Dr. Peter Okwero is a Senior Health Specialist in the World Bank’s Africa Region’s Human Development Department, based in Uganda Country Office, Kampala.
His presentation gave the symposium delegates a snapshot view of how health financing has been changing over the years in Uganda since the colonial period.
He mentioned the period 2001-to-date as the most significant in health financing in Uganda when a number of fundamental changes were introduced in the financing landscape. He mentioned the abolition of user fees, phenomenal increase in funds coming into the country globally, global commitment towards universal health coverage, increased understanding of health financing. “We see more explicit statements on health financing in national plans, more people are trained as health economists and a Budget Development unit in the Ministry of Health”, he noted.
On moving the Universal Health Coverage agenda ahead, he recommended opening up the debate on out-of-pocket payments; building capacity for planning; increasing the domestic resource base and having in place a clear strategy framework.
“It is important to expand the debate to start tackling out-of-pocket expenditure. We need to get discussions outside the Planning Department and involve other people in the Ministry of Health and then bring on board other critical ministries. The health sector needs to engage other sectors in Uganda in light of the sector reforms going on. Reforms like Decentralisation, Procurement impact how services are delivered”, he emphasised.
He decried the persistent technical nature of discussions on universal health coverage in Uganda that is blind to certain aspects and impacts. “It is unfortunate that discussions are still technical and key decisions rarely take account of financing implications”. He gave the example of the number of public health facilities that he said has more than quadrupled over the last 10 years. This, he said, comes with numerous financing implications including wage bill, utility bills and other maintenance and supply costs.
Dr. Okwero brought out another key area that will greatly impact implementation of universal health coverage, if not addressed. “We need clear strategy framework to achieve universal health coverage. Out-of-pocket expenditures have grown in this country and we cannot continue this way; it goes beyond paying for services in the facility (user fees) and covers the whole continuum of costs the users incur in the process of accessing health services”.
He further pointed out the need for increased and improved capacity in the Ministry of Health Planning Department to engage, sieve through the many issues and identify priorities for universal health coverage.
Although he mentioned that even with the available limited resources the country can achieve more, he noted that mobilization of domestic resources will have to improve. “Domestic resources in Uganda are not growing and to take charge of our health services we need to address this one. The informal nature of the way we do business means that revenue collection is hindered”
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