Financing Health Care in Uganda

Florence BainganaMSc HPPF

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Context

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East African country Independence from the British in 1962 Population is about 31 million, 13% is urban Poor country, GNI per capita is US$340 IMR is 78 per 1,000 live births U5MR is 137 per 1,000 live births MMR 435 per 100,000 live births Life expectancy at birth is 51 yrs HIV and Conflict

Health Policy and Health Sector Strategic Plan

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Ist Health Policy passed in 1999, process begun before that.

Defined a package of essential services, Uganda National Minimum Health Care Package (UNMHCP)

First HSSP 1999-2004, second 2005/06-2009/10

Organisation of Health Services in Uganda

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Primary679 HC III3624 HC II

Secondary87 Hospitals

Tertiary2 Hospitals

Western/Allopathic Traditional healing, SpiritualPsychosocial

Regional Referral

10 Hospitals

Health Sub District127 Health Center IV

Health Financing US$ 20 per capita per annum spent on

health. Of this, 58% is paid out of pocket 22% from Government 20% from donors

60% of health units are public and 30% PNFP

User fees contribute 50% of the PNFP hospital running costs

Govt (public contribution to health is going down)

Health Financing ContdFiscal Year 2004/05 2005/06

Govt Expenditure (billion Ug Shs

219.56 229.88

Sum of donor projects 254.85 (55%)

507.26 (68%)

Total Health Expenditure in health sector

474.41 737.14

Govt expenditure on health as % of total expenditure

9.7% 9.0%

Annual budget increase 5.7% 4.7%

Challenges Scrapping of user fees in 2001 36% of the population is living below the

poverty line 83% of the population is in the rural areas HRH challenges Macro level issues in relation to transparency

and use of resources (NSSF, Global Fund, create problems for introduction of SHI)

Options for the way forward Introduction of Social Health Insurance Problems include:

Very small formal sector No national patient information systems Problems of trust Huge resistance from the private health

insurance firms

Options for way forward Community Health Insurance: Problems

to over come include: Lack of information and poor

understanding of the concept Lack of trust Problems of ability to pay the premium Poor involvement of the community in

setting up and management Long distance to the health unit Poor quality of health care Unattractive benefits package

Conclusions More research has to be done for instance

in: How to scale up Community Health Insurance Feasibility of introducing Social Health

Insurance Explore other mechanisms to access health

care to the poor and the vulnerable, or targeted populations, such as voucher schemes for child immunisations, antenatal care services, TB treatment, mental health care, etc