Uganda
Country Information
Country indicators [2008]
Background information on national health financing policy
Uganda
|
Selected indicators |
2000 |
2005 |
2008 |
|
GGEH as % of THE |
26.8% |
29.7% |
22.6% |
|
PvtHE as % of THE |
73.2% |
70.3% |
77.4% |
|
GGHE as % of GGE |
7.3% |
10.4% |
10.3% |
|
OOP as % of PvtHE |
56.7% |
51.0% |
51.0% |
In 2007 per capita expenditure on health was $74
The HLSP survey recorded that health finance comes from public taxes (2%), aid partners (29%), private out of pocket (38%) and private risk pooling (35%). User fees are not charged in Uganda, where there has been free care in the public sector since 2001. Approximately 10% of public revenues for health are raised from fees for other services.
Reconstruction of the social sector in Uganda became a government priority after a protracted period of unrest in the mid- 1980s. The Government attempted to assist its population to manage the risk of ill-health in three different ways. First, during the 1990s, it introduced exemptions for poor and vulnerable groups from user fees for health services. From 1995 to 2002, it also supported community-based health insurance schemes. Its third approach, in 2001, was to abolish fees for health services, combined with reforms in the health sector to improve the provision of basic services.
The country’s decentralization policy, and the autonomy that followed it, gave many of the districts the window of opportunity to introduce cost-sharing in order to generate local revenue for health services. In February 2001, following reports of the detrimental effects of cost-sharing on the access of the poor to health services, the government decided to abolish cost-sharing in public facilities, while the usual community financing modes in the private not-for profit (PNFP) and private for-profit facilities were maintained. This decision meant total removal of cost-sharing in public health facilities at the community level, and the retention of a two-tier fee system in public hospitals, with a paying window for those who can afford to do so and a non-paying one for others. This policy decision was implemented in all public facilities effective on 1 March 2001. Subsequent research suggested that abolition of user fees has resulted in a marked increase in utilization of health services by all population groups. This had been especially beneficial to the poor.
Health services are currently funded by a combination of user fees, health insurance, (mostly for employees subsidised by employers) and the government. Government covers 14.9% of national health expenditure, donors 34.9%, households 49.7% and international NGOs 0.4%. In recent years, health expenditure as a proportion of government’s discretionary expenditure has been relatively stable around 9.6%, although it still remains below the Abuja Declaration target. No user fee is paid in lower level health units and general wings of publicly owned hospitals whereas the private sector charges user fees1.
Private Not-For-Profit providers (PNFPs) account for 41% of the hospitals and 22% of the lower level facilities and are more present in rural areas, thereby complementing government facilities. The PNFPs operate 70% of health training institutions with financial support from the government.
Strategic policy decisions on investing in health place the focus on continuing to operate a decentralised health service delivery system with the focus on strengthening district health systems to deliver the National Minimum Health Care Package (UNMHCP) including health promotion, disease prevention and early diagnosis and treatment.
CHI remains one of the mechanisms envisaged in the Ugandan health sector strategic plan 2005/6-2009/10 to finance health services. In some areas regulated and licensed private insurance companies provide health insurance to employees in the formal sector and to groups of households in the so-called informal sector, such as self-employed farmers. Research suggests that these schemes cannot offer households full protection against the direct financial effects of health risks, although it may reduce them.
Approximately 60% of Uganda’s population continue to seek care from Traditional and Complementary Medical Practitioners (e.g. herbalists, traditional bone setters, traditional birth attendants, hypnotherapists and traditional dentists) before visiting the formal sector.
1 MOH NATIONAL HEALTH POLICY: Reducing poverty through promoting people’s health - Policy paper 2009 http://www.health.go.ug/National_Health.pdf
From WHO Report on Health Financing 2006 http://whqlibdoc.who.int/emro/2006/WHO_EM_HEC_011_E.pdf