EU funded book anticipated to revolutionarise health care in Uganda

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The book that was edited by Associate Professor Freddie Ssengooba, Suzanne N. Kiwanuka, ElizeusRutebemberwa and Elizabeth Ekirapa-Kiracho is a product of the three-year project that was funded to the tune of Euros3.1m (about sh13b).

PIC:Thomas Tiedemann, Ag- Head of Cooperation, European Union Delegation to Uganda exchange copies of books with Sarah Opendi, the state minister for Health as other officials from Makerere University looks on after the Universal health coverage book launch at Serena Hotel Kampala. (Credit: Juliet Kasirye) 
 
BOOK REVIEW
 
KAMPALA – Experts under the European Union funded SPEED project implemented by Makerere University School of Public Health have put together practical interventions that could accelerate Uganda’s dream of achieving quality and universal health care.
 
Titled, “Universal Health Coverage In Uganda: Looking Back and Forward to Speed Up the Progress,” the 454 page book gives a nuanced discussion on health care challenges and practical interventions.
 
The book that was edited by Associate Professor Freddie Ssengooba, Suzanne N. Kiwanuka, ElizeusRutebemberwa and Elizabeth Ekirapa-Kiracho is a product of the three-year project that was funded to the tune of Euros3.1m (about sh13b).
 
Discussed under five major themes; coverage reforms, governance, financing, service delivery, priority interventions, the project brings together over 30 experts from a multidisciplinary background and organisations such as the Economic Policy Research Center at Makerere University, National Planning Authority, Uganda National Health Consumers Organisation, the Human Sciences Research Council in South Africa and the Institute of Tropical Medicines in Antwerp, Belgium.
 
The specific chapters according to the book were devised from the perspective of applied policy analysis – where policy problems are analysed from vital perspectives of stakeholders, beneficiaries and systems capabilities.
 
Unlike conventional analyses, policy analysis seeks to explicate the problem within its real-life context.
 
 
“Applied policy analysis was used to clarify and frame the problems for policy actions and innovations.
 
“In this process, the authors make attempts to find actions and entry points to resolve the problems within the context of vital stakeholders, resources and institutions.
 
“This is vital to identifying the technical and political economy variables that are central to understanding the problem and identifying feasible solutions.” Reads the Foreword.
 
Coverage Reforms
 
This theme explores such topics as framing the determinants of health and well-being for universal health coverage as discussed by Associate Professor Freddie Ssengoba and Charles Hongoro, universal health coverage and social protection agenda, challenges and policy considerations for Uganda by John Sekamatte, Judith Mutabazi and AloysiousSsenyonjo and how developments at global and regional levels are influencing progress towards universal health coverage in Uganda discussed by Remco van de Pas, Aloysius Ssennyonjo and Barr Criel.
 
Universal Health Coverage(UHC) as discussed by the experts is meant to promote health care without the concept is aimed at mitigating catastrophic health expenditure by making services affordable to all and comprehensive enough to address the health care needs of individuals in the community.
 
Universal coverage evokes the principle of equity and social protection – “leaving no one behind”.
 
Health as expressed by the experts is not a one ministry objective and therefore there is need to have these mainstreamed into all social and development programming. Health in all policies is thus identified as one of the core concepts to achieve universal health coverage.
 
Governance
 
The second theme in the book explores such concepts as governance for universal health coverage in Uganda, the right to health in Uganda, decentralisation and the Uganda health system and the partnerships between public and non-public sector in strengthening UHC.
 
Under governance for universal health coverage, authors Suzanne N. Kiwanuka and FreddieSsengooba highlight that the critical governance issues as; health issues are deeply entrenched in its colonial past with a health care system based primarily on the medical model, which threatens the achievement of UHC, the inextricable influences of global reforms and agenda such as Structural Adjustment Programmes and MDGs over the past decades have caused the government’s role to be increasingly weakened and distanced from its central role in providing public goods, the existence of multiple and often more influential multilateraland national stakeholders in a liberal health market has fragmented.
 
the system, leading to a lot of duplication and wastage. Moreover, the health service delivery terrain has become progressively more marketised to the detriment of the population, especially the poor.
 
These the say are some of the issues that make governance particularly sticky but critical for Universal Health Care (UHC).
 
