Health Care Delivery System in Uganda: a review

Abstract

This paper provides insights into Uganda’s health care delivery system and highlights its strengths, weaknesses, opportunities, and threats. Uganda’s health care system consists of both public and private health care providers. Uganda has around 6,940 health facilities, of which 45% are government-owned, 15% are private not-for-profit, and 40% are private for profit. In 2019, the health worker population ratio was 1.87 per 1,000 population, which is still lower than the WHO ratio of 2.5 per 1,000 population. The total health expenditure was UGX 5,309 billion, equivalent to US$ 1.8 billion. Public spending remains very low accounting for only 15% of total health expenditure. In the 2020/21 budget, the health sector was allocated UGX 2.7 trillion, equivalent to 6% of the total government budget. The total per capita health expenditure was estimated at US$ 51 for the financial year 2015/16, which is still low compared to the WHO recommended minimum level of US$84.

The SWOT analysis shows that Uganda’s health delivery system boasts of having clear policies and plans, provision of free health care in public facilities and the existence of active international health agencies and Non-governmental organisations. However, the system is still fragmented with a very poor referral system, high out-of-pocket expenditure, low public spending, and inequitable distribution of health facilities across the country. Although considerable progress has been made in achieving health-related targets, several issues still require attention. There is need for a comprehensive redefinition of the health service delivery system, enhanced investment in health infrastructure with a focus on reducing inequalities; and establishment of a national health insurance scheme.