The World Bank has complimented Uganda’s health sector, but warns that the recent reduction in government allocations may reverse or stall gains.
The World Bank’s 23rd Uganda Economic Update, titled Improving Public Spending on Health to Build Human Capital, states that Uganda has outperformed its peer countries in several important demographic and health indices, albeit many have made little improvement.
Uganda spends less per person on health care than any of its peer nations, but it makes better use of its resources overall. For instance, Uganda has superior maternal health outcomes than the majority of comparators. Nonetheless, the nation’s maternal mortality ratios differ significantly from one another. These discrepancies result from sub-regional health systems’ inefficient use of the resources at their disposal as well as variations in funding levels between sub-regions.
Also among the improvement indicators are the prevalence of stunting for children under five years dropping to 24.4 percent from 29 in 2016, the mortality rate for children under five from 64 to 52 percent, and the maternal mortality ratio of deaths per 100,000 live births from 336 to 189.
By the end of 2022/2023, Uganda’s three-tiered health system would have 8,386 public and privately administered health facilities at the primary, secondary, and tertiary levels.
Private for-profit providers ran 46 percent (3,856) of Uganda’s health institutions, followed by the government at 41 percent (3,448), and private nonprofit providers ran 13 percent (1,082) of them.
Rogers Ayiko, a Senior Health Specialist at the World Bank, says that the heavy investment in medical infrastructure has ensured a higher concentration of health facilities, which eases access to health services. He says that the results of their recent studies surprised them how much Uganda’s health sector had improved compared to the rest of the region.
He attributed some of these achievements to policies the government undertook, including the decentralization of the health sector, and the free health for all policy, despite the existence of corruption.
Richard Kabagambe, the Assistance Commissioner of Health Services Planning at the Ministry of Health says they are now concentrating on human resources, including improving the remuneration of health workers.
He says that absenteeism has reduced significantly at health facilities, while there has been an increase in the availability of ambulances, Intensive Care Units, blood banks, and oxygen plants, among others. Both the Bank and government officials are cautious that these gains might be reversed unless the government maintains its funding to the sector, amidst declining donor support.
Kabagambe is concerned, nevertheless, that a large number of the remaining development partners are beginning to use direct spending, which involves providing funding to specific projects directly rather than via the consolidated fund and budget assistance. He claims that this has the drawback that the government is unable to oversee these funds and projects.
Public healthcare facilities account for 79 percent of outpatient visits, followed by private nonprofit facilities at 14 percent and private for-profit facilities at 7 percent. The government is the largest healthcare provider and employer in the health sector because the majority of the nation’s largest and busiest health facilities are owned and operated by the public sector.
Sixty-seven percent of inpatient admissions are handled by public facilities, followed by private not for profit and for-profit organisations, respectively, at 27 and 6 percent. However, the research notes that the poor reporting rates among private health providers may lead to an underestimation of the number of patients treated at private hospitals.
Due in large part to the efforts of private for-profit providers, Uganda has seen a considerable growth in the number of health facilities over the last ten years—up 68%. “The number of government facilities increased by only 29% during the period, while the number of private not for profit providers and private for-profit facilities increased by 24% and 170 percent, respectively, despite the government building new health facilities and renovating and restoring several existing ones,” the report states.
The rapidly growing number of privately run healthcare facilities suggests a conducive environment for private investment in the health sector, though it may also reflect the limited availability of public health facilities and/or their inability to deliver high-quality healthcare.