Over the years, Uganda has experienced significant and accelerated improvements in most reproductive, maternal, newborn, child, and adolescent health (RMNCAH) indicators. Most notable are the marked reductions in under-five and maternal mortality rates, respectively plummeting from 187 to 62 deaths per 1,000 live births, and from 780 to 360 maternal deaths per 100,000 live births between 1990 and 2015. Despite such achievements, health system challenges remain as inadequate health infrastructure, equipment, and medical supplies continue to impede on positive RMNCAH outcomes. Moreover, economic and geographic disparities persist with 43 percent of women among the poorest 20 percent delivering with a skilled birth attendant compared to 87.5 percent among the richest 20 percent.
The government of Uganda is driving the GFF process using an existing health sector coordination mechanism, working in close collaboration with a wide range of partners.
Uganda’s selection as a second wave GFF country prompted the government of Uganda to revitalize a process begun in 2013 around the development of a “Sharpened RMNCAH Plan.” This plan identifies five “strategic shifts”:
- Emphasizing evidence-based high-impact solutions, including through identifying a package of evidence-based interventions for each service delivery level;
- Increasing access for high-burden populations by promoting a set of service delivery mechanisms that operate synergistically;
- Geographical focusing/sequencing, to determine where the package of interventions will be rolled out first;
- Addressing the broader multisectoral context, with a particular focus on adolescent health;
- Ensuring mutual accountability for RMNCAH outcomes, including through strengthening data systems (including civil registration and vital statistics).
The Sharpened Plan describes each of these “strategic shifts” in detail, including the health systems strengthening and capacity building required to deliver the Plan successfully. For example, the Sharpened Plan emphasizes strengthening district health management and scaling-up community-based health service delivery, while building capacity through health skills hubs. Additionally, the Sharpened Plan addresses both supply-side constraints (particularly by scaling-up results-based financing at the facility level) and demand-side challenges (particularly by expanding the use of vouchers and by including activities to generate demand for RMNCAH services).
A number of financiers are considering providing complementary financing for the Investment Case, including the governments of the United Kingdom and the United States as well as Gavi, the Vaccine Alliance and the World Bank, with financing from both the International Development Association (IDA) and the GFF Trust Fund.
Health financing strategy
The government of Uganda has finalized its health financing strategy. It contains a number of objectives:
- Enable equitable, efficient, and sustainable mobilization of adequate resources to finance the delivery of essential health services in line with Health Sector Development Plans.
- Establish and roll out a Social Health Protection system and reach 30 percent of the people in Uganda by 2025.
- Increase effective pooling and strengthen strategic purchasing mechanisms that ensure the attainment of equitable and efficient resource allocation and delivery of quality health services by 2025.
- Develop new and strengthen existing institutional arrangements that will ensure effective accountability and transparency in resource management and use.
- Strengthen mechanisms for harmonized and effective partnerships in financing and delivery of health services, including external and private sector actors, by 2025.
- Strengthen systems for timely generation and production of health financing and expenditure information to guide policy and decision-making.