Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

Orem, Juliet Nabyonga; Zikusooka, Charlotte Muheki

doi:10.1186/1475-9276-9-23

Cited by 35 publications

(41 citation statements)

References 5 publications

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“…In Uganda, user fees were abolished in all government health facilities in 2001; however, a dual system was later established in some health facilities: one health facility wing offers services at no cost for those who cannot afford payments while another wing charges user fees for those who can afford to pay [28,29]. In view of this, informants saw the potential to contract services from the private wing for voucher clients.…”

Section: Resultsmentioning

confidence: 99%

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

Okal

Kanya

Obare

et al. 2013

Health Res Policy Sys

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BackgroundContinued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities.MethodsData presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated.ResultsThe findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages.ConclusionsAccrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.

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Section: Resultsmentioning

confidence: 99%

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

Okal

Kanya

Obare

et al. 2013

Health Res Policy Sys

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“…This is even lower than is considered more realistic in budgetary allocation targets set in the country’s health sector strategic plans [ 11 ]. Prepayment arrangements in the form of voluntary community based health insurance schemes and private health insurance are generally insignificant [ 12 ]. For example, in 2009 prepayment schemes accounted for about 0.2% of total health expenditure [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Who pays for and who benefits from health care services in Uganda?

Kwesiga¹,

Ataguba

Abewe³

et al. 2015

BMC Health Serv Res

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BackgroundEquity in health care entails payment for health services according to the capacity to pay and the receipt of benefits according to need. In Uganda, as in many African countries, although equity is extolled in government policy documents, not much is known about who pays for, and who benefits from, health services. This paper assesses both equity in the financing and distribution of health care benefits in Uganda.MethodsData are drawn from the most recent nationally representative Uganda National Household Survey 2009/10. Equity in health financing is assessed considering the main domestic health financing sources (i.e., taxes and direct out-of-pocket payments). This is achieved using bar charts and standard concentration and Kakwani indices. Benefit incidence analysis is used to assess the distribution of health services for both public and non-public providers across socio-economic groups and the need for care. Need is assessed using limitations in functional ability while socioeconomic groups are created using per adult equivalent consumption expenditure.ResultsOverall, health financing in Uganda is marginally progressive; the rich pay more as a proportion of their income than the poor. The various taxes are more progressive than out-of-pocket payments (e.g., the Kakwani index of personal income tax is 0.195 compared with 0.064 for out-of-pocket payments). However, taxes are a much smaller proportion of total health sector financing compared with out-of-pocket payments. The distribution of total health sector services benefitsis pro-rich. The richest quintile receives 19.2% of total benefits compared to the 17.9% received by the poorest quintile. The rich also receive a much higher share of benefits relative to their need. Benefits from public health units are pro-poor while hospital based care, in both public and non-public sectors are pro-rich.ConclusionThere is a renewed interest in ensuring equity in the financing and use of health services. Based on the results in this paper, it would seem that in order to safeguard such equity, there is a need for policy that focuses on addressing the health needs of the poor while continuing to ensure that the burden of financing health services does not rest disproportionately on the poor.

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“…Beyond the health care reform in Ethiopia, there have been debates on implications of health care reform in resource-limited countries. In Uganda, while official reports developed by donor funded expatriate staff have tended to show a positive picture of the Ugandan health sector reform [ 5 ], other studies indicate that despite these reforms, the Ugandan health sector remains challenged by under-funding [ 6 ] and poor quality of care [ 7 ]. Kenya has been in the process of implementing health care reforms to secure a fundamental change in the functioning and performance of its health care services.…”

mentioning

confidence: 99%

Implementing health care reform: implications for performance of public hospitals in central Ethiopia

Manyazewal¹,

Matlakala²

2018

Journal of Global Health

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BackgroundUnderstanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia.MethodsA facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia. The reform documents were reviewed to assess the nature and targets of the reform for interpretive analysis. Adopting dimensions of health system performance as the theoretical framework, a self-administered questionnaire was developed. Consenting health care professionals who have been involved in the reform from inception to implementation filled the questionnaire. Cronbach’s alpha was measured to ensure internal consistency of the instrument. Descriptive statistics, weighted median score, χ2, and Mann-Whitney U and Kruskal-Wallis tests were used for data analysis.Results Despite implementation of the reform, the health care system in public hospitals was still fragmented as confirmed by 50% of respondents. Limited effects were reported in favour of quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%) of care, while poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. Though there was substantial gain in infrastructure and workspace, stewardship of health care resources was less benefited. The predominant hindrances of the reform were the working environment (adjusted Odds Ratio (aOR) = 2.27, 95% confidence interval (CI): 1.15-4.47), financial resources (aOR = 3.54, 95%CI = 1.97-6.33), management (aOR = 2.27, 95% CI = 1.15-4.47), and information technology system (aOR = 3.15, 95% CI = 1.57-6.32).Conclusions The Ethiopian health care reform has laid the groundwork for health system improvement, but progress was slow and the health care delivery system was still fragile. Healthcare reform efforts in such settings are feasible, but with regular mapping of programmatic outcomes and bringing a common understanding of the reform among stakeholders.

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Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

Cited by 35 publications

References 5 publications

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

Who pays for and who benefits from health care services in Uganda?

Implementing health care reform: implications for performance of public hospitals in central Ethiopia

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