Who Benefits from Health Care Services in Uganda? Sector-Wide Benefit Incidence Analysis for Uganda (2005/6 and 2009/10)
Posted: 20 Jun 2013
Date Written: December 18, 2012
Background: A health system with universal access system is defined as system where access to health care is according to need rather than ability to pay. While many health systems desire to attain universal access, there is not enough evidence showing progress towards universal access. This report accesses the distribution of benefits of health service utilisation according to socio-economic status and according to need in Uganda’s health system. This benefit incidence analysis includes both the private and public sector health service providers.
Methods: Data from the 2005/6 and 2008/9 Uganda household expenditure surveys were used for analysis. The data contained health care utilisation by individuals within households for the different levels of care that include Hospitals and Health Centres that are comprised of Health Centre IV, III and HC II. Individuals within households were grouped into socio-economic quintiles based on reported annual expenditures. In order to assess the distribution of health service utilisation and benefits, we considered public hospitals and private facilities. We obtained the utilisation rates of these services and multiplied them by the unit cost of providing them at each level to obtain the monetary benefits. The distribution of these benefits was assessed across the five quintiles (poorest to richest) by comparing the proportion of benefits enjoyed by each quintile. Such distribution is pro-poor (pro-rich) when the poor (rich) are benefiting more than the non-poor (poor).
Findings: The results show that health care benefits from hospitals in both in public and non-government (private not for profit facilities) are pro-rich implying that they benefit mainly the rich socio-economic groups. Similarly, private clinics were found to be pro-rich. On the other hand, lower health units particularly in the public sector were found to benefit mainly the poor households. Services of community health workers, drug shops/pharmacies and use of traditional healers were mainly used by the poor. Comparison of benefits and need shows that the poor got smaller share of benefits compared to their need while the rich had a much higher share of benefits compared to their need. The pattern of results is similar across both 2005/6 and 2009/10 although the distribution of benefits is shown to be more pro-rich in 2009/10.
Conclusions: BIA results show that health care service utilisation in Uganda is inequitable. Clearly benefits are not proportionately distributed according to need. These results indicate a need for improved resource allocation, as well as a need for health financing reforms that would enhance increased utilisation of public and private health facilities by the low-income groups of the population. Further, improved access to quality health services is needed at the lower level public health facilities that are largely utilised by the poor. While doing this, there is a need for emphasis on improving and strengthening primary health care.
Keywords: BIA, Uganda
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