Monday, July 4, 2011

Uganda Health Budget rises with impact on service delivery


By Esther Nakkazi

The Uganda government increased budget financing to the health sector for 2011/12 financial years further reducing on donor dependence, which is expected to improve sustainability and improve quality of health care delivery.

Financing the health sector increased to Ush 985.8 billion (412 million) this year from Ush. 660 billion (270 million) the previous year while financial assistance from development partners is expected to reduce in line with the overall budget. Uganda will fund 71 percent of its budget.

Mrs. Maria Kiwanuka the minister of Finance said the funds for health would mostly be spent on infrastructure development, drugs and basic medical equipment procurement as well as recruitment of key medical personnel.

The largest gaps have been in infrastructure, human resources, drugs, vaccines and consumable sundries.

Health care will be delivered more efficiently and we shall have a greater impact with increased financing of the budget, said Dr. Asuman Lukwago, the Permanent Secretary, ministry of Health.

The continued increase of financing its health sector budget and reduced aid flows to the sector will enable strengthened planning, better accountability and financial management said a health sector official.

Francis Runumi, the commissioner health services planning at the ministry of Health has always encouraged the government to increase its financing to the sector to match with the growing population.

“The budget is only a slight improvement which is good but it does not address the human resource issue. If Ushs. 400 billion ($165 million) of that money is used for infrastructure how will it impact directly on service delivery?” asked Runumi.

According to Mrs. Kiwanuka the health sector registered a growth rate of 12.6 percent in 2010/11, which was a better performance, compared to the 11.9 percent increase in 2009/10.

The trend in disbursements have been growing but still fall short of the demands for the large population creating a funding gap. The ministry of Finance National Budget framework paper shows that in the financial years 2006/07, 2007/08 and 2008/09 allocations where Ush139.23 bn ($57 million), 150.9 bn ($62 million) and 253.08 bn ($104million) respectively.

In 2010/11 and 2011/12 the financing from government amounted to 660 billion (270 million) and 985.8 billion (412 million) respectively. Over the years also the ratio of government to donor financing the health sector has continued to go down from 60:40 in 2008/09 to 75:25.

But most of the health sector funding from development partners is off budget, which has created a big disconnect between donor funding and implementation on the ground, health officials say.

For instance in 2010/11 financial year project aid for the health sector was Ush. 90.44 billion (37 million) and is expected to increase to 397.1 billion ($162.4) this financial year.

Of this the World Bank has already approved US$130 million to strengthen Uganda’s public health systems through improved human resources; provision of physical infrastructure; and greater accountability for service delivery.

Some of the funds will be used to support the Government to renovate hospitals, improve management of health workers, strengthen leadership in the sector and provide reproductive healthcare, including family planning services, according to Kundhavi Kadiresan, World Bank Country Manager for Uganda.

Effect of cutting travel and workshop budgets

Mrs. Kiwanuka in the 2011/12 budget proposed a 50 percent cut on advertising budgets for all Ministries and Agencies as well as 30 percent cut on the budget for allowances, workshops and seminars, travel inland and abroad.

The cuts will also be effective for allowances of fuel, vehicle maintenance, printing and stationary, welfare, entertainment, books, periodicals and newspapers, special meals and the purchase of furniture.

Purchase of new Government vehicles has been frozen and there will be an immediate forensic audit of Government salaries, wages and pensions.

“When these expenditures are cut off we shall improve efficiency and create a big impact in delivery of health services in the sector,” said Dr. Lukwago.

Health is one of the ministries that have been spending big sums of their budget on sectoral policy functions. For instance fuel costs and management took up almost 10 percent of the ministry budget in 2009/10 because of large fleet management.

Workshops and seminars accounted for 7.3 percent of the ministry recurrent budget in the same year twice the total sum allocated to 15 referral hospitals for non- wage expenditure.

Kenneth Mugambe the director budget, in the ministry of Finance said there is a higher priority attached to sectoral policy functions and a comparatively lower priority accorded to the actual health service delivery functions of hospital services. But this will now change with the new budget announcement.


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