Providing affordable healthcare to the population of low- and middle-income countries is a persistent development issue.

In 2016, the government of Uganda developed a health financing strategy to facilitate the attainment of sustainable development goal three (SDG3) of ensuring Universal Health Coverage.

This can be achieved by making the required resources for delivery of essential health services for Ugandans available, in an efficient and equitable manner. Revenue collection and risk pooling mechanisms such as insurance are one way of doing this.

The dream is that no one should face the risk of impoverishment when accessing healthcare, nor should anyone forgo medical services because of the financial cost of accessing health services.
Currently, the principal mechanism for funding health services in Uganda is through government revenue tax financing.

Out of pocket payments and contributions by health development partners constitute a substantial amount of health financing. Due to the poor quality of health service delivery, many households are compelled to seek services from private medical facilities, which are very expensive.

The cost of access to health services in private places is a huge burden on most families in Uganda, leading to financial hardships for many patients and their caretakers, and often to long-term indebtedness.

It is currently estimated that the total annual health expenditure is 7.5 trillion. Of this, 15 per cent is from government funding, with 42 per cent from donors and 41 per cent from individuals (out of pocket).

These statistics should be worrying because the government has abandoned its responsibility of providing healthcare in this country to donors and families.

The World Health Organisation (WHO) recommends that out of pocket expenditure on health should not exceed 20 per cent of a country’s total health expenditure, otherwise citizens will stand the risk of impoverishment in case a family member falls ill.

In terms of per capita health expenditure on health, Uganda stands at $53, which is less than the standard $84 dollars recommended by the WHO. In comparison with other East African states, this is the lowest.
 
It is evident that public financing available for the health sector remains the single most important constraint to Universal Health Coverage and overall enjoyment of the right to health. Over the last five years, the budget for the health sector has dwindled from 8.9 per cent of the national budget in 2016/2017 to the projected 6.2 per cent in 2021/22 financial year.

In 2019/2020, the needs analysis by the National Medical Stores (NMS) showed that there was a medicines funding gap of 6 per cent in Health Centre IIs, 56 per cent in Health Centre IVs, and 32 per cent in general hospitals. This means that Health Centre IIs are running with only 39 per cent of the drugs they need while Health Centre IVs are operating with only 44 per cent of the drugs they need.
 
The passing of the National Health Insurance Scheme Bill,  2019, by Parliament provides a glimmer of hope in enhancing access to health services. As can be demonstrated by the Rwandan experience, health insurance is instrumental in increasing access to health. By 2015/16, the health insurance cover in Rwanda had a coverage of 86.1 per cent compared to Uganda’s 2 per cent.

The Bill as passed by Parliament may not be perfect, but provides the best opportunity for beginning conversations on increasing funding to the health sector and catering for the poor and vulnerable groups.

By contributing to the health scheme, their dependants will benefit from the insurance and so will the poor  who are incapable of contributing. These shall be entitled to a defined package of healthcare benefits from government contribution  based on Uganda National Minimum Health Care package.

The Health Insurance Scheme will be an addition to the government contribution to the health sector. Government will continue to invest in health promotion and education; disease surveillance and response; immunisation and any other specialised services outside the National Health Insurance Scheme benefits package and health systems investment.

Government will also continue to finance major health sector infrastructural development, specialised medicines, technology and human resources.

Peter Eceru is a Programme Specialist, Health and Human Rights Advocacy at Center for Health, Human Rights and Development (CEHURD)
A version of this article was published in the Daily Monitor Newspaper on Friday 30th 2021.

PRESS STATEMENT

FOR IMMEDIATE RELEASE

Tuesday 27^th April 2021

GOVERNMENT DEFIES COURT ORDER TO INCREASE FUNDING TO MATERNAL HEALTH IN THE NATIONAL BUDGET

Kampala – Uganda.  Center for Health, Human Rights and Development (CEHURD) has filed a case with the Constitutional Court, seeking to hold the Attorney General and other government officials in contempt of Court. Last year, the Court ordered the Government to prioritize and provide sufficient funds in the national budget for maternal healthcare in order to meet its constitutional obligation of upholding the rights of women, and fulfil their reproductive rights. This order was given in the landmark judgment of the Petition 16 maternal health case (CEHURD and 3 others vs. Attorney General [Constitutional Petition No. 16 of 2011]).

