HEALTHCARE FUNDING: THE NEED FOR PRIVATE-PUBLIC PARTNERSHIPS IN FUNDING CARE HOMES IN UGANDA-NORTHERN UGANDA.

By Joan A. Atim¹

Governments bear a legal duty to provide healthcare yet due to the overstretched capacity of primary healthcare, persons (legal persons) have set up private hospitals including care homes to meet the healthcare needs of the population. Care homes are on the increase in the world today including in Africa, as some people resort to care homes to ease the burdens of sicknesses and assisted living. These care homes function with the help of medical and support staff to maintain and provide medical services to the patients. The integrated approach to healthcare services is much welcome and requires funding for it to be affordable to the target population.

Research and statistics reveal that funding for primary health remains low as against the national budget and has been on a regressive scale since 2010. Uganda’s health sector is still largely underfunded, making it difficult to attain sector targets. Further budget allocations to health still fall short of the Abuja target of 15 per cent. This is because domestic health financing remains dependent on budget allocations skewed towards funding recurrent expenditures largely focused on the remuneration of healthcare workers and personal costs. Such a budget approach to financing health has resulted in apportioning an average of 4.1 per cent for health, which is well below the Abuja and World Health Organisation (WHO) targets (Latif, 2020).

Whilst there is donor funding for health, this remains continuously under threat due to corruption. Additionally, Universal Health Coverage (UHC) is still under policy consideration in Uganda and has not been implemented nationwide. This leaves the population very vulnerable at the moment as access to quality healthcare is heavily undermined because the burden of payments is still out-of-pocket. The Ministry of Health in analysing the trend in catastrophic spending in Uganda between 1996-2019 shows that out-of-pocket health spending is high and leads to impoverishment (WHO, 2023).

Statistics for Northern Uganda show that the Acholi sub-region has the highest number of poor people in Uganda. According to the Multi-dimensional Poverty Index 2022 report (UBOS, 2022)², 64 per cent of people in the Acholi sub-region are poor. There are immense healthcare needs as a consequence of limited and/or unavailable healthcare services. There is also a shortage of healthcare professionals as evidenced by the wide doctor/nurses/therapies patient ratio in almost every healthcare facility in the Northern region and Uganda as a country at large. These problems are further exacerbated by a lack of medical awareness of preventive healthcare measures in the community. Care homes could be the way out for both patients and medical workers. Therefore, there is a need for private-public funding to finance primary healthcare including care homes. Innovative revenue raising becomes very critical.

In a nutshell, just like primary health care needs funding from stakeholders, care homes also require funding. This is a major justification and will not only help relieve the overstretched primary healthcare system but help subsidise costs in that, services for the target group of those under palliative care, assisted living (old age, disabilities et al), and recovery including children receive the necessary treatment and care and attain the highest attainable health (General Comment No.14) because health is a fundamental human right indispensable for the exercise of other human rights.

References

1. The Universal Declaration of Human Rights. Available at https://www.un.org/sites/un2.un.org/files/2021/03/udhr.pdf
2. ICCPR, Available at https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-civil-and-political-rights
3. The UN Charter. 1945. Available at https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-civil-and-political-rights
4. The African Charter on Human and People’s (ACHPR)- Banjul Charter. available at https://au.int/sites/default/files/treaties/36390-treaty-0011_-_african_charter_on_human_and_peoples_rights_e.pdf
5. The UN Sustainable Development Goals (SDGs). Available at https://sdgs.un.org/goals
6. The Constitution of the Republic of Uganda, 1995
7. Institute for Health Metrics and Evaluation (IHME) (2014), Assessing Facility Capacity, Costs of Care, and Patient Perspectives. Available at http://publications.universalhealth2030.org/uploads/abce_kenya_full_report_2014.pdf
8. Latif, L. A (2020), Can you reap what you don’t sow? Health Finance in Kenya’s Progress towards Universal Health Coverage. Finance for Development Journal Vol 1 (2).
9. Uganda Bureau of Statistics (UBoS), 2022 – Multi-dimensional Poverty Index 2022 Report.
10. WHO (2023), Health Financing Progress Matrix Assessment- Uganda 2023. Available at https://iris.who.int/bitstream/handle/10665/373071/9789240078611-eng.pdf?sequence=1

Footnotes

1. Written by Joan A. Atim. She is an advocate of the High Court of Kenya and Uganda. Holds a Bachelor of Laws degree from Makerere University, Uganda and a Master of Laws degree in Public Finance and Financial Services Law from the University of Nairobi. She is a member of the Law Society of Kenya and Uganda Law Society. ↩︎
2. Uganda Bureau of Statistics (UboS), 2022 – Multi-dimensional Poverty Index 2022 Report. ↩︎