SUSTAINABILITY, EQUITY AND EFFECTIVENESS IN PUBLIC FINANCING FOR HEALTH IN UGANDA: AN ASSESSMENT OF MATERNAL AND CHILD HEALTH SERVICES

Year 2019, Volume: 4 Issue: 3, 233 - 246, 13.12.2019

Vincent Okungu , Marshal Mweu Janine Mans

https://doi.org/10.23884/ijhsrp.2019.4.3.08

Cited By: 1

Abstract

The aim of this assessment was to
understand whether financing for maternal, child health and immunization
services are sustainable, efficient, effective and equitable. Data
sources included various national and international reports related to
financing maternal and child health services. The results show that funding for
maternal and child health (MCH) services are unsustainable over the long term
because the main financing source are out-of-pocket (67% of total for MCH).
However, Uganda shows higher efficiency in delivery as it has the lowest
average cost per delivery (USD 50) compared to USD 70 (Kenya) and USD 95
(Ghana). Overall, MCH interventions being financed show some levels of
effectiveness; e.g. maternal mortality rates dropped from 420/100000 live
births in 2010 to 343/100000 live births in 2016; under-5 mortality rates
reduced from 151/1000 live births in 2000 to 64/1000 live births in 2016. There
are however, inequities by region, age, education status and wealth index; e.g.
37% in the poorest quintile have unmet family planning needs compared to only
23% in the wealthiest quintile. In conclusion, public financing for primary
services such as MCH requires reforms to strengthen health sector performance.
The reforms should address sustainable financing, efficiency, effectiveness and
equity in service delivery.  

