Demand for health care services in Uganda: implications for poverty reduction

Health is a fundamental dimension of well-being and a key component of human capital development. Previous studies have shown that ill health is a major cause and consequence of poverty. There is also evidence showing that poor people utilise health facilities less, and their utilisation patterns indicate a preference for more expensive private health facilities. This paper investigates if the poor and other socially vulnerable groups are being reached and what factors are affecting their demand for health services. Using national household survey data, the study provides evidence on the importance of individual, household and community characteristics on individuals’ health care seeking decisions.

The paper begins by discussing the trends in health care utilisation in Uganda between 1992/1993 and 2002/2003. The authors find evidence of increased report of illness and seeking of health care in this timeframe as well as a rise in the availability of health facilities. There is also a broad overview of the health sector in Uganda including funding, reforms and health care. In the next section the methodology is presented which begins with a review of the related literature followed by model specification and estimation issues. Finally, the authors analyse the factors that influence individual’s decisions to seek health care. They find that:

• the cost of care is regressive and substantially reduces the health care utilisation by poorer individuals
• education is associated with a higher probability of seeking care, though the effect is only significant for post secondary education – there is also increasing demand for private health care with more education
• demand for care rises significantly with increasing proportion of qualified medical staff
• the probability of seeking care from any formal provider decreases with the increase in distance to that provider – this is because distance is highly related to travel costs

The paper makes the following policy recommendations:

• investing more in education to increase the probability of seeking formal care
• health reforms should not sideline the role of the private sector
• efforts should be made to increase the demand for health services
• strategies aimed at increasing the incomes of the poor should be put in place and those already in place should be strengthened
• public health authorities need to increase information and health education concerning self medication
• increase the supply of qualified health staff