Browsing by Author "Yates, Rob"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Health Sector Reforms and Increasing Access to Health Services by the Poor: What Role Has the Abolition of User Fees Played In Uganda?
    (London School of Hygiene & Tropical Medicine, 2006) Tashobya, Christine Kirunga; McPake, Barbara; Nabyonga, Juliet; Yates, Rob
    User fees were introduced in Uganda in the late 1980s against a background of poorly funded health systems and strong international support for the role of user fees in encouraging community participation and ownership, and for their value in generating revenue. By the late 1990s, there were conflicting opinions about the effect of user fees on access to health services, particularly by the poor and other vulnerable groups, in Uganda and other developing countries. In March 2001, user fees were abolished in all public health units in Uganda except for private wings in hospitals. Abolition of user fees is only one of a number of reforms introduced in the health sector in Uganda since the turn of the century. To assess the impact that this policy change has had on the health sector, this chapter draws on evidence from a number of different sources including data from the Ministry of Health, the World Health Organisation, Participatory Poverty Assessment Reports and the Uganda National Household Surveys. The data point to a significant and immediate increase in utilisation of health services following the abolition of user fees, in particular by the poor. We conclude that user fees may be a bigger barrier to health service access for the poor than was previously envisaged in developing countries. Furthermore, in order to achieve sustained improvements in health service utilisation, the policy of abolition of fees should be implemented simultaneously with supply side reforms.
  • Thumbnail Image
    Item
    The Ugandan Health Systems Reforms: miracle or mirage?
    (2006) Yates, Rob; Tashobya, Christine Kirunga; Ssengooba, Freddie; Murindwa, Grace; Lochoro, Peter; Bataringaya, Juliet; Nazerali, Hanif; Omaswa, Francis
    Poor health indicators in the 1990s prompted the Government of Uganda and development partners to embark, at the turn of the century, on an extensive programme of health systems reforms to improve sector performance. With only a modest increase in resources, these reforms have resulted in large increases in outputs for ambulatory services. Out-patient attendances and immunisation rates have doubled. Furthermore, the growth in consumption of these services appears to be highest for the poorest socio-economic groups. However, statistics for key in-patient services, most noticeably maternity services, remain virtually unchanged. This chapter attempts to assess the significance of these changes. Is it a miracle of improved efficiency or a mirage unlikely to lead to improved health outcomes? We try to identify the key reforms within health and across government, which may be responsible for the changes in output performance. A number of supply side reforms that have have increased the availability of essential inputs are highlighted. In addition, a major demand side policy (abolishing user fees) had a significant impact on the consumption of services. We conclude that increased utilisation of ambulatory services does signify improvements in consumer welfare and therefore health sector performance. However, stagnant maternity outputs indicate that key in-patient services are still not meeting the expectations of the population. Only reliable outcome data will resolve the debate about the significance of the changes in output indicators. Further research will also be required to disentangle the relative impact of the different components of the reforms.