The Ministry of health in Uganda has secured $20 million from the Global Financing Facility to foster the result based financing initiative, which aims at improving the quality of health care at health facilities country wide.
Prof. Anthony Mbonye, the Director of health services in charge of Clinical and Community Health in the Ministry of Health revealed this while addressing Journalists at the first national symposium on universal health coverage that took place last week at Silver springs Hotel.

“The hope is that more private and public health facilities will get accreditation because the more a facility avails services to pregnant women and children of immunisable age, the more funding it gets. This performance based funding is meant to improve quality of care at health facilities and to make sure health workers get allowances, uniforms and buy supplies. This will be one of our stronger paths to universal health coverage,”He said.

 At the symposium, there were further earnest deliberations on how best Uganda can build an understanding on attaining universal health coverage. Universal health coverage, according to the World Health Organization (WHO) is the goal that all people have access to health services and do not suffer financial hardship in paying for them. It ensures that all people have access to needed promotive, preventive, curative and rehabilitative health services of sufficient quality. The symposium was convened by Makerere University School of Public Health under the umbrella of the Supporting Policy Engagement for Evidence-based Decisions (SPEED) project- an initiative that focuses on advancing Universal Health Coverage in Uganda.

Speaking on the opening day of the symposium, Prof. Freddie Ssengooba of the Makerere University School of Public Health, College of Health Sciences (MakCHS) noted that the trajectory towards achieving universal health coverage in Uganda is gaining momentum, notwithstanding the many challenges, the country faces.  "As a nation, we need to begin positioning ourselves on how best to achieve this development agenda. Universal health coverage is central to the question of how health should be represented in the new development agenda that will succeed the Millennium Development Goals this year," said Ssengooba.

"The process of developing the new Health Sector Strategic and Investment Plan (HSSIP) of 2015-2020 by the Ministry of Health is a welcome development and a step in the right direction. The goal of Universal Health Coverage which is being inserted into Uganda's health policy is still new to many. These deliberations are meant to help us understand the idea of Universal Health Coverage and what its implications are for the different stakeholders like the government, the private sector and academia."

       Whilst everyone acknowledges that the goal of attaining universal health coverage will be no mean feat, the government seems intent on making it feasible and bringing changes to bear especially as regards the provision of cost effective health interventions for the poorest of its citizens, a key prerequisite if the programme is to fall in line with the requirements of the WHO. Mbonye noted that the government was obliged to provide interventions such as antenatal care, family planning, curative and rehabilitative care to all its citizens. "In South Eastern and Eastern Uganda, a Voucher system has been introduced to enable poor pregnant women to access antenatal and delivery health care services at every visit. A woman will only be required to pay 3000 shillings. The Voucher scheme will be rolled out in the next six months countrywide," Mbonye said.

"The pilot project registered many successes. It is on the basis of that, that we were able to get funding from the World Bank for the scheme. We are also working on the National Health Insurance Initiative, which essentially aims at improving our health indicators. It is now with the Parliamentary council and there is green light from the Ministry of Finance regarding funds for it."   Dr. Patrick Kadama, the Executive Director of the Platform on Human Resources for Health at the African Centre for Global Health and Social Transformation underscored that for Uganda to accelerate towards universal health coverage (UHC), a number of critical reforms need to be put forth to achieve equity.  "There is need for reforms to manage the social determinants of health through stronger inter-sectoral action. We also need reforms to introduce patient centered or family based health care services, and reforms to strengthen health governance and management," Kadama explained.


Low access to safe, clean drinking water and sanitation

          Dominic Kavutse, an engineer from the Directorate of Water Development, Ministry of Water and Environment noted that the current access to safe water supply and sanitation in Uganda stands at 65%. 
          "That leaves 35% of the Ugandan population with access but not safe access.  That translates into 10 million Ugandans exposed to water-borne diseases due to consuming unsafe water. There are 110,000 water points in the country.  Out of the budget we have we are able to produce new water sources for about 800,000 people per year but the population increases by at least 1.2 million people per year. At the present rate of investment, the coverage of water supply and sanitation is going down," Kavutse said.

The inaptitude of the health system in Uganda

            Dr. Stephen Lock, the acting head of Cooperation, Delegation of the European Union noted that whilst there have been notable declines in the infant mortality ratios and HIV related deaths, the health system in Uganda is still lagging behind in terms of providing assurance to Ugandans of adequate social protection.  "Deaths for example related to pregnancy and child birth remain unacceptably high with an estimated 20 women dying daily while giving birth in Uganda. There are still pertinent questions to answer regarding the functionality of public hospitals which are the most visible aspects of health system capabilities," Lock stated.
Out of the pocket payments as a major barrier to health access
       "Direct payments have serious implications for health. Making people pay at health facilities or other points of delivery dissuades them from using services (particularly health promotion and prevention). That in essence means they do not receive treatment early and they steer clear of health checks. The absence of financial protection in Uganda's health system calls for concerted action aimed at reducing the large proportion of out-of-pocket payments currently present in total health financing." Ssengooba observed.

Burden of communicable and communicable disease
        Professor David Serwadda, Director of the Institute of Public Health at Makerere University in Kampala raised a red flag about the possibility of a double burden of disease in Uganda. "Whilst Uganda is suffering the burden of communicable diseases like malaria, HIV, TB and others, the prevalence of Non-Communicable Diseases like Cardiovascular Diseases is on the rise as well. This raises fears concerns of a double burden of disease. Additionally, there is a third layer of emerging or re-emerging epidemics," Serwadda explained.
The other discussions centered around themes like Human resources for health, Resilient Health systems and Global health epidemics, Contributions of private sector players to health sector development in Uganda, Information systems and technologies for Universal Health coverage, amongst others.


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