Global health initiatives and bilateral donors have played a big role in the declining quality of Uganda’s health systems, a new report says.
The initiatives blamed include UNAids, the UN programme on HIV/Aids, Global Alliance for Vaccines and Immunisation (Gavi), Global Stop Tuberculosis Partnership and the Global Fund to fight Aids, Tuberculosis and Malaria. The Presidents Emergency Plan for Aids Relief (Pepfar) is the bilateral programme identified as having played a role in this decline.
The report, produced by the African Centre for Global Health and Social Transformation at the request of Uganda’s Health Ministry found that the failure to manage funding from these global initiatives led to the collapse of the health system.
The organisations offered money to fund particular diseases instead of allowing the country to budget and respond to the whole health system’s needs.
The government is also blamed for failure to provide enough funding to the health sector because of its dependence on these initiatives.
Donors through these global initiatives had been giving budget support but pulled out over corruption allegations, affecting funding to the health sector and the quality of services offered.
“Seamless delivery of services bore good results and by 2005, the health financing envelope had grown substantially, utilisation had shot up dramatically and health outcomes had recovered,” the report states.
The study adds that parallel re-introduction of vertical programmes for priority intervention funded by global health initiatives without appropriate mitigation of adverse impact upon institutional capacities begun to erode the successes of comprehensive health system reforms and by 2010, the health financing envelope had fallen, core service indicators were also falling and health outcomes began to reverse negatively.
In the 2003/2004 financial year, the Ministry of Health was receiving Ush375.06 billion ($143.2 million), equivalent to 11.6 per cent of Uganda’s total budget. The plan was to increase this funding to 15.9 per cent in the subsequent year meaning Uganda would have met its commitment on the Abuja Declaration in less than five years.
Africa’s heads of state signed a commitment in 2001 to fund the health sector with at least 15 per cent of the total budget devoted to increase health services to communities and meet the millennium goals on health.
By 2005 Uganda had already met the global immunisation target of 90 per cent of the children in the country. Gavi then withdrew most of its support to the immunisation programmes budget after Ush1.6 billion ($616,055) was embezzled.
The percentage of immunised children has since drastically reduced to 52 per cent, making Uganda the worst performer on routine immunisation coverage on the African continent.
Jane Ruth Aceng, Ministry of Health Director General, says the reduced funding led to a reduction in quality primary health care.
In the 2012/2013 financial year, the Ministry of Health received Ush852.2 billion ($325.4 million). This allocation makes up just 7.8 per cent of the country’s total budget for the year.
The other segments of primary health care that have suffered are the hiring and retention of health workers and maternal health. Maternal mortality rates have increased slightly from 435 per 100,000 in 2006 to 438 per 100,000.
In 2004/2005, 68 per cent of the health work positions in Uganda were filled; the number has since reduced to 56 per cent. The ministry blames failure to hire health workers on non-governmental organisations that attract these people with better pay.