Efficient Use of Resources is key this Financial Year

The Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda commends the Government of Uganda (GoU) for the prioritization of the health sector as a key element of human development. We support the increments in the budget allocations to the health sector from Uganda Shillings 628.46 billion in 2008/2009 to 784.4 billion for 2009/2010, especially the allocation of 47% (300.9 billion) of the health sector budget to Essential Medicines and Health Supplies (EMHS), and the 128 billion allocation to monitoring and quality assurance.

The FY 2008/2009 witnessed chronic stock-outs of essential medicines in districts and hospitals owing to mismanagement of supplies, deficiencies in the procurement process and lack of funding. The increased allocation pharmaceutical supplies and the proposed measure to build the capacity of planners to forecast and quantify the need for EMHS is welcome. The challenge is ensuring that money allocated is put to intended use.

AGHA however expresses concern over the Government’s consistent failure to honour the Abuja commitment of 2001. Despite the increase in health sector allocation, the percentage out of total national expenditure has in reality gone down. While total revenue in 2008/2009 was 5858.67 billion, the revenue for 2009/2010 has gone up to 7000.2 billion. Even with external support, the budget allocation for the health sector in 2008/2009 was at 10.7% and will be 10.2% in 2009/2010. In 2001, African Heads of State made a commitment to allocate 15% of their annual domestic budgets to health during the special summit on AIDS, TB and Malaria held in Abuja. The Abuja commitment was to exclude external support. The budget allocations have been 9.3%, 9.0%, 10.7%, and 10.2% in 2006/2007, 2007/2008, 2008/2009, 2009/2010 respectively. Although the GoU budget support has gone up by 2.5 billion this fiscal year, the Abuja commitment of 15% has never been met, and the percentage allocated to health has decreased this financial year.

While recognising that the Global Financial Crisis has had an impact on domestic revenue as well as on donor contribution to budget and project support and that the revenue basket is limited and must be divided among competing priorities, we still wish to remind the Government of Uganda that health is about life. Health service delivery in most cases depends on resource availability. All the sectors of the economy depend on it. It is a healthy individual that goes to school, invests, produces and makes decisions. What priority can compete with human life? Who would use the roads if the population is sick? Who would go to school if their health was not attended to? Therefore sectors such as Works and Transport, Education, Security, cannot compete with the health sector whose effectiveness determines if people live or die.

Uganda ranked third most corrupt country in the 2009 Corruption Barometer by Transparency International. The health sector is yet to recover from the effects of the gross mismanagement of money from the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM). Yet the budget for accountability mechanisms including the Inspector General of Government, the Auditor General, Parliament, the Directorate of Public Prosecutions, and the Ministry of Ethics has been cut by Uganda shillings 82 billion. With the limited resource basket, efficient use of resources is key to attaining optimal results. What the country needs more then ever is the strengthening of monitoring and accountability mechanisms to ensure that resources are effectively utilized. Allocating enough resources to that cause is the first and the most important step.

We therefore call upon the Government of Uganda to:
1. Ensure that resources for the health sector are put to the right purpose--which is the delivery of healthcare and not the private enrichment of individuals. Money intended for health must be channeled for healthcare.
2. Take a proactive role in strengthening the watchdog role of accountability mechanisms such as the Parliament, IGG, DPP, and Civil Society (CSOs) by meaningfully involving them in decision making and monitoring the delivery of health care and use of resources for health.
3. Allocate resources based on needs and current data and not political decisions. Resources must be placed where the greatest need is which in experience has shown is EMHS, and strong mechanisms for monitoring resource use and fostering accountability.