Health service delivery needs financing

Author: Peter Eceru. PHOTO/COURTESY

What you need to know:

  • As a country we have not been successful in increasing financing to the health sector. 

With the aim of ensuring access to affordable quality health and reduce out of pocket cost for Ugandans several initiatives have been enforced including the elimination of user fees in 2001.

The user fees at health facilities were used as additional source of revenue to fund healthcare. Unfortunately, over the last 10 years government contribution towards healthcare as a percentage of the national budget has reduced from 8.9 percent in 2010/11 to 6.1 percent in 2020/21 and this burden has been shifted to the donor community and households. 

Similarly, government contribution as a percentage of the national health budget reduced from 74.2 percent to 57 percent over the same period. This clearly demonstrates that health of citizens is being gradually scaled down in terms of government prioritisation. What is even more worrying is that of the 57 percent government contribution towards the health budget, 53 percent is spent on recurrent expenditure such as salaries, oils and fuels, allowances and only four percent is spent on capital expenditure.

In the budget Framework Paper for the financial year 2022/23 that was laid before Parliament on December 21, 2021, it is evident that there will be no significant change. The budget framework papers indicate a number of unfunded priorities which will significantly affect quality of healthcare. This means that the healthcare system will still deal with challenges of unmotivated staff, inability to kick-start the national ambulance service, etc.  

The World Health Organisation recognises that there are three inter-related domains that are fundamental to achieving and maintaining universal access to healthcare - raising sufficient funds for healthcare, reducing financial barriers to access by pooling funds in a way that prevents out of pocket costs and allocating funds in a way that promotes quality, efficiency and equity. Over the last 10 or so years government has failed on all the three domains.

As a country we have not been successful in increasing financing to the health sector as a percentage of the national budget. The World Health Organisation argues that for a country to be able to achieve universal health coverage, it must allocate about 15 percent of its budget towards health.

Uganda has for most of the last 10 years allocated less than half of that. To be able to achieve our health targets as set out in the NDPIII Uganda, the programme Implementation Plan for Human Capital Development projects an expenditure of more than Shs9 trillion in the 2021/22 FY. 

However, in the same financial year, government allocated only Shs2.7 trillion leaving a funding gap of Shs6.3 trillion.  In terms of pooling resources, Parliament passed the National Health Insurance Scheme Bill in 2021, but this was not assented to by the President and in accordance with the ruling of the Speaker of parliament, this was one of those bills that abetted. As a result, out of pocket expenditure on health is over 40percent which is more than twice the World Health Organisation recommended.

Maternal, reproductive and new-born health is a key determinant of the opportunities that women and their children have in life.

The budget must therefore ensure that pregnant mothers are capable of accessing a doctor regardless of where she is, be able to access blood whenever she needs it during child births among others. Women should have a right to safely bear children and to freely decide whether to have them, how many to have and when to have.