Is Health Care Financing in Uganda Equitable?

ABSTRACT

Introduction: Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on financial protection; progressive financing and cross-subsidies. This paper describes Uganda's health care financing landscape and documents the key equity issues associated with the current financing mechanisms. Methods: We extensively reviewed government documents and relevant literature and conducted key informant interviews; with the aim of assessing whether Uganda's health care financing mechanisms exhibited the key principles of fair financing. Results: Uganda's health sector remains significantly under-funded; mainly relying on private sources of financing; especially out-of-pocket spending. At 9.6of total government expenditure; public spending on health is far below the Abuja target of 15that GoU committed to. Prepayments form a small proportion of funding for Uganda's health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms; mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance; Uganda has limited pooling of resources; and hence minimal cross-subsidisation. Although tax revenue is equitable; the remaining financing mechanisms for Uganda are inequitable due to their regressive nature; their lack of financial protection and limited cross-subsidisation. Conclusion: Overall; Uganda's current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes; enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms