Is Health Care Financing in Uganda Equitable?

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

Will Private Health Insurance Schemes Subscriptions Continue after the Introduction of National Health Insurance in Uganda?

Introduction: Uganda is currently designing a National Health Insurance (NHI) scheme; with the aim of raising additional resources for the health sector. Very little was known about the health insurance market in Uganda before this study; so one of our main objectives was to investigate the nature of the private health insurance market in Uganda and the opinions of various stakeholders on NHI; with the view to establish the impact of NHI implementation on the existing PHI. Specifically; we aimed to gather the opinions of employees and employers on the likely impact of NHI on their PHI schemes. Methods: We conducted interviews with health insurance providers; and a sample of employers and employees in Kampala; using structured questionnaires and analysed quantitative data using STATA8. Qualitative data was analysed through grouping of emerging themes. Community-based health insurances were excluded from the study. Results: Health insurance and/or prepayment schemes are offered by a handful of organisations or private health providers; mainly in Kampala and cover a relatively small percentage of Uganda's population. The premiums charged and the benefit packages offered by the different agencies vary widely. There are 2 health insurance agencies; 2 HMOs and about 5 or more private providers offering pre-payment schemes to their patients. Responses from a significant proportion of employers and employees show that PHI schemes may be abandoned once the mandatory NHI scheme is implemented. A few respondents argued that they would maintain their PHI subscriptions because of their perceptions of the quality of services likely to be provided under the NHI scheme. Conclusion: If successfully introduced; the NHI scheme may displace existing private health insurance and/or pre-payment schemes in Uganda. The extent to which PHI schemes are displaced depends on whether NHI is successfully implemented and the quality of services being offered under the NHI scheme

Burkitt's Lymphoma in Africa; a Review of the Epidemiology and Etiology

Burkitt's lymphoma (BL) was first described in Eastern Africa; initially thought to be a sarcoma of the jaw. Shortly it became well known that this was a distinct form of Non Hodgkin's lymphoma.The disease has given insight in all aspects of cancer research and care. Its peculiar epidemiology has led to the discovery of Epstein Barr virus (EBV) and its importance in the cause of several viral illnesses and malignancies.The highest incidence and mortality rates of BL are seen in Eastern Africa. BL affects mainly children; and boys are more susceptible than girls. Evidence for a causal relationship between EBV and BL in the endemic form is fairly strong. Frequency of association between EBV and BL varies between different patient groups and different parts of the world. EBV may play a role in the pathogenesis of BL by deregulation of the oncogene c-MYC by chromosomal translocation.Although several studies suggest an association between malaria and BL; there has never been a conclusive population study in support of a direct role of malaria in causation of BL.The emergence of HIV and a distinct subtype of BL in HIV infected have brought a new dimension to the disease particularly in areas where both HIV and BL are endemic. BL has been reported as a common neoplasmin HIV infected patients; but not in other forms of immuno-depression; and the occurrence of BL seems to be higher amongst HIV positive adults; while the evidence of an association amongst children is still disputed.The role of other possible risk factors such as low socio-economical status; exposure to a plant species common in Africa called Euphorbiaceae; exposure to pesticies and to other infections such as schistosomiasis and arbovirus (an RNA virus trans- mitted by insect vectors) remain to be elucidated