FILE Patients at the Uganda Cancer Institutute
According to the recently released World Bank’s 23rd Uganda Economic Update, about one million Ugandans fall into poverty each year due to health expenditures.
This troubling statistic highlights the government’s inadequate budgeting for the health sector. Over the past two decades, Uganda has made significant progress towards universal health coverage (UHC). The UHC service coverage index score for Uganda increased from 22 in 2000 to 49 in 2021, indicating that investments in the health sector are yielding positive results.
This progress has contributed to improving health and nutrition outcomes across the country. To achieve universal health coverage, it is essential that everyone in Uganda has access to quality services at the right time without having to forego treatment due to financial constraints.
Rogers Ayiko, a senior health specialist at the World Bank, emphasized the need for increased spending to reach UHC goals.
“Low-and middle-income countries need to spend about $112 per person to achieve universal health coverage, but Uganda is currently spending only $50,” he said.
Notably, 84% of this $50 comes from development partners and out-of-pocket (OOP) expenditures. While the incidence of household impoverishment due to OOP spending on health in Uganda has reduced over the years, many people are still being pushed into poverty.
Based on Uganda’s national poverty line, the percentage of households impoverished due to OOP spending on health decreased from 4.6% in 2005/6 to 2.3% in 2019/20.
However, Ayiko noted that this remains a significant issue: “When you combine all the poverty eradication interventions in Uganda, how many Ugandans are brought out of poverty? If the number is two million, just know that half of them will go back to poverty every year because of health care. As the population grows, our anticipation is that the number of people falling back into poverty will increase to over one million.”
This data underscores the urgent need for the Ugandan government to prioritize health sector funding to prevent more citizens from slipping into poverty due to healthcare costs.
He noted that the country needs to increase public domestic spending to address the growing burden of complex medical conditions that require more funding and long-term treatment, unlike diseases like malaria, which can be cured in three days.
The provision of quality healthcare in Uganda is hindered by ineffective management of health inputs, including financial and human resources, medicines and medical supplies. Fraud and corruption further exacerbate these issues, with annual direct losses in the health sector estimated at US$180.2 million, equivalent to 25 per cent of the annual government spending on health.
“The annual cost of absenteeism is estimated at US$78.5 million. There are significant deficiencies in payroll management in some districts, with discrepancies in data between budgets, payroll registers, health facilities, and cost centers,” the review report states.
Access to medicines and medical products in the country is also low, with only 46 per cent of facilities having 95 per cent of tracer medicines in 2020/21. These challenges highlight the urgent need for increased and more effective public domestic spending to ensure the provision of quality healthcare and to address the systemic issues that undermine the health sector’s performance.
The World Bank has emphasized that with Uganda’s rapid population growth, the country will need to double its health infrastructure and significantly increase its budget for the health sector.
“As Uganda transitions into the middle-income space, partner funding is going to stop be- cause we have known it from experience in other countries. Uganda needs to progressively start taking up that gap that is going to be created. The problem with partner funding is that it is not very regular, which makes it difficult to do long-term planning,” a representative from the World Bank stated.
He further noted that some countries have failed to immunize their children after funding from GAVI was abruptly stopped. Countries that allocate more of their domestic resources to health services progress faster towards universal health coverage because they can better plan for their needs rather than relying on inconsistent external funding.
According to the review, only 59% of public health facilities in Uganda are ready to deliver services, indicating that 41% are not prepared.
“If I go to the health facility and I get half of the medicines and next time I get zero, I will have that perception that things don’t work. But there have been a lot of efforts that are moving towards improving the performance of service delivery entities,” the representative added.
The World Bank urged the Ugandan government to strengthen the health financing system to enhance adequacy, equity, effectiveness and efficiency. They recommended focusing investment on primary health care, health promotion, and disease prevention to ensure sustainable progress in the health sector.
Source: The Observer