Keywords

Uganda, Public financing, Maternal Health, Effectiveness

References

• [1] Government of Uganda, "State of Uganda Population Report 2018: Good Governance- A prerequisite to harness the Demographic Dividend for Sustainable Development " Government of Uganda, Kampala2018.
• [2] Uganda Bureau of Statistics, "Uganda Demographic and Health Survey," Government of Uganda, Kampala2016.
• [3] Uganda Bureau of Statistics, "Statistical abstract," Uganda Bureau of Statistics, Kampala2017.
• [4] Global Burden of Collaborative Disease Network, "Global Burden of Disease Study 2016 (GBD 2016) Results," Institute for Health Metrics and Evaluation (IHME), Seattle. Available: http://ghdx.healthdata.org/gbd-results-tool2017.
• [5] Ministry of Health, "Family Planning 2020 Commitment," Kampala. Available: http://www.familyplanning2020.org/entities/802017.[6] Ministry of Health, "Comprehensive EPI Multi Year Plan (2016- 2020)," Government of Uganda, Kampala2016.
• [7] Ministry of Health, "Annual Health Sector Performance Report," Government of Uganda2018.
• [8] Save the Children, "State of the World's Mothers Report 2015," Save the Children, London, United Kingdom2015.
• [9] World Bank. Uganda Poverty Assessment: 2016: Fact Sheet [Online].
• [10] MCS Program, "Uganda country summary," Available: https://www.mcsprogram.org/wp-content/uploads/2017/04/Uganda-Country-Summary-March-2017.pdf2017.
• [11] Ministry of Health, "National Health Accounts: Financial Years 2012/13 & 2013/14," Government of Uganda, Kampala2015.
• [12] Ministry of Health, "National Health Accounts 2015/16," Government of Uganda, Kampala2017.
• [13] GAVI, "Gavi Full Country Evaluations: 2016 Dissemination Report," IHME, Seattle, WA2017.
• [14] IHME, "Assessing Facility Capacity, Costs of Care, and Patient Perspectives," University of Washington, Seattle: Available: https://www.healthdata.org/sites/default/files/files/policy_report/2014/ABCE/Uganda/ABCE_Uganda_full_report_2014.pdf2014.
• [15] T. Dmytraczenko, M. McEuen, and A. Levin, "Costs of Maternal Health Care Services in Masaka District, Uganda. Special Initiatives Report 16," USAID, Washington DC1999.
• [16] S. Nam, "Final Evaluation of the Figo Saving Mothers and Newborns Project in Uganda," Options. Available: https://www.figo.org/sites/default/files/uploads/project-publications/SMN/Uganda_3.pdf 2011.
• [17] Uganda Bureau of Statistics and ICF, "Uganda Demographic and Health Survey 2016: Key Indicators Report," Uganda Bureau of Statistics (UBOS) and ICF, Kampala, Uganda and Rockville, Maryland, USA:2017.[18] The Partnership for Maternal Newborn & Child Health, "Maternal and Child Health: Uganda," Available: https://www.who.int/pmnch/media/membernews/2011/ugandabackgroundpaper.pdf2012.
• [19] K. Xu, A. Soucat, J. Kutzin, C. Brindley, N. V. Maele, H. Touré et al., "Public Spending on Health: A Closer Look at Global Trends," World Health Organization, Geneva(WHO/HIS/HGF/HFWorkingPaper/18.3). Licence: CC BY-NC-SA 3.0 IGO, 2018.
• [20] WHO, "Sustainable health financing, universal coverage and social health insurance. World Health Assembly Resolution WHA58.33," World Health Organization, Geneva2005.
• [21] WHO, "Domestic resource mobilization for sustainable financing for health in Africa African Region. Working Paper prepared by the WHO Regional Office for Africa," World Health Organization, Geneva2017.
• [22] K. Xu, D. B. Evans, G. Carrin, and A. M. Aguilar-Rivera, "Designing health financing systems to reduce catastrophic health expenditure," World Health Organization, Geneva2005.
• [23] K. Xu, D. B. Evans, K. Kawabata, R. Zeramdini, J. Klavus, and C. J. Murray, "Household catastrophic health expenditure: a multicountry analysis," Lancet, vol. 362, no. 9378, pp. 111-7, Jul 12 2003.
• [24] W. Van Damme, L. Van Leemput, I. Por, W. Hardeman, and B. Meessen, "Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia," Trop Med Int Health, vol. 9, no. 2, pp. 273-80, Feb 2004.
• [25] A. Leive and K. Xu, "Coping with out-of-pocket health payments: empirical evidence from 15 African countries," Bull World Health Organ, vol. 86, no. 11, pp. 849-856, Nov 2008.
• [26] O. Galarraga, S. G. Sosa-Rubi, A. Salinas-Rodriguez, and S. Sesma-Vazquez, "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," Eur J Health Econ, vol. 11, no. 5, pp. 437-47, Oct 2010.
• [27] T. Bright, L. Felix, H. Kuper, and S. Polack, "A systematic review of strategies to increase access to health services among children in low and middle income countries," BMC Health Serv Res, vol. 17, no. 1, p. 252, Apr 5 2017.
• [28] W. B. Asea, "Combating political and bureaucratic corruption in Uganda: Colossal challenges for the church and the citizens," HTS Teologiese Studies/Theological Studies, vol. 74, no. 2, 2018.
• [29] R. Flanary and W. David, "The state of corruption: A case study of Uganda," Third World Quarterly, vol. 20, no. 3, pp. 515-536, 1999.
• [30] J. M. Kewaza, "Fighting corruption in Uganda: Despite small gains, citizens pessimistic about their role," Afrobarometer Dispatch2016, vol. No. 77 Available: http://afrobarometer.org/sites/default/files/publications/Dispatches/ab_r6_dispatchno77_uganda_corruption.pdf.
• [31] M. Martini, "Uganda: Overview of corruption and anti-corruption," Transparency International, Available: https://knowledgehub.transparency.org/assets/uploads/helpdesk/379_Uganda_Overview_of_corruption_and_anticorruption.pdf2013.
• [32] S. Leiderer, "Fungibility and the Choice of Aid Modalities: The Red Herring Revisited," United Nations University, Helsinki2012, vol. Working Paper No. 2012/68 Available: https://www.wider.unu.edu/sites/default/files/wp2012-068.pdf.
• [33] S. Devarajan and V. Swaroop, "The Implications of Foreign Aid Fungibility for Development Assistance," Development Research Group, World Bank, Washington, DC1998.
• [34] R. Atuhaire and W. Kaberuka, "Factors Contributing to Maternal Mortality in Uganda," African Journal of Economic Review, vol. IV, no. 2, pp. 43 - 57, 2016.