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The UNMHCP is delivered by public, private-not-for-profit (PNFP), and private-for-profit health
providers, and traditional/ complementary medicine practitioners (TCMP). Facility-based PNFPs are
predominantly faith-based and have a large infrastructure base comprising of a network of hospitals
and lower level health facilities administered by the religious bureaus at the national levels in
partnership with local diocesan boards. About 75 per cent of PNFP facilities are administered by four
faith-based medical bureaus while the rest under humanitarian and community - based health care
organizations.
Private for Profit (PFP) health providers encompass all cadres of health professionals who provide
health services outside the PNFP establishment. The PHP have a large urban and peri-urban presence
and provide a wide range of services mainly in primary and secondary care. They are managed
privately but are licenced and supervised by regulatory boards and councils. (GoU, 2010). A significant
proportion of the population often seeks health services from traditional medical practitioners in
addition to or instead of the modern sector of health service system. Examples of these include
herbalists, traditional birth attendants, traditional bone setters, hydro therapists, traditional dentists
among others (MoH, Uganda, n.d.).
Majority of both rural and urban populations seek services in the private clinics and drug shops or self-
medicate at home. These sources of care attract out of pocket payments on the part of the households
and are a reflection of inadequate coverage and or quality of the curative services delivered through
the public and PNFP sectors. Failure to align the resources to a feasible range of interventions and to
target them where they are needed most makes it impossible to buy a $28 package for every Ugandan
with a purse of $8 per capita (Ssengooba, 2004). Given the inadequacy of the resources to shoulder the
UNMHCP as designed on the HSSP, there is re-prioritization with an explicit and implicit rationing
process within the package of services and across population coverage. It is this re-prioritization that
in part works against quality, equity and utility of benefit to the users.
The Ministry of Health has been designing a National Health Insurance Scheme (NHIS) to ensure that
adequate funds are raised for residents to use health care services and remain protected from financial
catastrophe or hardships. The design was informed by national stakeholder consultations as well as
visits to other countries to study health insurance systems, and studies with the P4H Alliance, the
World Bank, African Development Bank, ILO and WHO amongst others (Basaza et al., 2013). However,
according to the stakeholder interviews, political support is low for this strategy, and few Ugandans
are in formal employment to be tracked down and/or being able to afford a contribution to such
scheme. Whilst different ministries are working on plans for the financial implementation in order to
proceed with the proposed National Health Insurance Bill from 2012, there are worries that there
might be a significant lag if the integration of informally employed and indigent persons is contingent
upon the scheme’s sustainability/ profitability (ISER, Uganda, 2015).
Access to health services by Uganda’s poor
Access to health services by the poor is plagued by a number of challenges related to infrastructure,
human resources and financial affordability. Although 72 per cent of Uganda’s population lives within
5 kilometres of a health facility, even where health facilities exist, access to basic health care elements
is far from optimal. The health infrastructure remains out-dated, old and dilapidated at all levels
(Ministry of Health, Uganda, 2015). Functionality of some health facilities particularly Health Centre
IVs remains inadequate (National Planning Authority, 2015). Public health facilities are plagued with
a frequent and at times chronic stock out of essential medicines and supplies. Intensive and critical
care services are only available at 37.5 per cent of the hospitals. 13.4 per cent of health facilities carry
out scheduled maintenance of medical equipment (Ministry of Health-Uganda, 2014).
Furthermore, the number of health workers per 1,000 population in Uganda is still far below the WHO
guidelines. In 2017/18 FY, the doctors, nurses and midwife’s ratio per 1,000 population was only 0.4.