Tight healthcare budget coming

Analysts predict more individuals will have to pay for treatment in private clinics as government fails to deliver on its pledges and donors flee health sector

In September 2013 when her mother was first diagnosed with cervical cancer, Fausta Akech was a young professional doing her first job as a nutritionist. With doctors advising that the disease was in initial stages and that she could be saved, Akech realised she had to act fast. This meant Akech taking her mother to the Uganda Cancer Institute (UCI), the only public treatment center for a country of 34 million people. At UCI it can take a while for a patient to see a doctor. Akech decided to go private.

The first private specialist she consulted gave her a bill of Shs6 million for the recommended operation. Akech paid it. But it was only the beginning of Akech’s endless expenditure. Long after her mother succumbed to a more aggressive cancer of the bladder in April last year, Akech continues to repay loans she took in a futile attempt to save her mother’s life.  And she is not the only one. Medical bills drive an estimated one million Ugandans into poverty annually. Unfortunately, they are little-noticed by healthcare managers in the country.

The main reason many Ugandans seek treatment in private medical facilities is that the government invest very little in the health sector. In the FY2017/18, for example, the government proposes to spend around Shs34, 000 on the health of each of the 34.6 million Ugandans.

The government currently contributes only 17% to the healthcare of citizens. Donors contribute 41% and individuals cover the biggest part, 42%.

The government has allocated Shs1.2 trillion to the health sector, according to its planning document; the National Budget Frame Work Paper. The figure could change, and will be either higher or lower when the national budget is announced in June. However, the money allocated per individual will certainly be nowhere near the Shs100, 000 (US$28) the government set as its target health expenditure per person in the Health Sector Strategic Investment Plan.In total, under the Health Sector Development Plan (2015/16 – 2020/21), for government to meet standard health needs of Ugandans, it needs to invest Shs3.4 billion into the sector next FY 2017/18. Then it must progressively increase to 3.5 in FY 2018/19. That means the government should be spending US$91 about 320,000 per person’s health in 2017/18 and US$96.6 about 340,000 in 2019/20. For some, this is evidence that people’s health is not rated highly in government priorities despite it having signed a number of international pledges to improve the health sector. One of such ignored pledge is the 2001 Abuja Declaration in which Uganda, together with other African countries, resolved to contribute 15% of its annual budget to improve the health sector.

While some countries like Rwanda have fulfilled the pledge, Uganda’s highest allocations to health were in FY 2002/3 when the sector budget constituted 9.6% and FY 2016/2017 when the sector got 8.9%. Now, with the proposed Shs1.2 trillion this year, the share is a paltry 5.7% of the Shs22.6trillion total budget.

Tom Aliti Candia is one of the officials responsible for Planning at the Ministry of Health. He told The Independent on Jan.30 that they are still in talks with the Ministry of Finance which prepares the budget. He said, however, they are tentatively budgeting to spend Shs1.8 trillion next FY. That would be same as was allocated in current year.  But there has been talk of budget cuts coming in June