However, this year’s health sector budget allocation is estimated to decline by 9.3 per cent (UGX 2,781.17 Billion in FY2020/21 to UGX 2,522.88 Billion in FY2021/22). The reduction in funding to the health sector as projected in the national budget framework paper FY 2021/22 is therefore in contempt of the Court, and the Government should be sanctioned accordingly.

CEHURD is also demanding for a vote for maternal health under the health sector. A vote would require the Ministry of Health to budget and account for funds to maternal health, independent of the general health sector budget. This would make it easier to track how much money is spent on maternal health, and therefore provide the only clear way the judicial pronouncements and orders will be achieved.

Part of a wider problem

Adequate funding to maternal health would go a long way in reducing the number of women who die while trying to bring life into the world.  

Uganda suffers a persistently high maternal mortality ratio (MMR) currently at 336 per 100,000 live births which translates into 16 women dying every day during childbirth majorly because of lack of basic maternal health commodities like gloves, syringes, blood, and medicines etc., which enable women to give birth safely. This is worsened by low political will to equip and sufficiently fund healthcare facilities, which sees two midwives working on more than 30 expectant mothers at a go. There is also no access to emergency obstetric care which has left women to die in very painful, heinous and cruel ways. The causes of these preventable deaths can be traced to insufficient funding in health facilities.

This case is therefore an effort to ensure that Government complies with the Court order and prioritizes the health care system. This is through increased budgetary allocation and creation of a maternal health vote under the health sector.

The state has an obligation to uphold women’s rights and fulfill their reproductive rights, and this should be reflected in the next financial year (2021/2022). We call upon the Parliament to stand with the people of Uganda to prioritize health and allocate more resources to the health sector.

For more information contact: info@cehurd.org and copy in nsereko@cehurd.org or call our toll free line 0800300044.

These rains can lead to flooding, which contaminates water sources and increases vegetation around homes, creating a conducive atmosphere for mosquitoes to breed.

– Katia Olaro, Strategic Litigation program, CEHURD

World Malaria Day | 25th April 2021

With all the work that has gone into fighting it, malaria still kills tons of people despite the fact that it is preventable. In an article on news.trust.org a 74 year old Rose Acayo of Gulu District narrates how she had been sleeping under a worn out inherited mosquito net which consequently exposed her to malaria infection. Just as she was recovering, her two-year-old grandchild in her care also fell ill which left her with medical bills she could not meet. How can we draw the line for zero malaria infections as this year’s World Malaria Day theme states?

According to the World Health Organisation 2019 report, Uganda was the third highest contributor to global malaria cases, at 13.7 million cases. Globally, we were the eighth highest contributor to malaria deaths at 5,610 deaths. Malaria therefore remains a high cause of death and financial constraints, considering its non-discriminatory nature in terms of age, gender, race, economic or social status. Transmission lines are very thin and so is the severity, failure to stop its spread will continue causing high levels of poverty among the poor as treatment is a financial burden which they cannot afford.

What we can do

As the world puts the spotlight on the fight against malaria, CEHURD joins the rest of the world to ensure acceptable, accessible, affordable and good quality health for all. As a country, Uganda is making efforts to reduce malaria infections and morbidity in a sustainable way through mass media awareness campaigns, and distribution of free mosquito nets, among other interventions.

