World Bank: Ugandan govt health facilities worth visiting

Kampala, Uganda | THE INDEPENDENT | The World Bank has given credit to Uganda’s health sector but says the recent slowdown in government allocations might either reverse or stagnate the development.

By the end of the year 2022/2023, Uganda’s three-tiered health system had a total of 8,386 public and privately managed health facilities at the primary, secondary, and tertiary levels.

Private for-profit providers operated 46 percent (3,856) of Uganda’s health facilities, followed by the government at 41 percent (3,448), while private nonprofit providers run 13 percent (1,082) centres.

In its 23rd Edition of Uganda Economic Update under the title: Improving Public Spending on Health to Build Human Capital, the World Bank says that Uganda has performed better than its peer countries in several key demographic and health indicators, although many registered little progress.

Some of the improvement indicators are the prevalence of stunting for children under five years dropping to 24.4 percent from 29 in 2016, the mortality rate for children under five from 64 to 52 percent, and the maternal mortality ratio of deaths per 100,000 live births from 336 to 189, among others.

Rogers Ayiko, a Senior Health Specialist at the World Bank, says that the heavy investment in medical infrastructure has ensured a higher concentration of health facilities which eases access to health services.

He says that the results of their recent studies surprised them how much Uganda’s health sector had improved compared to the rest of the region.

He attributed some of these achievements to policies the government undertook, including the decentralization of the health sector, and the free health for all policy, despite the existence of corruption.

Richard Kabagambe, the Assistance Commissioner of Health Services Planning at the Ministry of Health says they are now concentrating on human resources, including improving the remuneration of health workers.

He says that absenteeism has reduced significantly at health facilities, while there has been an increase in the availability of ambulances, Intensive Care Units, blood banks, and oxygen plants, among others.

Both the Bank and government officials are cautious that these gains might be reversed unless the government maintains its funding to the sector, amidst declining donor support.

However, Kabagambe is worried that many of the remaining development partners are increasing using direct spending where the resources are given directly to their targeted projects instead of going through the consolidated fund and as budget support.

He says the disadvantage of this is that such funds and projects cannot be monitored by the government.

Because most of the country’s largest and busiest health facilities are publicly owned and operated, the government is the leading healthcare provider and employer in the health sector, with public healthcare facilities accounting for 79 percent of outpatient visits, followed by private nonprofit facilities (14 percent), and private for-profit facilities at 7 percent.

Public facilities also receive 67 percent of inpatient admissions, followed by private nonprofit facilities at 27 percent and private for-profit facilities at 6 percent.

However, the volume of patients treated at private facilities may be underestimated due to the low reporting levels among private health providers, according to the report.

Over the past 10 years, the number of health facilities in Uganda increased significantly, driven by private for-profit providers, the number rising by 68 percent.

“Though the government built new health facilities and modernized and restored several existing ones, the number of government facilities only increased by 29 percent while the number of private nonprofit providers and private for-profit facilities increased by 24 percent and 170 percent, respectively, over the period,” it says.

The rapidly growing number of privately run healthcare facilities suggests a conducive environment for private investment in the health sector, though it may also reflect the limited availability of public health facilities and/or their inability to deliver high-quality healthcare.

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