A persistent funding gap is impeding the delivery of health services in Uganda, despite the government increasing budgetary allocation to the sector over the years.

The largest gaps exist in the human resources, drugs, vaccines and consumable sundries.

The Finance Ministry is accusing the Ministry of Health of misusing the scarce resources allocated to the sector.

“There is a higher priority attached to sectoral policy functions compared with the actual health service delivery,” said Kenneth Magabe the director of budget.

For instance, workshops and seminars account for 7.3 per cent or Ush1.7 billion ($800,000) of the health ministry budget, he said.

Between 2005 and 2009, the government tripled the health budget from Ush240 billion ($120 million) to Ush734.67 billion ($367.33 million).

But this increase has barely had any impact on health service delivery partly due to parallel increases in infrastructure as well as operational and administrative costs.

But Francis Runumi, the commissioner of planning in the Ministry of Health said the funds allocated to the sector are four to five times lower than what is required.

On the other hand, observers have blamed the mismanagement of health care funds on “a disconnect between donor funding and the implementation of agreed programmes.”

Officials from the Ministry of Health said they had no control over how donor funds were spent.

For instance, Uganda is highly dependent on donor funding for the treatment of HIV/Aids and malaria, but health officials say the lack of control over how funds are used makes planning impossible.

The biggest donor to the health sector in Uganda, the President’s Emergency Plan for AIDS Relief for instance spent $290 million last year on projects.

But the Ministry of Health says it has no idea how the money was distributed.

“The Japanese and Chinese on the other hand mobilise people, bring in their contractors then only call you to open the doors to a hospital they have built. It is impossible to plan,” said Dr Runumi.

Ministry of Health officials also link administrative challenges to the management of the Global Fund for TB, Aids and Malaria is managed.

Under the Long Term Institutional Arrangements, grants worth $200.8 million have been assigned but only $43.7 which is 23 per cent has been approved.

They cite challenges to grant implementation as being responsible for delays to contracting a procurement agent and to aligning the grants with the national budget.

But ultimately, the country’s fast-growing population and related reproductive health issues, may be the main cause of the funding gap.

Uganda has one of the highest rates of maternal mortality in the world, at 435 per 100,000 births, and the third highest fertility rate in the world at 6.7 births per woman.

As a result, the country is not on track to achieve the health Millennium Development Goal with a slow decline in under-five and infant mortality, despite a fairly robust economic growth.

Health development partners say the lack of appropriate contraceptive strategies have also crippled the sector.

“Increasing access and utilisation of family planning would reduce the population growth. Imagine no district was supplied with contraceptives and related supplies by the end of December last year,” said a statement from a group of health development partners released last month.

Experts have advised that in order to reduce the funding gap, resources should be targeted at service delivery, which means improving the wages and primary health care budgets should be prioritised.

But records show that even when the health budget doubled, an increase in the non-wage recurrent allocation budget for primary health care rose from Ush51 billion ($25.5 million) to Ush56 billion ($28 million) — which was too small when compared with the fast growing population.

Experts also advice that more needs to be done to improve human capital and staffing levels, which needs to be doubled in most health facilities.