As CSOs, we note with concern the drastic reduction in projected budget allocations for the Health sector for FY 2017/18.
According to the Budget Framework Paper FY 2017/18, the Health sector is projected to experience the biggest budget cut in history of over UGX 541.5bn. This reduction from 1,828.07 billion to 1,285.76bns amounts to a 30% budget reduction to the Health sector budget and is totally unacceptable. As Citizens of this country we stand united to challenge this move by government.
It is inconceivable at such a time to have the health sector budget cut by such a huge margin yet the country has made international commitments on health like UNAIDS 90x90x90, adopted the new WHO (2014) ART test and treat guidelines, embarked on a mission of Universal health coverage
A review of all known government policy commitments on health for example the NRM-O 2016 campaign Manifesto, National Development Plan II and Health Sector Development plan shows very poor alignment of policies to the budget. The 2016 NRMO manifesto promised to focus on efficiency and effectiveness in delivery of health services and ensuring Ugandans have access to high quality health care with a preventative oriented approach, well equipped health facilities and well trained, motivated health workers in addition to developing systems to support health care. Interestingly the president’s manifesto promised to specifically;
• Recruit health workers to 100% staffing level by 2018,
• Increase Anti-retroviral Treatment (ART) enrolment from 800,000 to 1.4 million to achieve the target of 90% of all HIV positive people by 2020
• Provide ARVs to 100% of all HIV positive pregnant mothers, children and adolescents,
• Establish a National Ambulance System with ambulances in strategic areas co-ordinated by a command centre.
• Progressively increase the budget of the National Medical Stores.
• Train and facilitate highly specialized health professionals in cancer care, organ transplant, neurosurgery, bone surgery, in order to reduce on referrals abroad.
Such aspirations cannot be attained with drastic budget cuts to the Health Sector Budget.
A further analysis of the National Development Plan (NDP II) and Health Sector Development Plan (HSDP), reveal a poor alignment of the Health Sector BFP FY 2017/18 to the NDP II and HSDP projections. Whereas the NDP II projected a total allocation of 2,221.00billion Ushs to the health sector, the BFP reflects just 1,285.76 billion Ushs. This is just 58% of the funding provided for health as a share of NDP II projections.
CSOs also note with concern the continued poor absorption of loans in the sector. The FY 2015/16 Annual government performance report highlighted that 25% of the loans assessed under the health sector registered a satisfactory performance while 75% had unsatisfactory performance. Half of these loans had accrued commitment charges between 2010 and 2016. The continued failure of the sector to absorb funds poses questions in light of the challenges the sector still struggles to address.
As CSOs we take note of the fact that the National Health Insurance Scheme Bill conceived in 2007 has up to 2017 never been presented to Parliament for consideration. This points to a lack of commitment and political will on the part of the key players to support the sector with domestic resources yet we continue to heavily rely on external partners’ support for health service delivery. We want to point out to government that this is unsustainable in both the short term and long term and undermines the logic of state sovereignty.
The high attrition rate among critical lower cadre health workers in public health facilities is still of great concern to us. According to the Annual health sector performance report, it was noted that during FY 2015/2016, most departures reported were nurses at 34%, followed by midwives at 25%, 20% for administration and support staff and to a lesser extent the medical officers and paramedical staff.
CSOs’ Call
1. Align the National Budget to the National Development Plan II and resource projections. As a country we should desist from being known to have good laws and policies but very poor at implementing our policies.
2. Allocate funds to attract, recruit and facilitate health workers for districts with the lowest staffing levels of key cadres. We propose that government progressively allocated Ushs15billion each year in a span of 2 years to address the staffing gaps. This should be able to recruit 1500 health workers every financial year so as to bring staffing to 100%. Additionally, an incentive mechanism that government agreed with the teachers association UNATU should be emulated for progressive enhancement of lower health workers.
3. Increase and decentralize PHC funds for better services to ordinary citizens. According to Ministry of health estimates, PHC non-wage enhancement requires an additional Ushs 34billion. We also caution Ministry of Health against implementing PHC development budget on behalf of local governments as has been the norm for the last 2 financial years. This practice has created more hitches in service delivery.
4. Government must treat the issue of operationalizing the National Health insurance scheme with the most urgency. The money allocated for construction of a health centre II at 2.5billion must be re allocated towards the NHIS as part of the 5bn startup capital reflected as unfunded priority. Government should as well institute an inter-ministerial team to iron out the differences that seemingly is taking the country round the circle to table this bill.
Conclusion
Like former UN secretary general once said “we can cut back on health expenditures and incur massive losses in lives and fundamental capacity for growth or we can invest in health and spare both the people and economies the high cost of inaction” . As CSOs we think that the cost of cutting back is just unthinkable. Investments to scale up basic health services can bring a six fold economic return and accelerate our quest as a country to attain middle income status by 2020.