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The health minister, Dr Jane Ruth Aceng has called for domestic financing for health, considering that partner resources will continue to dwindle.

“There is no sustainability in partner funding. As such, we need to generate more resources for health domestically, rather than looking at partner financing.”

Aceng further notes that the Government is already operating in a constrained fiscal context, hence the need to identify innovative ways to fund the sector.

Richard Kabagambe, the commissioner, budget and health financing, agrees, saying external funding comes with conditions.

“They bring money and allocate it for certain interventions which may not fit our conditions, and they can withdraw any time,” Kabagambe notes.

Dr Aceng says the issue of domestic financing for health is timely as the country moves into the National Development Plan (NDP) IV era, leading us to the goal agenda of 2030 of the sustainable development goal.

Unlike any other previous plans, NDP IV will prioritise reforms for financing and domestic resource mobilisation to improve the financing of government programmes. She explains that financing for health is an investment element for social and economic development in Uganda.

“We, therefore, need our own domestic financing and we should look at health as an investment and not just social service,” she says, and further adds that the health sector has a strong bearing on our Universal Health Coverage (UHC) aspirations.

Progress made

That said, Uganda has made commendable progress in health financing. For instance, the current health expenditure for the financial year 2018/19 to 2020 /2021, the out-of-pocket expenditure reduced from 41% to 27.4%, which is still unacceptably high.

The Government’s domestic resources increased from 17% to 21.7% while external financing increased from 41% to 50.3% in the financial year 2021. The disparity in the figures clearly shows that the health system is heavily dependent on resources from external donors, which is not commendable for sustainable purposes, Dr Aceng says.

The Government’s budget for health as a percentage of the national budget in Uganda has progressively increased from 5.9% in financial year 2019/2020 to 7.7% in 2022/23 in line with the Growth Domestic Product(GDP).

However, this is still far below the commitment of the Abuja target of 15%. Dr Charles Ayume, the chairperson parliamentary committee says the growth in the health budget is not matching the rising healthcare demands, high costs due to rapid population growth, the ever-increasing disease burden and the transition from communicable to non-communicable diseases such as cancers which is a big chapter and has to get funded.

Domestic financing for health options

Dr Aceng says the health ministry will engage the Ministry of Finance, given that there are many openings for health to get more money.

For instance, funding can be got through targeted tax that ring-fences SIN tax imposed on alcohol and cigarettes or any of the causes of non-communicable diseases.

“Can we have a small percentage of that money go to the Uganda Cancer or Heart Institute to take care of those patients who develop diseases such as liver or lung cancer as a result of excessive alcohol consumption or smoking cigarettes,” she asks.

Ayume says increasing domestic financing for health requires strengthening the public financial management system for governance transparency and accountability using the little resources available.

However, it calls for frugality in terms of accountability to fight corruption which is endemic in this country, avoiding wastage, conducting monitoring and evaluation, and ensuring value for money across the board, right from the centre to the local governments while improving efficiency, he notes.