In responding to the above challenges, the experts propose such interventions as;
 
A deliberate shift in health policies from planning for health based on curative care to planning to promote health.
 
The ministry of health and the Office of the Prime Minister should endeavor to holistically promote health by emphasising inter-sectoral collaboration across the education, water and sanitation, road and works, agriculture and environment sectors using the health-in-all policies strategy.
 
Strengthen regulatory, accountability and enforcement mechanisms at all levels and across different players in the health sector, coordination and zoning of health development partners (HDPs) should be monitored to ensure that it does not lead to inequity inservice delivery or threaten the resilience of the system.
 
The Government should strengthen community governance systems for oversight over the health, water, sanitation and environment,education, agriculture and nutrition sectors to ensure accountabilityat population level.
 
“In order to discuss the implications of good governance for UHC in Uganda, it is necessary to reiterate that the state, as an organ “in charge” of the health system overall, needs to ensure that its policies facilitate fair approaches to providing preventive, curative, rehabilitative and palliative health services of sufficient quality to the whole population.” the experts emphasize.
 
Financing
 
Financing for health care remains one of the single most complex factors at the heart of health service delivery in the country. Currently, Uganda covers just about 15.3% of the entire health sector budget.
 
The development partners contribute 46.5% and private sources especially households and health insurance taking up the 38.4%.
 
Under the financing theme, the different authors delve into such topics as resource mobilisation in the context of moving towards universal health coverage, pooling resources and health risks for universal advancement in Uganda and purchasing health care services for universal health coverage.
 
Health financing according to the experts is about raising adequate funds for health in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. 
 
In one of the chapters under this theme, Baine and others argue that government budget allocation to health has consistently been low with the biggest percentage borne by external funding and household out-of-pocket expenditure. This they say raises sustainability, access to services, and financial catastrophe concerns.
 
To achieve UHC in Uganda, the team proposes a number of interventions;
 
Adoption of alternative financing mechanisms to increase funding for health. These may include: tax reform to incorporate alternative tax measures such as ‘sin-tax’; tapping into the informal sector resources; and promoting health insurance.
 
Improvement of efficiency gains, especially by streamlining procurement systems, monitoring and supervision, and enhancing absorptive capacity within the health sector.
 
Strengthening the resource coordination mechanisms that bring together external funds in a basket will improve planning and implementation, the alignment of funds to essential or priority national health interventions and programmes, and reduce duplication of resources and effort. In the longer term, the Government should gradually reduce dependence on external funding.
 
Establishment of a special “Health Fund” will ensure that adequate resources are available which can be tapped into to deliver on the health sector priorities. A Health Fund would be devoid of the politics involved in budget allocations.
 
Strengthening the Public Private Partnership for Health (PPPH) framework to include mechanisms to tap into private organisations’corporate social responsibility (CSR) obligations and channel theminto health.
 
Service Delivery
 
Through discussions around physical health infrastructure, health workforce development and managing health technologies to advance universal health coverage, the authors under this theme explore the tools or resources that support service delivery. This covers buildings, plants medical devices, other equipment for health facilities and IT equipment), transport and health care waste management.
 
The absence or presence of certain physical infrastructure according to the experts may sustain or impede the expansion of health services and access to health services by certain populations; it can also lead to high costs of health care.
 
For UHC to be realised, the experts argue that the public and private sectors need to be coordinated as one health care system, an effective referral system should be instituted, it should ensure that all populations are served and that services are accessible and safety nets instituted.
 
Priority interventions
 
The last theme handled in the book explores such concepts as health promotion, making family planning programs accessible for all, non-communicable diseases in low income countries, outbreak management, child survival and maternal health.
 
Health promotion as discussed in the book contributes to disease prevention, which reduces the amount of sickness in the population, thereby reducing the number of hospital visits and, presumably, lowering the costs of health care.
 
Citing examples such as the successful campaign that saw the reversal of the devastating trend of HIV epidemic in the 1990s, health promotion remains a model that needs to be considered significantly in a bid to achieve UHC.
 
The book as expressed by the State Minister for Health, Sarah Opendi during the launch held at Serena Hotel in Kampala last week will work as an important guide in policy and decision-making as the country moves to transform the health sector.

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