Document Abstract
Published:
1 Jun 2009
Financing for HIV, AIDS, TB and malaria in Uganda: An equity analysis
The impact of global health initiatives on equity in financing Uganda's health sector
Global health initiatives (GHIs) are an emerging and global trend in health that focus on partnerships. The introduction of GHIs in Uganda has had significant impacts on the overall financing of the health system, though there has been no assessment of their impact on equity in health sector financing in Uganda. This report, published by the Regional Network for Equity in Health in East and Southern Africa (EQUINET), explores and presents the current patterns of AIDS, TB and Malaria financing within the health sector, and investigates the extent to which GHI financing for the three diseases has influenced heath care financing reforms.
The authors find that routing GHI resources in project mode does not allow for effective co-ordination and harmonisation, and not all GHI resources are aligned to sector priorities. As such, they conclude that this is likely to promote gender and geographic inequities, considering that project funds and some GHI funds are usually spent on selected geographic areas, the selection of which might not be always based on equity considerations.
Additionally, the report finds that although each GHI creates a relatively large risk pool, there is limited integration between the different GHIs. This lack of integration is likely to lead to inefficiencies, such as overlaps in funding from different donors for certain areas or interventions. In the case of the US Presidential Emergency Plan for AIDS Relief (PEPFAR), the authors conclude that the predetermined allocation of resources without Uganda's input or without considering specific country needs may enhance the unequal allocation between the different types of interventions, as well as geographical inequities.
The authors recommend that the Ministry of Health should redouble its efforts to improve co-ordination and harmonisation of all development aid, including support from GHIs through design of mechanisms that will help integrate GHIs resources to allow for greater cross-subsidy and to reduce overlaps and inefficiencies. Finally, the authors recommend monitoring of equity in the health sector by the Ministry of Health, including health financing equity, equity in access to care, geographical equity and gender equity.
[adapted from author]
The authors find that routing GHI resources in project mode does not allow for effective co-ordination and harmonisation, and not all GHI resources are aligned to sector priorities. As such, they conclude that this is likely to promote gender and geographic inequities, considering that project funds and some GHI funds are usually spent on selected geographic areas, the selection of which might not be always based on equity considerations.
Additionally, the report finds that although each GHI creates a relatively large risk pool, there is limited integration between the different GHIs. This lack of integration is likely to lead to inefficiencies, such as overlaps in funding from different donors for certain areas or interventions. In the case of the US Presidential Emergency Plan for AIDS Relief (PEPFAR), the authors conclude that the predetermined allocation of resources without Uganda's input or without considering specific country needs may enhance the unequal allocation between the different types of interventions, as well as geographical inequities.
The authors recommend that the Ministry of Health should redouble its efforts to improve co-ordination and harmonisation of all development aid, including support from GHIs through design of mechanisms that will help integrate GHIs resources to allow for greater cross-subsidy and to reduce overlaps and inefficiencies. Finally, the authors recommend monitoring of equity in the health sector by the Ministry of Health, including health financing equity, equity in access to care, geographical equity and gender equity.
[adapted from author]
