Universal Health Coverage in Uganda: The Critical Health Infrastructure, Healthcare Coverage and Equity
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
SPEED Initiative
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.