In a recent press statement, Dr Joyce Kaducu, Minister of State for Health- Primary Health Care revealed that there are currently no malaria outbreaks in the country. She, however, warned that there is a risk of outbreaks due to the ongoing heavy rains in various parts of the country. These rains can lead to flooding, which contaminates water sources and increases vegetation around homes, creating a conducive atmosphere for mosquitoes to breed.  In order to prevent these outbreaks, the Ministry of Health  urges everyone to step up the implementation of preventive measures. This includes sleeping under treated mosquito nets, getting rid of stagnant water, and seeking medical assistance where symptoms present.

Call to action

It is important to improve overall health care. The government should therefore provide quality assured services for malaria prevention and treatment to all the people in Uganda. This will lead to a good standard of health, which contributes to national development. It is also important to ensure that there is sufficient stock of essential supplies and medicines to minimise possible capacity constraints, and reduce the burden on health facilities in providing services to diagnose and treat malaria.

Change also begins with each of us. Let us do our part in preventing malaria, and if diagnosed, seek medical treatment. While preventing COVID-19 is the current issue, let us not forget that “mosquitoes are not in lockdown, they are still free”, as Mr Jimmy Opigo, a programme manager of the National Malaria Control Programme said.

By Esther Kamede –Center for Health, Human Rights and Development

World health day | 7 April 2021

“The COVID-19 pandemic has been a stark and painful reminder that nobody is safe until everyone is safe”.

The Pandemic Century!

On March 11, 2020 the World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic. Just weeks later, we went from sharing memes and jokes about the virus to actually experiencing a life-altering year that globally turned our lives upside down. On 1^st April, announcements came in of a 14day nationwide lockdown. We now went to staying and working from home, pulling our children out of school, getting scared of dying, business loss and very steep falls in income.

More than a year later, the virus continues to plague the world with new deadly variants in sight, novel viruses should never be taken lightly; this one is highly infectious yet often causes no symptoms for some time. It also deepened vulnerabilities and inequalities including cracks in our health systems especially the unpreparedness and response in dealing with a pandemic. At this point the sign of hope are vaccines!-the key to overcoming the pandemic. Vaccines stimulate our immune system to produce immunity to a specific disease, protecting and preventing us from disease. This is what makes vaccines and immunization such powerful medicine and such an essential public good for all. Governments are responsible for managing public health crisis in line with human rights and fundamental freedoms. When it comes to vaccination, this involves ensuring that everyone, without discrimination, is offered a fair opportunity to receive a safe and effective vaccine.

Uganda receives its Vaccines!

On 5^th March, 2021 Uganda received 864,000 doses of the AstraZeneca COVID-19 vaccine, from the global COVAX facility-that aims to ensure even low income countries have access to the vaccines. On 10^th March launched its mass COVID-19 vaccination program, joining a host of countries in Africa to initiate the inoculation. Each phase is planned to cover 20 per cent of the population – approximately 4.38 million people, 20% is not enough, 60% would suffice this means low income countries may not realize equitable access to Vaccines. A number of determinants come into play for example the cost of the vaccines, buying vaccines for 90% of Uganda’s population would plunge the economy into borrowing and further debt .The Auditor General warned that by 2022, the country’s debt would be unsustainable. This cost would also deplete the 32.8%bn budget allocated to the health sector for the entire fiscal year, also the surplus doses from high income economies could be enough to inoculate 90% of the population.

The world has two economies!

We have two economies, the wealthy economies-high income and the poor economies-low income, this partially explains the inequities in vaccine distribution. The low income countries cannot afford vaccine equity. For example Aljazeera reported rich countries have bought more than half of the world coronavirus vaccines and are estimated to have received 90% of the delivered vaccines in sharp contrast, 9 out of ten people in poor nations may not get vaccinated. Africa has secured a meagre 300m doses of the vaccine for its population of 1.3bn people!

This World Health Day, the pandemic is still with us and its devastating impact. We hold the hope that as we fight to overcome the COVID-19 pandemic together, we are better prepared for future generations and learn from the incredible human ability to drive change and innovation even in a pandemic. We take home that ensuring universal and equitable access to safe, efficacious and affordable vaccines and medicine is building a fairer and healthier world together.