Universal Health Coverage in Uganda: The Critical Health Infrastructure, Healthcare Coverage and Equity

Abstract

Universal Health Coverage (UHC) has gained popularity within the global health policy and academic circles as countries strive to meet the UHC target established under the Sustainable Development Goal agenda. To accomplish this goal, developing countries such as Rwanda, Ghana and others have pursued bold policy initiatives including the introduction of health insurance schemes. In addition to financing, presence of critical health infrastructure and Human Resources for Health (HRH) are crucial to achieving UHC. Using administrative data from IntraHealth Uganda Country Programme (as well as document review) and the Demographic & Health Survey data, this paper analysed Uganda’s critical health infrastructure (including HRH) needed to attain sustained progress towards UHC. It also reviewed UHC progress and analysed equity by computing Composite Coverage Index (CCI) and Coverage Gap Scores. Results show fundamental challenges with the health infrastructure needed to deliver UHC in Uganda. Spatial inequality exists in health facility population coverage and private sector health infrastructure investments. Low health workforce density imply that the existing health workforce is deficient and unable to expand populationbased healthcare services. Progress towards UHC [considering reproductive, maternal, new-born, and child health (RMCH) interventions] has improved marginally over the reviewed period, although the CCI remained low, and regional and socio-economic disparities in coverage remained. Findings also demonstrate that improved healthcare coverage corresponds to better health outcomes. Accelerating progress towards UHC require; increased investments in health infrastructure and strengthening Public Private Partnership arrangements to establish health infrastructure in disadvantaged regions; and improvement in health workforce density by reviewing current staffing norms for critical cadres as well as increased deliberate investments in HRH using similar initiatives like the HRH programme model of Rwanda. To scale up healthcare coverage for RMCH, interventions should aim to maintain successes obtained for immunization and address existing gaps in lagging intervention areas. These objectives can only be achieved if the country institutes and effectively implements a coherent set of health sector policy reforms, regarding health financing, for instance, while drawing lessons from the successful policy efforts observed in the Rwandan case scenario.