The health sector financing in Uganda for the last five years demonstrates an even allocation with occasional oscillations on account of external financing without which the sector MTEF ceiling stagnates at 6% as a share of the national Budget. The implication of this trend is that the sector currently invests about US$9 per capita per person for 2.5 treatment episodes per year as compared to the HSSIP requirement of US$28 exclusive of wages. This leaves an estimated annual shortfall of US$200 Billion which may not be available even by 2020. With less than one year to go (2015), reports on progress of achievement of health MDGs (4, 5 and 6) reveals that Uganda is still among the Sub-Saharan countries that are lagging behind and perhaps given up on chasing down this targets. It is obvious that the current level of health funding significantly correlates with the state of health services in the country. The proportion of deaths among mothers and children remains un-acceptably high at, 438 deaths per 100,000 live births and 90 under-five deaths per 1,000 live births respectively (UDHS, 2011) and have as well remained key investment priorities for Uganda in the health sector
Code named: “Going beyond supply and demand; the health budget we want” This annual budget analysis report gives an overview of resource allocation by agency and key institutions in the health sector, budget performance within the institutions and changes over time in the priority setting in FY 2014/15. The analysis looked at gaps and implications of under resourcing health sector towards quality health services delivery in the community.
The focus of this year’s budget analysis continued to target implementation of the Health Sector Strategic Investment Plan (HSSIP) by looking at key areas that are critical in improving health outcomes among women, children, youth and men in the country; access to essential medicines, human resources for health, Primary health care and HIV/AIDS. The analysis was done to obtain evidence to influence bureaucrats, policymakers and donors to efficiently implement the national health sector strategic investment plan (FY 2010/11-2014/15) and contribute rapidly to socio-economic transformation of the economy.
Key findings of the analysis showed a growing concern of the unfunded priority in budgetary provision of UGX 129 Billion for enhancement of salaries for other health workers other than the medical doctors at HCIVs.
The key areas of focus for FY 2014/15 were remotely in line with Uganda National Minimum Health Care Package (UNMHCP) though noted that the Nutrition cluster seems not to be given the attention that it deserves calculated to cost about UGX 1.8 trillion annually, equivalent to 3% of GDP malnutrition cases in Uganda.
Though the priority areas are in line with National Policy, the resource allocation did not seem to reflect all the key priority areas identified by the sector. For example: while human resource (attraction motivation and retention) is a key priority area, in the allocation to wages remained static and expected to remain static in the medium terms.
In addition, enhancing blood collection though reflected as another key priority, Uganda Blood Transfusion Service remained with funding gaps for human resources and equipment.
Funding of HIV/AIDS Interventions remained largely donor supported with external financing taking a share of 67%, Private/out of pocket 23% and Public/Government allocation 10%. The proposal to establish a national HIV/AIDS trust fund remained oblique with very little political commitment and legal framework for its operationalization
In the Local Government Act 1997, districts and municipal councils are mandated to offer health services at all levels; I,II,III and IV where the majority of Ugandans seek for health services. However, only UGX 41.185 Billion had been allocated as non-wage recurrent budget to run health service delivery in 137 local governments, leaving a shortfall of UGX 41.2 Billion to boost non-wage recurrent budget. During the last planning session, the Ministry indicated the sector would be using a new PHC allocation formula in the medium term. However this is not disclosed or reported in the year 2014/15.
The analysis was used for advocacy and engagement in three key events
a) Round table meeting with the health committee of parliament where AGHA together with civil society coalition presented the technical analysis to the committee members. AGHA called for consideration of two important issues for this financial year 2014/15 i.e. Enhancement of PHC non-wage recurrent to enable health facilities deliver on the mandate and enhancement of salaries of lower cadre health workers to attract, motivate and retain them.
b) Breakfast meeting with CSOs, Parliamentarians, Ministry of health and donors to share key concerns in health financing in the country.
c) Dissemination to civil society organisations as blue print for concerted engagements and advocacy on health service delivery in their various forums. Increasingly before, CSOs advocacy had lacked in-depth technical analysis of often bulky budget document. A round table meeting was organised at AGHA board room to share the key findings of the analysis
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