Aid effectivenessin Uganda by

Enyaku RogersACHS ( B & F)

Presentation at Fifth IHP+ Country Health Teams Meeting 2-5 December 2014, Sokha Angkor Resort,

Siem Reap, Cambodia

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Key features of health financing

• General Government Health expenditure per capita is US $ 9 excluding external financing

• Health development partners contribute about 45%: NHA report for FY 2011/12

• On average domestic resources constitute about 53% of the CHE .

• GCHE as % of GDP is 1.38%, HSSIP recommends minimum of 4%,

• GGHE as % of TGE is at an average of 9% for the last three years

• Free access Health services in public facilities

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Structure of Aid in the Health Sector

• In Uganda, on-budget aid is defined as aid that is included in the Medium Term Expenditure Framework (MTEF).

• General and sector budget-Targeted-support are always classified as on-budget.

• General Budget support is aid that is not attached to particular projects, but it is usually accompanied by conditions for policies and/or governance

• Earmarked/Targeted aid resources, or project aid, may be on-budget or off -budget.

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Categories of General Budget Support

• MFPED registers four categories of General Budget Support (GBS):

• grants,• loans, • debt relief and• grants for the Poverty Action Fund (PAF

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Off Budget Support

• Off budget aid includes donor resources channeled to the government but also resources transferred to the private for profit or not for profit sector.– support to the war zone in North Uganda. USAID – Programme Funding-PEPFAR and PMI (the

President’s Malaria

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Trends in Targeted Funding to the Health Sector

• In 1999, the Government of Uganda and a large group of donors agreed on a Sector Wide Approach (SWAp) in support of HSSP 1. User charges for government health care facilities were abolished in

2001.

• the years 2005/06 to 2009/10. HSSP 1 brought an increased focus on primary health care (PHC) through a reallocation of resources towards districts, and via the districts to lower level health

units.

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Trends in Targeted Funding Cont’d

• there has been substantial increase in project funding for health from around 2003-4 onward, largely as a result of the global health funds and

other vertical funds for health.

• large part of this funding is off budget• Declined 2007 due to suspension of GAVI &

Challenges with GFATM

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Government allocation to health sector 2004/5-2013/14

.

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Table: Government allocation to the Health Sector 2004/05 to 2013/14

Year GoU Funding(Ushs bns)

Donor Projects and GHIs (Ushs bns)

Total (Ushs bns)

Per capita public health allocation (UGX)

Per capita public health allocation(US $)

GoU health allocation as % of total government allocation

2004/05 219.56 146.74 366.30 13,843 8.0 9.7 2005/06 229.86 268.38 498.24 26,935 14.8 8.9 2006/07 242.63 139.23 381.86 13,518 7.8 9.3 2007/08 277.36 141.12 418.48 14,275 8.4 9.0 2008/09 375.46 253.00 628.46 20,810 10.4 8.3 2009/10 435.8 301.8 737.6 24,423 11.1 9.6 2010/11 569.56 90.44 660 20,765 9.4 8.9 2011/12 593.02 206.10 799.11 25,142 10.29 8.3 2012/13 630.77 221.43 852.2 23,756 9 7.8 2013/14 710.82 416.67 1127.48 32,214 12 8.7 N.B. The per capita public allocation increased majorly due to financing by GAVI and Global Fund.

Health Sector Financing 2004/5-2014/15

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Positive Effects of Targeted Aid in the Health sector

• Increased funding to the Sector• Focus on primary health care (PHC) through a

reallocation of resources towards districts• More harmonized approach to Planning &

Monitoring in HSSP 1 thru; SWAP -Partnership Instruments: HPAC, JAF. IHP+

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Positive Effects of Targeted Aid in the Health sector

• Thru the use of the Joint Budget Support Frame work the following was put to practice:Use by DPs of Data by provided by GOU as highlighted

by the Paris declaration of 2005Emphasis on removal of barriers on Public Finance

managementUse of the Sector Results matrixInclusion of Donor Performance in the Assessment

• More Disease specific Interventions;– HIV, Malaria, Tb..?

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Increase of Health Facilities 2004-2011 that reduced length to nearest facility

Level 2004 2011

Hospital 55 65

HC IV 151 166

HC III 718 868

HC II 1055 1662

Total 1979 2761

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Negative Effects of Targeted Aid in the Health sector

• Unpredictability of the aid• Less than appropriate input mix• In accordance with a study commissioned by

ACCORDAIDI in 2011:– In 2006/07, 74% of all donor funding to the health

sector was

• channeled to the private sector in health a bulk of which procured non-HSSP inputs

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Expenditure on Donor Project Aid by Input 2004/5-2006/7

Input 2004/5 (%)

2005/6(%)

2006/7(%)

Average(%)

Human Resource

4 5 7 5

Training 0 14 24 13

Drugs 20 58 10 29

Other Recurrent

7 2 20 10

Capital non Infrastructure

4 7 1 4

Infra structure

9 4 5 6

Non HSSP Inputs

58 9 31 3314

Effects of the Health Sector Financing

• On average an estimated 37% of the disease based expenditure is spent on HIV/AIDS ,20% Malaria and only 14% on reproductive Health.

• Only 16 % of the CHE was spent on prevention according to the NHA latest report

• About 66% of the CHE is spent on infectious and parasitic diseases and only 4.3% on average is spent on non communicable diseases

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Total Funding by commodity area 2010 - 2013

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Percentage of total funding by commodity area in 2012/13

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Other Challenges to Maximizing Benefits from Targeted Aid to Health

• Institutional Capacity• Aligning Donor practices• Reducing GOU stewardship• Accountability• Overload of Senior Management• Movement of senior staff to Donor

organizations• Epidemics (Ebola, Murberg)

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Other Challenges to Maximizing Benefits from Targeted Aid to Health

• Donors by passing LTIA arrangements e.g HSBWG and funding departments and Local Governments

• Direct targeting of Depts and LGs reduces adherence to one M & E system

• More emphasis on outputs than outcomes• More emphasis on curative vis avis prevention• Weak inter sectoral collaboration

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Government Efforts to Minimize Challenges

• Revise the Health Financing Strategy including:– Harnessing complementary financing schemes

• More emphasis on Prevention thru revision of VHT strategy

• Requirement by Donors to seek permission from MoH before going to LGs

• Strengthening Accountability Measures• Improve resource tracking of off & on budget

funds to ensure alignment and harmonization

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THANK YOU

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