Uganda
25-26 Oct 2011 - Joint Annual Review and Roadmap for the Health Financing Strategy
25-26 Oct 2011: The Joint Review Mission (JRM) was held on 25 – 26 October, and focused on trends in health financing, as well as the challenges of funding key aspects of service delivery. Notable topics of discussion were: - the wage bill; incentives for health workers; increasing the non-wage recurrent allocation to districts; ensuring sustainability of programmes that are largely donor funded; efficiency in health spending; and the institutionalisation of the National Health Accounts (NHA).
After the JRM, a meeting attended by the World Health Organization (WHO), the World Bank (WB), the Ministry of Health (MoH) (present were Director of Planning, Assistant Commissioner of Planning, and colleagues from the Budget and Finance division and Planning division) discussed a road map to finalise the health financing strategy and support requested from P4H. This road map will be drawn up under the overall leadership of the Director Planning and Development and will include:
- Putting together a team to spearhead development of the health financing strategy by 9 Nov;
- Reviewing the health financing synthesis paper developed by P4H, providing comments and finalizing the paper by 16 Nov;
- Consulting with top management using the synthesis paper by 2 Dec;
- Further refining the synthesis paper and consulting with selected stakeholders outside of the MoH;
- Drafting the health financing strategy - draft to be ready by March 2012
- Undertaking final consultations and producing a final draft by May 2010.
P4H will assist in finalisation of the synthesis paper, and support drafting of the health financing strategy, working with the health financing strategy team.
Joint Annual Review - Health Financing Synthesis Paper
October 2011: In preparation for the Joint Annual Review Meeting on 25-26 Oct, the P4H network partners jointly developed a health financing synthesis paper. The key objectives were to maintain the momentum of the health financing strategy development process, and to make connections with previous work on health financing (reviews, etc) and discussions of the National Health Insurance Scheme (NHIS) (including the National Social Security Fund’s plans) over the past two years.
National Health Insurance Scheme – progress update
April 2011: The National Health Insurance Scheme (NHIS) bill has been referred back to cabinet by the Solicitor General in view of changes introduced into the document without being endorsed by cabinet. The NHIS Task Force is in the process of preparing a cabinet paper, which will be submitted once ready. The Ministry of Health (MoH) expects to obtain cabinet approval before the end of April, but this is not certain with the new government set to come on board in May 2011. The cabinet earlier endorsed the Social Health Insurance (SHI) principles, but not the National Health Insurance (NHI) principles reflected in the revised bill. It is worth noting that the MoH may use the opportunity to engage cabinet to explain the value of the new changes and to build consensus around the main features of the scheme. This should help move forward discussions which seem to have stalled at the technical level.
Status of analytical and preparatory work. The exercise on economic analysis has been delayed considerably and without the findings the MoH cannot engage the Ministry of Finance and Economic Development (MoFPED). This matters because while there have been discussions with the private sector, there have been only limited consultations with the MoFPED. The time has come for the MoH to engage the MoFPED and the “powers that be” on the scheme and to do this it needs to know the cost implications of the proposed actions. Considering the limited capacity in the MoH to take the process forward, the P4H network has been asked to explore the possible provision of a long term technical assistance (TA) of 2 years.
Ugandan State Minister of Health at ministerial conference in Berlin
November 2010: The Ugandan Minister of State for Health, Dr. Richard Nduhuura, participated in a ministerial conference on health financing and universal coverage, as well as attending the P4H Open Forum in November 2010 in Berlin. Dr. Nduhuura expressed his appreciation for the support of P4H, stating that the initiative had ‘made a difference’; he noted in particular that the recommendations by P4H partners have reorientated the proposed insurance scheme towards social health protection.
Initiation of health financing strategy process
September/October 2010: In response to the recommendations of the Joint Review Mission (JRM), confirmed by the International Health Partnership (IHP) JANS assessment and based on the health financing review, the Ministry of Health Planning Department (MoHPD) initiated the health financing strategy process by drafting the terms of reference for a task force, including timelines for the process and a conceptual framework.
Joint assessment of the national health sector strategy
June/July 2010: One of the recommendations of the International Health Partnership (IHP) JANS assessment related to universal coverage and social health protection was to speed up the health financing strategy development process.
In depth discussion of health financing options
February 2010: The P4H network supported in-depth discussions of the health financing options and recommendations of the 2009 P4H mission report in Feb 2010 in Kampala. The team recognized the need to provide more details on the pros and cons of the different options, and to provide policy briefs using appropriate (non-technical) language for communication/interaction with a broader audience at different levels (political, general public, etc.). The in-depth discussion on alternative health financing options initiated a more strategic approach towards the revision of the proposed draft bill. The P4H team again emphasized the importance of integrating the revision of the draft bill in the broader health reform process and linking it with the social protection framework.
Health financing review
January 2010: The Ministry of Health (MoH) and World Health Organization (WHO) carried out a health financing review supported by P4H to contribute to a deeper understanding of possible health financing options and to inform the planned health financing strategy process, including the further revision of the proposed National Health Insurance Scheme (NHIS). The review will be published soon and will be discussed as part of a national consultation meeting on health financing strategy.
P4H Mission including network partners at national, regional and global level
August 2009: The P4H mission included an assessment of the proposed National Health Insurance Scheme (NHIS), in particular the part it can play in helping to achieve universal coverage and social health protection (SHP), its links to health reform and the broader social protection framework, and an assessment of the operational design issues of the proposed scheme.
As a result of the mission, the originally proposed draft bill for the NHIS is being revised, taking into consideration the objective of SHP and alternative options outlined in the P4H mission report (2009). The Government of Uganda has formed an inter-ministerial committee to discuss and further develop the NHIS, comprising the Ministry of Health (MoH), the Ministry of Public Services (MoPS), the Ministry of Finance (MoF) and the Ministry of Labour (MoL).
- The originally proposed draft bill of a National Health Insurance Scheme is being revised taking into consideration the objective of SHP and alternative options outlined in the P4H mission report (2009).
- The Government of Uganda has formed an inter-ministerial committee to discuss and further develop the NHIS. The committee comprises the Ministry of Health, the Ministry of Public Services, the Ministry of Finance and the Ministry of Labour.
Universal Coverage and Social Health Protection part of national health policy
June 2009: The concept of social health protection (SHP) and the role of the Ministry of Health (MoH) as steward in the transition towards universal health coverage have been included in the national health policy 2010-2020. Agreement has also been reached on the development of a health financing strategy as part of the sector strategy.
First contact with P4H
February 2009: Providing for Health (P4H) support has been initiated following an invitation by the Government of the Republic of Uganda to a sensitization workshop in Feb 2009 for different stakeholders including Parliament to discuss the principles of social health insurance (SHI) and to get feedback on a draft bill for a National Health Insurance Scheme (NHIS).