Can we achieve Universal Health Coverage in Uganda without private sector participation?


phylis By Dr. Phyllis Awor

The private health sector includes private-for-profit (commercial) health providers, private-not-for profit providers (for example non-governmental organizations, faith based groups and charities), as well as traditional health providers. Private health providers are both formal (legally recognized, for example physicians and nurses) and informal. Informal private health care providers are defined as those who practice allopathic medicine but have no formally recognized training, are not legally recognized, and typically function outside the realm of government regulation. Such informal providers are common in Uganda.

The role of the private sector in management of illness in Uganda

The Uganda health system was originally designed on a national health model, characterized by government owned health services, ideally financed through government tax revenues. However, a low tax base and inability to collect sufficient revenue to finance all sectors has rendered this national health model insufficient to meet the health needs of most people. Thus, despite substantial public health investments made over the last 40 years in Uganda, the government cannot be viewed as the principal health care provider.

Due to persistent public health sector weaknesses, our health system has evolved and is pluralistic in nature, having various stakeholders and agents present and working in different ways, in an attempt to meet the health needs of Ugandans. This often includes the existence of public and private providers as well as allopathic and alternative providers, all within the same health system. The private sector particularly plays a significant role in the delivery of health services, providing more than 50% of all health care in Uganda and sub-Saharan Africa (SSA).

Let us take the example of management of childhood illnesses in Uganda. The extent of utilization of the private sector for management of childhood illness is also high. All previous nationally representative health surveys and many independent research surveys show that 50 – 60% of health care seeking for children with fever, pneumonia, and diarrhea occurs within the private sector. This private sector mainly includes drug shops and clinics. Further, people from all income groups (poor and rich), seek care in the private sector.

Two important questions arise: Are we able to improve public health care right now to ensure that these children receive appropriate and timely care in the public sector? How can we ensure that all these children seeking care in private drug shops and clinics in rural areas actually receive appropriate and timely care? The answer to the first question is NO. We cannot improve the public health sector immediately. But we must have short term, mid-term and long term plans to improve the public health sector, which we must implement. At the same time we must utilize the private sector today, to continue to provide health care to Ugandans, but ensure that the quality of care in the private sector is improved. In a follow up article, I will provide answers to the second question, showing tested approaches to improve quality of care in private sector drug shops.

Dr. Phyllis Awor is a Postdoctoral Fellow on the SPEED Project and a Public Health Researcher at Makerere University School of Public Health