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Nurses and midwives are staffed to 83 per cent and 76 per cent respectively. Overall, this translates to
a doctor to patient ratio of 1: 24,725 (target 1: 23,500), midwives: client ratio of 1: 11,000 (target 1:
9,500) and Nurse to patient ratio is 1: 18,000 (target 1: 17,000). There are other critical cadres that
are severely in short supply; such as pharmacists, anaesthetic staff, health administrators and cold
chain technicians (Ministry of Health, Uganda, 2015). In addition to a shortage of staff, the sector has
been plagued with high levels of organized absenteeism by HRH especially in the public sector as
raised by several stakeholders. Absenteeism by health workers cheats Government time of up to 40
per cent of their employment time (MoH, Uganda, 2016b). Through funding from DFID and Office of
the Prime Minister (OPM), the government acquired 52 biometric finger print-readers and 188 robust
phones. The intervention was observed to rise duty attendance from 79 per cent in January 2017 to
87 per cent in May 2018 (AHSPR, 2018).
Stakeholders argued that most of the barriers were most felt in access to maternal, neonatal, child and
adolescent health services and non-communicable diseases (NCD). The rural population, where
majority of the poor live, are particularly constrained in terms of access to health care by geographical
physical features such as rivers, mountains, poor road network and hills (Pariyo et al., 2009). The
majority of health facilities are found within urban and peri-urban areas. Furthermore, where PNFP
facilities are the closest point of health service, different faith impedes citizens from using their
services. Additionally, concerns around quality, health worker attitudes and inadequate physical
infrastructure of most health facilities for persons with disabilities pose challenges to demand. Those
who can afford it (upper and middle-income earners), then purchase private insurance from
employers or use out of pocket expenditures to pay for private health services.
A recent health facility survey revealed that the unavailability of medicines (23 per cent), long waiting
times (13 per cent), long distance (12 per cent), limited range of services (14 per cent) and
understaffing (10 per cent) were the main reasons for people to avoid health public facilities. Private
facilities were mainly avoided due to the associated costs (39 per cent) and a limited range of services
(23 per cent) (UBOS, 2016).
With respect to financial affordability, a review of government allocation to the health sector as a
percentage of the total budget, indicates a downward trend in funding that currently stands at 6.9 per
cent for FY 2017/18 from 8.9 per cent 2016/2017. Health expenditure per capita stands at 15 per cent
government, 42 per cent donors and 43 per cent OOP (MoH, Uganda, 2016a) (see an overview on
health spending between 2000 and 2016 i below). Feedback from stakeholders identified
this as a problem as indicated below. As far as delivery and financing of the UNMHCP is concerned,
government provides $8 per capita instead of the initial costed $28 per capita. WHO recommends a
per capita funding for UHC to be $34. It is such funding gaps that have contribute to high out of pocket
expenditure for the population even at government health facilities. The private wings of hospitals,
PNFPs and Private Health Providers (PHP) are financed through user fees. The dependency on user
fees as the main mechanism of financing for private sector has created equity gaps with the poor
unlikely to afford the services (GoU, 2010). The poor in Uganda then rely on savings and help from
family and friends to mitigate the impact of health shocks.