Identification of priority research questions in three thematic areas: human resources for health, health financing and the role of the non-state sector
Health Financing and Role of the Non-State Sector in Uganda
More often than not, the research agendas in low- and middle-income countries are seen to be driven by researcher interests and funding sources, with too often little or no serious relationship with prevailing policy concerns. Consequently, the results of much of the researchers’ work geared towards influencing policy tend to be challenged by policy makers, dismissing its finding as being too academic and not suited for any practical implementation. This is particularly so because high-priority research questions do not necessarily arise from the concerns of policy-makers and other key stakeholders.
This study was part of a larger objective to identify priority research questions in health financing, human resources for health and the role of the non-state sector in the low- and middle-income countries of the East Africa Region. The study was carried out in the public and private sectors, covering key ministries, non-governmental organisations (NGOs), private health facilities, bi/multi-lateral organizations, public and private provider associations, as well as research and consumers’ organizations in Uganda. Data from key informants was collected using qualitative methods; a set of tools with each tailored to the roles and responsibilities of the selected informants were used as guides during the interview. Additionally, a comprehensive literature search of official documents and grey literature in libraries, information centers and on the Internet was carried out.
Findings
Policy Concerns – Health Financing
The National Health Policy priorities in Uganda focus on ensuring access to the Minimum Health Care Package. However, available data shows that delivery of the Minimum Health Care Package reveals a huge resource gap between the requirements of the Health Sector Strategic Plan II (HSSP II) and the resources available under the current Medium Term Expenditure Framework (MTEF).
Policy Concerns – Human Resources for Health
The major human resource problems in Uganda’s health sector were found to be the misallocation of human resources; the shortage of trained staff in the health sector; and the attrition of qualified staff from private not-for-profit practitioners to public facilities and private practice. In addition, poor remuneration of health workers and over dependence on untrained personnel in the primary health care facilities, pose major challenges to effective implementation of health programmes in Uganda.
Policy Concerns – The role of the non-state sector
The health financing, human resources for health and Non-State Sector hurdles seem to stem from the country’s governance and financing approaches. The governance and policy environment for Uganda’s health sector – composed of various actors (public, private and donors) – require harmonization of the basic rules, standards, as well as information and management systems. The financing regimes need a system to plan and utilize resources effectively in order to realize cost-effective interventions. Priority setting should be based on information on the overall health sector to help assess cost-effective use of human and financial resources.
The role of non-state sector services was acknowledged by most informants. However, much of its contribution to national health care delivery in not well known, except for the facility-based private not-for-profit organizations (PNFPs) whose contribution is about 40% of the national health care delivery. In support to PNFPs, government willingness to spend and the condition that user fees be kept minimal overrides the basis of what is required to deliver the services. The inelastic funding from the public sector forces PNFPs to increase user fees rendering their services inaccessible to the very poor. On the other hand, though the private for-profit (PFP) and traditional medicine sub-sectors are recognized as partners in health care delivery, they are never provided for in the national health sector strategic planning.
Project description
Programme:Identification of priority research questions in three thematic areas: human resources for health, health financing and the role of the non-state sector
Research title:Identification of priority research questions within the areas of: health financing, human resources for health the role of the non-state sector in Uganda
Thematic Research Area: Cross-cutting
Grantee Country:Uganda
Grantee Institution:Makerere Institute of Social Research, Makerere University
Program Coordinator/Principle Investigator: Dr Asiimwe Delius
Start date: June 2007
Status of grant: Completed in March 2008