Uganda still Off Target from Abuja Commitment of 15%

The budget for next financial year 2009/2010 will be read on June 11, 2009. Figures released ahead of the budget reading indicate that the budget allocation to the health sector has gone up from 628.46 billion in 2008/2009 to 636.90 billion for 2009/2010. However, calculating the percentage out of total expenditure, Uganda figures have gone down. While total revenue in 2008/2009 was 5858.67 billion, the revenue for 2009/2010 has gone up to 6, 268.85 billion. Even with external support, the budget allocation in 2008/2009 was at 10.7% and will be 10.1% next financial year. Yet 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. This was to exclude external support.

The World Health Organization’s Commission on Macroeconomics and Health (CMH), estimated that a basic package of health services costs US$34 per capita (the so-called “CMH target”). However, current per capita spending on health is lower in sub-Saharan Africa than in any other region at $23, and would need to increase by 68 percent to provide the CMH package. Current spending in Uganda is at US $ 25 (50,000) of which the Government is providing half and other half is private out of pocket. The health sector is therefore under-funded by 50%.

Fiscal planners at the ministry of Finance, Planning and Economic Development have made the argument that the revenue basket is very small amidst competition priorities. Despite the commitment the Government of Uganda made in 2001, fiscal planners argue that 15 percent of the domestic budget cannot be allocated to health because roads, works, and education are equally important sectors that need substantial budget allocations. Fiscal planners look at health as just one of the sectors, yet this is not the case.

Health is about life and death of human beings. Health service delivery in most cases depends on resource availability. Resources are needed for procurement of essential medicines and health supplies; for payment of health workers, for maintaining facilities and so on.

Uganda has a growing population and high disease burden. The fertility rate is 7.1, one of the highest in the world. The population of Uganda is growing at 3.5% per annum. Current statistics from the Uganda Bureau of statistics (UBS) indicate that the current population is about 31,000,000. Yet resources allocation for the health sector does not much the population growth trends. About 100,000 children are HIV infected and 50,000 in need of Anti Retroviral Therapy (ART), but only 26 percent of those in need receive ART. As of February 2009, about 160,000 patients had been initiated on ART which represents only 50 percent of those that are eligible for treatment. Neonatal and maternal conditions constitute the highest percentage of the burden of disease in the country at 20.8 percent.31% of the population live on less than a dollar a day and cannot fend for themselves. Greater resources than available are needed to deal with the ever increasing population and high disease burden particularly for those who cannot afford to pay for health services out of their pockets.

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.

Equally important is the way available resources are utilised. The Government of Uganda must 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 channelled for healthcare. The Government must take a proactive role in involving communities in decision making and monitoring the delivery of health care and use of resources for health.

Furthermore, priorities for resources use must be informed by health trends, and data. Resources must be placed where the greatest need is. Focus must be placed not on dealing with symptoms of disease but prevention. This calls for greater use of Health Management Information Systems Indicators for decision making.

Greater emphasis is needed on ensuring external assistance helps to build the overall health system in addition to channeling aid into specific diseases and interventions.

New and innovative sources and approaches such as community and social health insurance offer promise for improving efficiency & equity if implemented equitably and in view of current needs.

The Government of Uganda must live by its commitment and invest greater resources in the health sector and therefore the health of her people. We need health children, healthy mothers, and healthy workers. We need the Government of Uganda to allocate 15% of its domestic budget on health.