Who is going to give the money to fund Universal Health Coverage in Africa – it is the Education Sector


By Elizeus Rutebemberwa

Every budget has two sides: the income and expenditure sides. As we endeavor to ensure that all people access the necessary care (the expenditure side), there is the looming question: who will finance the delivery of care (the income side)? There is need for human resources to be in the health units and have equipment that matches the demands of the 21st century. All these need finances.

So, who will Fund?

Different communities and countries have addressed the problem of health financing ( in different ways. Some countries have insurance.  There have been mixed fortunes for insurance in terms of coverage and sustainability. Are people able to pay the premium?Ellie 2 The disadvantaged that need health care most are usually the least able to afford the premium. Financing the health sector through taxation will work well in those instances where the tax base is big and the tax envelope is able to support the challenges that these countries face. Are people able to be taxed? When there is no support to give subsidized or free health care, the alternative is out-of-pocket expenditure. The challenge here is again that the poor and disadvantaged have more than their proportion of illnesses and yet are least able to pay the out-of-pocket expenditure. At the end of the day, people who need the health services need to earn so that they are able to pay a premium in insurance, are able to pay taxes in a taxation system and are able to pay an out-of-pocket expenditure if and when needed to do so. How do we make people earn?

Education system that enhances production


People earn through the production of either services or goods. In order to produce them, they need to have the skills and competencies that can produce these services and goods. This underlies the critical need to have an education system that produces graduates who are relevant to the production system in the country in which system they will be incorporated to contribute to the production cycle. A relevant education system is not just the curriculum. It is the way the entire education system links with the other sectors of the country like the production sector. What is needed in production is not what we receive from school, it is what we get when we integrate school knowledge with practice – this is skills development. Skills are developed through practice.



Education beyond the School compound

With a population where more than half of the population is below 16 years, this is a golden opportunity to enable the young population to acquire the skills that will enable them to be employable, be able to earn, be taxable, be able to pay a premium or out-of-pocket expenditures.

The challenge squarely lies in how the young population is trained. This is not the sole responsibility of schools. Education goes beyond school compounds. It also involves linking with production sector to give them opportunities of internship and the administrative sector to institute policies that make it possible for the trainees to access the necessary training.

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Unless there is appropriate training for the population to be able to acquire skills and competencies necessary to increase production of goods and services, it will be an up-hill task funding universal health coverage in Africa.

Dr. Elizeus Rutebemberwa is Associate Professor in the Department of Health Policy, Planning and Management at Makerere University School of Public Health. He is Co-Principal Investigator on the SPEED Initiative.


Katwe primary school –