Uganda’s minimum health care package: rationing within the minimum?

The concept of a minimum health care package (MHCP) has been used as a means of setting priorities for national health budgets. The aim is to identify a set of health services to which the government can afford to provide free access; this is intended to assist with resource allocation in the face of a huge and growing health burden and small public budgets.

This paper examines the MHCP written into Uganda’s health sector plan in order to assess the problems in evaluating costs and effectiveness of health care interventions as well as in the planning and delivery of services. It draws on secondary sources including a national household survey from 2002/03.

It argues that:

• the application of cost-effectiveness techniques seems not to have had an effect on priority setting in the MHCP
• fulfilling the health system’s aim of providing universal access to the MHCP would cost $28 per capita, whereas only $8 per capita is currently available
• as a consequence of this funding shortage, implicit rationing has occurred in the provision of the MHCP; urban populations have been more able to benefit than those living in rural areas who face significant costs in travelling to hospital
• wealthier groups have also been more able to access higher quality services within the MHCP
• only about 30 per cent of the population actually use the public health system; the remainder use private clinics and drug shops
• poor targeting of the package to poor and vulnerable means that the groups most able to benefit are not the main beneficiaries of the interventions
• data on the costs and effectiveness of the interventions in the Ugandan context have been lacking.

The paper recommends that:

• in order to meet its aim of contributing to poverty eradication, the health sector needs to refine the service package that it offers so that it is in accordance with the system’s capacity for financing and its human and technological resources
• an explicit and vigorously pursued policy of targeting is required, including reducing access costs to services for the rural population; this would entail a community-based approach to planning and financing in order to identify workable strategies for particular localities
• a significant increase in financial and other resources will be required to provide the minimum package given its current scope; the increase will have to be even greater if the aim is to provide universal access.