1. Financing Health Care in Uganda Florence Baingana MSc HPPF 1

2. Context 2  East African country  Independence from the British in 1962  Population is about 31 million, 13% is urban  Poor country, GNI per capita is US$340  IMR is 78 per 1,000 live births  U5MR is 137 per 1,000 live births  MMR 435 per 100,000 live births  Life expectancy at birth is 51 yrs  HIV and Conflict

3. Health Policy and Health Sector Strategic Plan 3  Ist Health Policy passed in 1999, process begun before that.  Defined a package of essential services, Uganda National Minimum Health Care Package (UNMHCP)  First HSSP 1999-2004, second 2005/06-2009/10

4. Organisation of Health Services in Uganda 4 Primary 679 HC III 3624 HC II Secondary 87 Hospitals Tertiary 2 Hospitals Western/Allopathic Traditional healing, Spiritual Psychosocial Regional Referral 10 Hospitals Health Sub District 127 Health Center IV

5. Health Financing  US$ 20 per capita per annum spent on health.  Of this, 58% is paid out of pocket  22% from Government  20% from donors  60% of health units are public and 30% PNFP  User fees contribute 50% of the PNFP hospital running costs  Govt (public contribution to health is going down)

6. Health Financing Contd Fiscal Year2004/052005/06 Govt Expenditure (billion Ug Shs 219.56229.88 Sum of donor projects254.85 (55%)507.26 (68%) Total Health Expenditure in health sector 474.41737.14 Govt expenditure on health as % of total expenditure 9.7%9.0% Annual budget increase5.7%4.7%

7. Challenges  Scrapping of user fees in 2001  36% of the population is living below the poverty line  83% of the population is in the rural areas  HRH challenges  Macro level issues in relation to transparency and use of resources (NSSF, Global Fund, create problems for introduction of SHI)

8. Options for the way forward  Introduction of Social Health Insurance  Problems include:  Very small formal sector  No national patient information systems  Problems of trust  Huge resistance from the private health insurance firms

9. Options for way forward  Community Health Insurance: Problems to over come include:  Lack of information and poor understanding of the concept  Lack of trust  Problems of ability to pay the premium  Poor involvement of the community in setting up and management  Long distance to the health unit  Poor quality of health care  Unattractive benefits package

10. Conclusions  More research has to be done for instance in:  How to scale up Community Health Insurance  Feasibility of introducing Social Health Insurance  Explore other mechanisms to access health care to the poor and the vulnerable, or targeted populations, such as voucher schemes for child immunisations, antenatal care services, TB treatment, mental health care, etc