Ugandan voters ready to punish MPs over health funding

By Ronald Musoke

Healthcare has surged forward as the most prominent priority for Ugandan voters according to a survey report released on Sept. 8 by a group of civil society organizations working to ensure access to essential health services in Uganda.

The survey was conducted in Uganda last month by researchers from both Uganda and the US-based Columbia University.

According to the survey findings, during the course of the 9th Parliament, healthcare has surged forward and is now considered far more important than crime, education, or unemployment by Ugandan voters.

The survey reveals that a majority of voters will not support an MP who does not prioritize health issues, such as correcting medicine stock outs or increasing health financing.

The latest findings support conclusions from other recent surveys such as the one done by AfroBarometer two years ago which also confirmed the importance of healthcare for the Ugandan voter.

In a 2012 survey, a majority of citizens polled by AfroBarometer reported that the current government was doing very badly in terms of handling the provision of essential health services.

The researchers for the August survey interviewed up to 1,426 Ugandan voters across the country about their priorities ahead of the 2016 general elections and 86% of those polled said they would only vote for MPs who are willing to fight for an increase of the budget for health services while 66% said they would only vote for MPs who work to secure health services.

Another 86% of those polled said they would vote in legislators who were ready to stop stock outs of essential drugs in Uganda’s public health facilities. However, the 2014/15 budget for the health sector fails to address these voter concerns.

This is the reason the coalition which brings together over 30 civil society organizations is calling for MPs to take action based on these data with particular emphasis put on revising the 2014/15 national budget so that it dramatically scales up investments in recruitment and motivation of front line professional health workers, alongside expansion in primary health care (PHC) funding for health facilities.

“A nation of sick Ugandans cannot benefit from economic development,” said Dennis Odwe, the executive director of the Action Group for Health, Human Rights and HIV/AIDS (AGHA-Uganda).

“These data show clearly that MPs cannot ignore the health priorities of their voters,” he said.

“Without expanded funding for these priorities, pregnant women will continue to suffer preventable deaths and complications, people with HIV will wait in line for life saving treatment, and Ugandans will continue to suffer without access to essential health services.”

Odwe added that for too long, health workers have toiled without adequate remuneration, leading to demotivation, attrition, and lack of accountability for poor quality service delivery.

Coalition members also demanded an increase for primary health care funding which includes the resources health facilities use to pay for electricity, clean water, fuel, and other priorities.

“The current PHC non-wage recurrent funding levels are only Shs 41 billion instead of the required Shs 82 billion,” said Samuel Senfuka of White Ribbon Alliance for Safe Motherhood Uganda.

“Government is failing to deliver on its commitment to ensure access to emergency obstetric care in all Health Center IVs, and women are dying as a result.

“Our health facilities cannot respond to the leading causes of preventable maternal death—post partum hemorrhage, sepsis, obstructed labour, unsafe abortion and eclampsia—unless they are equipped to provide essential health services. Government must match their promises with the funding levels needed to save the lives of pregnant women, newborns and children.”

When Maria Kiwanuka read the 2014/15 budget in June, she said the government would enhance health workers’ remuneration and improve their skills through capacity building” and that “health facility infrastructure at both local government and referral levels, would also be expanded, in addition to the construction of additional staff houses in lower level health facilities to minimize absenteeism.”

However, according to civil society, the government did not emphasize what portion of the Shs 450 billion allocated for enhancement of civil servants’ salaries would be invested in health workers.

Already Shs 215 billion is ring fenced for a raise in teachers’ pay.

The coalition says the balance of Shs 235 billion should be invested in production, recruitment and retention of front line health workers, particularly priority cadres such as midwives working in local government health facilities.

They also want government to expand funding for HIV treatment so as to be consistent with prior years’ increases.

“This year’s budget proposes a flat line in funding for lifesaving anti retroviral treatment,” said Margaret Happy of the International Community of Women Living with HIV Eastern Africa (ICW EA).

“Yet more people are waiting in line for treatment because Uganda has changed the clinical eligibility criteria so that more people with HIV can benefit from the clinical and prevention benefits of treatment. We call on government to increase investments in HIV treatment by 50%.

According to the coalition, there should also be a dramatic enhancement of the primary health care budget by Shs 41.2 billion in the priority areas of administration of health facilities to cater for immunization, supervision, coordination, hygiene inspection, and health education as well as prioritize enhancement of wages for midwives and other critical cadres of the health workforce is estimated to cost UShs 13.3 billion.

The coalition also wants the government to complete the recruitment exercise of over 3,300 health workers at a cost of Sh 28.3 billion in annual salary and allowances as well as increase investment in HIV and TB treatment by 50% to UShs 150 billion.

In 2012, about Shs 49.5 billion investment in health workers by the government resulted in tangible benefits for pregnant Ugandan women and their communities.

This followed an unprecedented effort launched by civil society and MPs to ensure that Uganda’s financial year 2012/13 budget was not passed without a focus on increasing the number and motivation of professional health workers at Health Centre IIIs and IVs.

The effort succeeded, with the budget passed on Sept. 25 last year having an extra Shs 49.5 billion to recruit 10,231 professional health workers and deploying them to Health Centre IIIs and IVs.

Salaries for medical doctors at these two health centre levels were also enhanced from Shs 1m to Shs 2.5m per month to strengthen their retention.

Asia Russell, the director of international advocacy at Health GAP [Global Access Project] said the impact of the Shs 49.5 billion investment in health worker recruitment and retention has been undermined because Parliament and government did not finish the job by funding health worker motivation and retention.

“The draft 2014/15 budget is completely out of step with voter priorities,” she said.

Russell said, as the draft 2014/15 budget shows, government is not giving health the political prioritization it urgently needs and voters are recognizing that.

“They are demanding government make bolder, smarter health investments to end needless suffering and death from preventable and treatment diseases and conditions such as HIV, malaria, tuberculosis and pregnancy related causes,” she told The Independent in a separate interview.

“Parliament should take action this week by prioritizing wage enhancement for midwives and nurses–the budget should be delayed if needed, since these are life and death matters.”