The poverty reduction strategy papers (PRSP) and resource allocation to the health sector in Uganda

This report reviews the effects of the poverty reduction strategy paper (PRSP) prepared in Uganda in 1997 on investment in the health sector, drawing on other studies and interviews with government representatives, civil society organisations, and donors.

It finds that:

• improvements in the health arena since 1999 have included a reduction in HIV prevalence; increased coverage of health facilities; and progress in malaria, TB, guinea worm and measles
• the abolition of user fees in 2001 contributed to a large increase in service utilisation from 41 per cent in 1999 to 84 per cent in 2002
• however, infant, child, and maternal mortality rates have stagnated; the number of assisted deliveries has declined; and service quality is poor, due to lack of qualified staff and shortage of drugs, especially in remote areas
• Uganda's health budget has increased since 2001, but total per capita expenditure on health remained low at around USD 15
• the Ugandan PRSP recognises health as key to poverty reduction and focuses on the development of basic health services and disease control programmes; but neither the analysis nor the strategies presented for the health component of the PRSP is consistently poverty focussed
• the PRSP does not mention indicators to monitor short-term progress in implementation or indicators of the health impact of reforms in other policy areas, such as employment
• IMF-imposed targets designed to control inflation and reduce the fiscal deficit have placed a ceiling on government expenditures in ‘non-productive’ sectors such as health
• the financial requirements for implementation of the country’s health sector plans have not been met, and consequently Uganda will not be able to meet Millennium Development Goals on health targets and human rights obligations.

The report argues that macroeconomic reasons for restricting further increases in health spending are over-exaggerated and that the government should realise that a healthy population is needed in order to meet economic growth targets. Its recommendations for policymakers include that:

• the trade-offs between macroeconomic targets and investments in health and poverty reduction should be assessed and made subject to public debate as part of the PRSP review process
• programmes that support the implementation of the PRSP should be developed with the full involvement of line ministries, parliament, and civil society, and should be subject to public scrutiny
• the government should increase domestic resource mobilisation through progressive taxes, with donors stepping in to cover the remaining funding gap.