Have systems reforms resulted in a more efficient and equitable allocation of resources in the Uganda health sector?

One of the claims of the sector-wide approach in the health sector is that improved coordination mechanisms should lead to a better allocation of resources within the sector. In particular, it is argued that the pooling of financial resources, in order to fund a coherent sector-wide plan, should lead to improved efficiency. This chapter provides evidence to support this assertion in the case of the Ugandan health systems reforms since 2000. The increase in service uptake at primary care levels and health centres in particular shows that the shift in the allocation of resources from hospitals towards primary health care services at district level has improved the overall efficiency of the health system.

Key points:

• This increased efficiency has largely been driven by improvements in the performance of the government budget.

• This in turn led to an increase in the provision of services available for the rural population and for addressing the major causes of ill health.

• Donor projects appear to be less efficient at allocating resources to these services, so it may be appropriate that this mechanism has been overtaken by the budget as the largest contributor to sector funding.

• Increased funding for rural services also indicates a more equitable allocation of resources towards high need groups.

• The authors suggest that as the reforms have progressed, there has been an improvement in both allocative and operational efficiency, and also in equity. However, the battle has not yet been won and a number of issues still need to be addressed, in particular the overall shortage of resources for the sector.