Doctors attend to a patient at Mulago National Referral Hospital, on August 15, 2023. Observers have warned that tough times lay ahead as the Ugandan health sector readies itself to start a new financial year with dwindling budgetary support from non-state actors. Photo | File
Observers have warned that tough times lay ahead as the Ugandan health sector readies itself to start a new financial year with dwindling budgetary support from non-state actors.
Statistics show that external financing has significantly contributed to Uganda’s health sector resource envelope in recent times. It has grown from 19 percent during the Fiscal Year (FY) 2021/2022 to 38 percent in FY 2023/2024.
Ahead of the start of FY 2024/2025 in July, a slew of donors have indicated an interest in reducing their budgetary support to the sector. Last month, Uganda’s Health minister told Parliament that donors told malaria-high-burdened countries—Uganda inclusive—that no additional funds will be made available going forward.
“Our partners are no longer willing to increase, anymore, funding for malaria. They have all levelled off,” Minister Jane Ruth Aceng said, adding, “The 10+1 high-burden countries were invited to Cameroon recently. I was there in person and we were told [that] the world has moved on to [tackling] climate change issues, global health security and many others.”
The 2021/2022 Annual Health Sector Performance Report shows that malaria remains a millstone around Uganda’s neck. In FY 2021/2022, it accounted for 32.1 percent of all outpatient department attendances. It was closely followed by cough or cold (20.4 percent), urinary tract infections (4.7 percent), and gastrointestinal disorders (4.0 percent) in that order.
“We were told to sign a declaration saying [that] each of the high-burden countries will look for their own domestic resources and bring their malaria pandemics or epidemics to an end by themselves,” Minster Aceng revealed.
A fortnight ago, a top official from the Health ministry told the House Public Accounts Committee that the country’s Anti-Homosexuality Act (AHA) is further complicating things.
“With the passing of the law, somehow we have seen that partners have started recoiling and this might, in the long run, affect our performance and also our budgeting because our biggest chunk of our funding comes from external,” Dr Diana Atwine, the ministry’s chief accounting officer, said.
Plugging the gaps
The fears of the Health ministry’s permanent secretary were not unfounded. On April 8, health development partners told a House committee that Uganda should start thinking about plugging possible gaps. They made it abundantly clear that fiscal measures can be used to make ends meet.
“Taxation for tobacco control, tax revenue on cigarettes has the potential to increase by Shs16.8 billion annually if a uniform specific tax for all cigarettes is set at Shs10,000 per mill,” Ms Christabel Abewe, an officer on the health financing desk at the World Health Organisation (WHO), said, adding, “This would also reduce consumption of cigarettes by seven percent.”
The government was also advised to consider creating, per Ms Abewe, “a national motor third party insurance fund capitalised by revenue collected from the motor third party collections.” The global health partners proceeded to reason that “if only five percent of the gross premiums collected from the motor third party insurance are earmarked for the motor third party fund, an average of Shs2.9 billion could be generated per annum.” The war chest could be channeled to support Uganda’s health sector.
Road carnage
The health development partners also recommended that stringent measures be deployed to tame the traffic indiscipline that fashions road accidents that continue to burden Uganda’s health sector.
The partners that met the House Committee on Health included: the United States Agency for International Development (USAID), United Nations International Children’s Emergency Fund (Unicef), the Centers for Disease Control and Prevention (CDC), among others.
Last September, a junior Health minister told the House Physical Infrastructure Committee that the government spends a minimum of Shs1.5 billion providing medical services to accident victims alone.
“The average cost of treating a critically ill patient is about Shs3.6 million per day. With surgical intervention the cost rises to Shs13.6 million, which translates to Shs648 million for the care of an average 180 critically injured patients at the [Accident and Emergency] unit of Mulago National Referral Hospital. Half of these patients require surgery, increasing the total cost to Shs1.548 billion per month,” Minister Hanifa Kawooya said.
Dr Charles Ayume, who steered the committee session that interfaced with the health development partners, welcomed the aforementioned proposals. He reasoned that the inability of the Works and Transport ministry as well as the Uganda Police Force to enforce traffic discipline results in accidents that eventually burdens the health sector with accident victims.
“Road traffic accidents is a behavioural issue. And that is not in the ambit of the Ministry of Health. So the mischief occurs in a different sector and we bear the brunt. So why wouldn’t we make enforcement strict,” Dr Ayume told Saturday Monitor.
Corruption
The health development partners also, in no uncertain terms, asked the government to decisively deal with corruption whose effects on the health sector are abundantly clear. Empirical evidence shows that basic infrastructural challenges at health facilities and communities have continued to contribute to poor health outcomes.
For instance, a recent study showed that only 38 percent of health centres have reliable electricity. This means that 62 percent of the cold chains of the country’s health centres are compromised. The nebulous hand of corruption can be cited in this infrastructural challenge and others.
In a 2021 report on government entities, the ombudsman discovered that 23 percent of the government’s annual budget is lost to corruption. Mr Allan Mayanja, the Nakaseke Central lawmaker, told Saturday Monitor that the government should strictly enforce disciplinary measures to arrest the rot.
On his part, Dr Ayume recommended that in addition to the proposals by the development partners, there is a need to focus on disease prevention measures. He reasoned that this would immensely relieve the health sector of the burden suffered while treating and offering medical redress to patients.
Key areas per the 2024/2025 ministerial policy statement
• Shs5b to set up the Organ Transplant Council.
• Shs54b to procure 758 ambulances for constituencies.
• Shs35.9b for allowances for medical interns and senior health officers.
• Shs5.82b be provided to Uganda Red Cross for emergency medical services and blood donor recruitment.
• Shs1.3b be provided to the Health Service Commission.
