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service providers in public health facilities with majority of staffs being located in mainly urban and
peri-urban areas (GoU, 2016). Above the districts hospitals, Uganda has 12 Regional Referral Hospitals
(RRH) each serving 2,000,000 people, and two National Referral Hospitals which provide tertiary
services to all 44 million Ugandans.
The functioning of the health sector at the various levels is guided by clearly set policies. In line with
the African Union adopted the Common African Position (CAP) on the Post-2015 development agenda
on January 31st, 2014, the key national health sectors policies and plans are designed to align with the
current global health development agenda of ensuring healthy lives and promotion of well-being for
all. Uganda’s focus for the Post 2015 agenda is therefore to achieve universal and equitable access to
quality health care. Priorities identified include:
1. Improved maternal, new born and child health,
2. Enhanced access to sexual and reproductive health and rights including family planning,
3. Special focus on vulnerable groups including children, the youth, the unemployed, the elderly
and people with disabilities,
4. Reduced incidence of communicable diseases (HIV/AIDS, Malaria, and TB), including mental
health and emerging diseases,
5. Strengthened health systems including health financing,
6. Improved hygiene and sanitation, and
7. Improved Monitoring and evaluation and quality assurance systems.
In order to ensure implementation of sector priorities, Uganda has developed a health financing
strategy to guide resource mobilization using a multisectoral approach. There has not been enough
progress made to pool resources through health insurance schemes. Sector effectiveness however, is
being tracked using the Results Based Financing (RBF) mechanism. There’s increased effort to
embrace civil society, to increase accountability for invested resources (MoH, Uganda, 2016a). The
central Government has established and funds semi-autonomous institutions to deliver specific public
health services, such as the Uganda Heart Institute, Uganda Virus Research Institute, Uganda Cancer
Institute, and Uganda National Health Research Organization. Other national level institutions are
National Drug Authority, National Medical Stores, National Blood Transfusion Services,
Chemotherapeutic Research Institute, Central Public Health Laboratories, National and Regional
Referral hospitals (National Planning Authority, 2015).
Development partners, such as USAID, SIDA, PEPFAR, GAVI, Global Fund, African Development Bank
and WHO, provide budget support to the national rollout policies and NGOs to reach the lowest strata
of the population with free or subsidized services. They also support streamlining of the health sector
response in accelerating Universal Health Coverage. However, a number of concerns were raised in
stakeholder interviews interviewed regarding (a) the sustainability of interventions funded by
development partners; (b) a lack of agreement over health priorities, e.g. donors like PEPFAR and
Global Fund have interest in the control of infectious diseases like HIV, TB, and Malaria; however,
interest in controlling NCDs is limited; (c) limited support for health physical infrastructure from
donors; (d) lack of ICT development leads to barriers to improving access to health services by the
poor; and (e) lack of reach of in the most under- privileged areas by NGOs.
Pro-poor approaches for better access to health services
As part of the health sector reforms of the 1990s, Uganda identified and defined an Essential Health
Benefits package called the Uganda National Minimum Health Care Package (UNMHCP), designed to
address its key health priority areas (Ssengooba, 2004). The overriding aim is for the state to guarantee
free access to a set of health services it can’t afford and to assist in resource allocation in the health
sector in the face of a huge and growing health burden that has to be addressed with small public
health budgets.