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collaboration with Makerere University – Monitoring and Evaluation Technical Support (METS)
Program.
According to the Department of Health Information at Uganda’s Ministry of Health, a number of
information systems are pilots by donors & implementing partners that will need to be streamlined
and strengthened. Examples of partners with such systems that improve access are UNICEF that is
piloting the family connect platform for RMNCAH, BRAC andWorld Vision. The Government continues
to maintain a strong stewardship over this development area, to ensure the emerging e-health
architecture is aligned to the pillars of e-health house of value and are contributing to the National
Health Record Program (Ministry of Health, Uganda, 2015). There are isolated mobile applications
developed by local innovators which have not yet gone to the market. Many of the existing e-health
services are development partner projects and have tended to be proof of concept pilots awaiting
formative evaluation to inform buy in and scale up by the Government (MoH, Uganda, 2013). At the
moment, the projects fail due to sustainability in terms of supporting infrastructure such as affordable
and reliable power, connectivity, maintenance and hosting options (MoH, Uganda, 2016c).
Summary and Conclusions
Uganda’s difficulties to ensure access to health care is evident by its performance in health-related
MDGs, as Under- 5 mortality rate was the only goal that was achieved. Over the years, the country has
initiated a number of health system reforms and initiatives. While the Ministry of Health is the primary
steward, both public and private healthcare providers (public–private partnership) are working
together under the governance of local governments at district level with a goal to cover all households
within a 5km radius of a health facility. The relevant health policies have been designed in accordance
with global health development agenda of ensuring healthy lives and promotion of well-being for all;
i.e. the health financing strategy to guide resource mobilization using a multisectoral approach. Two
of the most important reforms to include the poor are health insurance schemes and Results Based
Financing (RBF) mechanism for sector effectiveness. Healthcare actors like NGOs, International
Organizations and other development partners have envisioned universal health coverage and has
made considerable progress in the control of infectious diseases like HIV, TB, and Malaria. However,
there is little interest in controlling NCD.
The physical access to healthcare is suffering from the lack of trained health professionals. The number
of health workers per 1,000 population is currently of 1.5 which is below the WHO threshold of 2.5
medical staff (Doctors, nurses, and midwives) per 1,000 population. The functionality of the integrated
human resource information system (iHRIS) is still low due to inability of various institutions to
update data in the system regularly and low use of HRIS data for decision making at district level. As a
result, there is high level of absenteeism of the healthcare providers, especially in the public sector.
There is evidence of chronic stock out of essential medicines and supplies, unavailability of intensive
and critical care services, lack of scheduled maintenance of medical equipment. There is high
concentration of health facilities around urban and peri-urban areas. Furthermore, there is low
acceptability and utilization of available services due to perceived quality and faith of the people.
Access to healthcare by the poor in Uganda is also affected by the high out of pocket (OOP) expenditure.
Health expenditure per capita stands at 15% financed by the government, 42% financed by donors
and 43% financed by OOP. 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% for FY 2017/18
from 8.9% 2016/2017. As far as delivery and financing of the UNMHCP is concerned, government
provides $8 per capita instead of the initial costed $28 per capita. Observation and discussion with
relevant stakeholders suggest that the poor in Uganda rely on savings and help from family and friends
to mitigate the impact of shocks.
Uganda is also one of the countries who are considering technology for health. eHealth has become a
stronger area of focus and there is a completed national eHealth technology framework and a draft
eHealth strategy in the country. At National level, the country was able to transition to Health