A critical review of literature on health financing reforms in Uganda – progress, challenges and opportunities for achieving UHC

Abstract

Background: Universal health coverage (UHC) is one of the sustainable development goals (SDG) targets. Progress towards UHC necessitates health financing reforms in many countries. Uganda has had reforms in its health financing, however, there has been no examination of how the reforms align with the principles of financing for UHC.
 Objective: This review examines how health financing reforms in Uganda align with UHC principles and contribute to ongoing discussions on financing UHC.
 Methods: We conducted a critical review of literature and utilized thematic framework for analysis. Results are presented narratively. The analysis focused on health financing during four health sector strategic plan (HSSP) periods.
 Results: In HSSP I, the focus of health financing was on equity, while in HSSP II the focus was on mobilizing more funding. In HSSP III & IV the focus was on financial risk protection and UHC. The changes in focus in health financing objectives have been informed by low per capita expenditures, global level discussions on SDGs and UHC, and the ongoing health financing reform discussions. User fees was abolished in 2001, sector-wide approach was implemented during HSSP I&II, and pilots with results-based financing have occurred. These financing initiatives have not led to significant improvements in financial risk protectionas indicated by the high out-of-pocket payments.
 Conclusion: Health financing policy intentions were aligned with WHO guidance on reforms towards UHC, however actual outputs and outcomes in terms of improvement in health financing functions and financial risk protections remain far from the intentions.
 Keywords: Uganda; Universal health coverage; health financing.

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“…The implementation of most current UHC programs have suffered significant setbacks stemming from lack of administrative coordination within the respective ministry of health´s overall structures, inadequate health information systems, lack of integrated clinical and frontline health worker data collection and synthesis networks, insufficient utilization and inaccurate interpretation of the available data, underfunding and poor quality medical facilities, thereby lowering the overall success of the programs. Experiences from sub-Saharan countries like Uganda have shown that health financing and risk prevention strategies protecting UHC reforms are far from the desired results [4] .…”