enough.
There is a notable reduction of 9.3 per cent in the health budget from Shs2.781 trillion in Financial Year 2020/2021 to Shs2.523 trillion. This reduction specifically affects two parts of the health budget; the Uganda Cancer Institute and Uganda Reproductive and Maternal Health (RMH) Programme.
The five-year RMH World Bank-funded programme received Shs178.9 billion in FY 2020/2021 which will reduce by 51.6 per cent in its last year of implementation to Shs86.5 billion in FY 2021/22 while funds for Uganda Cancer Institute will reduce by 96.1 per cent to Shs2.68 billion. These two health budget items almost exclusively affect women.
At such a time when the country is reeling from a debilitating pandemic whose effects are yet to be fully known, any reduction in the health budget will exacerbate the plight of women and girls. For instance, it has already been reported that there is an acute rise in teenage pregnancies which has most likely surpassed the national average of 25 per cent, leaving thousands of girls out of school and at a higher risk of long-term health consequences.
Relatedly, a significant number of girls have been married off at an early age exposing them to unsafe abortions and sexually transmitted infections such as HIV/Aids. There’s no doubt that government made an effort to increase health funding for local governments and regionalreferral hospitals according to the National Budget Framework Paper FY 2021/22. Some might argue that the increased allocations to those entities should sufficiently address the needs of women and girls. That is where the problem lies. When funds meant to address issues peculiar to women are pooled with funds for other activities, there’s no assurance those women-specific issues will be addressed.
National statistics reveal that 28 per cent of Ugandan women have an unmet need for family planning and about 7,500 babies are infected with HIV annually. With Covid-19, most of the gains made in the previous years could be lost.
Anecdotal evidence from Forum for Women in Democracy (FOWODE)’s work on sexual, reproductive health expenditure tracking in Mityana and Busia districts in 2020 showed that 4.9 per cent of the teenagers who had received antenatal care in Busia did not give birth at the health facilities, which is considered risky in case of any emergencies. Cervical cancer screening was still low compared to vaccination of young girls with the HPV vaccine and on average, less than half of the respondents within the community did not receive family planning services largely because they could not access the services or had limited knowledge on family planning.
Although financing for reproductive and maternal healthcare has been availed over the years, it has not been sufficient to meet the challenges women face. Most maternal and neo-natal deaths could be averted with timely management by a skilled health professional working in a supportive environment.
Uganda committed to ensure universal access to sexual and reproductive health and rights under the Sustainable Development Goals and the Beijing Platform for Action and to allocate 15 per cent of the budget to health (The Abuja Declaration). How then, is the reduction in the health budget moving us closer to attaining those targets? We call on government to replenish the reproductive and maternal health fund that is phasing out in 2022 and increase funding to the Cancer Institute in the short term.
In the medium and long term, it should gradually shift from external financing to a more sustainable domestic fund in order to ensure that pregnant women and new-borns receive the right care at the right time, hospital-acquired infections are prevented and those who need referrals obtain them without delay.
Ms Arinaitwe is the program manager, gender and economic justice at the Forum for Women in Democracy.