Observers have warned that Uganda's health sector faces tough times as it prepares to start a new financial year with reduced budget support from non-state actors.
Statistics show that external funding has contributed significantly to Uganda's health sector resource budget in recent years. It increased from 19 per cent in the 2021/2022 financial year to 38 per cent in the 2023/2024 financial year.
A number of donors have expressed interest in reducing budget support for this sector ahead of the start of the 2024/2025 financial year in July. Last month, Uganda's health minister told parliament that donors had told him they would no longer provide additional funding to high-malaria countries, including Uganda.
“Our partners are no longer willing to increase their funding for malaria. They have all leveled off,” said Minister Jane Ruth Asen, adding that “10+1 high-burden countries recently invited Cameroon to I was there in person and was told. [that] the world has moved on [tackling] climate change, global health security, and much more. ”
The 2021/2022 Health Sector Annual Performance Report shows that malaria remains the millstone around Uganda’s neck. In 2021/2022, it accounted for 32.1% of all outpatients. Close behind were coughs and colds (20.4%), urinary tract infections (4.7%), and gastrointestinal disorders (4.0%).
“We were asked to sign a declaration that read: [that] “Each high-burden country will seek its own domestic resources and end the malaria pandemic and epidemic on its own,” Assen said.
Two weeks ago, a senior Health Ministry official told the House of Commons Public Accounts Committee that the country's Anti-Homosexuality Act (AHA) further complicates matters.
“With the passing of the law, we have found that somehow our partners are starting to back down. The largest portion of our funding comes from outside, so in the long run this will impact our performance and budgeting.” ” says Dr. Diana Atwine. said the ministry's finance chief.
The concerns of the Permanent Secretary of the Ministry of Health were not unfounded. On April 8, health development partners told a House of Commons committee that Uganda needs to start looking at closing potential gaps. They have made it abundantly clear that they can use fiscal measures to make ends meet.
“If a tobacco control levy, a flat specific tax on all cigarettes, was set at Sh10,000 per mil, tobacco tax revenues could increase by Sh16.8 billion annually,” says Christa of the Health Finance Desk. Bel Abeve said. “This will also reduce cigarette consumption by 7 percent,” the World Health Organization (WHO) official added.
According to Ms Abewe, the government was also recommended to consider the creation of a “national motor vehicle third party insurance fund funded by the proceeds collected from third party repossessions of motor vehicles”. Global Health Partners further states that “If just 5 per cent of the total premiums collected from third-party motor insurance were allocated to the third-party motor vehicle fund, an average of Sh2.9 billion could be generated annually. “There is,” he reasoned. Military funds could be redirected to support Uganda's health sector.
Health development partners also recommended that strict measures be taken to curb road indiscipline, which causes road accidents, which continues to burden Uganda's health sector.
Partners participating in the House Health Committee meeting included the United States Agency for International Development (USAID), the United Nations International Children's Emergency Fund (UNICEF), and the Centers for Disease Control and Prevention (CDC).
In September last year, the Deputy Health Minister told the House of Commons Physical Infrastructure Committee that the government was spending at least Sh1.5 billion on medical services alone for accident victims.
“The average cost of treating a critically ill patient is approximately Sh3.6 million per day. Surgical intervention increases the cost to Sh13.6 million, which translates to Sh648 million for treating an average of 180 critically ill patients in hospital. It becomes a shilling. [Accident and Emergency] Mulago National Referral Hospital Unit. Half of these patients will require surgery, increasing the total cost to Sh1.548 billion per month,” Minister Hanifa Kawooya said.
Dr. Charles Ayume, who led the committee session in conjunction with health development partners, welcomed the aforementioned proposals. He reasoned that the inability of the Uganda Police Force as well as the Ministry of Works and Transport to enforce traffic discipline led to accidents and ultimately brought accident victims to the health sector.
“Road accidents are a matter of behavior. And it is outside the jurisdiction of the Ministry of Health. Therefore, fraud occurs in another department and we bear the brunt. So why not tighten enforcement? ''Dr. Ayume told Saturday Monitor.
Health development partners also called on the government, in no uncertain terms, to decisively address corruption, whose impact on the health sector is clear. Empirical evidence shows that basic infrastructure challenges in health facilities and communities continue to contribute to poor health outcomes.
For example, a recent study showed that only 38% of health centers have reliable electricity. This means that 62% of the country's health center cold chain is at risk. The vague hand of corruption can also be seen in infrastructure issues.
In its 2021 report on government agencies, the Ombudsman found that 23 percent of the government's annual budget is lost to corruption. Medieval House Central MP Alan Mayanja told Saturday Monitor that the government should strictly enforce disciplinary measures to arrest the corrupt.
In addition to suggestions from development partners, Dr. Ayume recommended that there should be a focus on disease prevention measures. This, he reasoned, would significantly reduce the burden on the health sector in providing patient treatment and medical relief.
Key areas according to the Ministerial Policy Statement 2024/2025
• Shs5b establishes Organ Transplant Council.
• Shs54b to procure 758 ambulances for the constituency.
• Allowance for trainee doctors and senior health staff is 35.9b shillings.
• Shs5.82b will be provided to Uganda Red Cross Society for emergency medical services and blood donor recruitment.
• Shs1.3b will be provided to the Health Board.
