Abstract
BackgroundUganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors.MethodsSecondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models.ResultsThe odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP.ConclusionAlthough overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and rural populations. Public private partnerships should be broadened to increase access to health services among the vulnerable.
Highlights
Uganda implemented health sector reforms to make services more accessible to the population
Uganda implemented a number of health sector reforms in an attempt to improve access to health services
In one response to reduce this problem and better harmonise resource inflows for planning in the health sector, budget support mechanisms were introduced with significant amounts of donor funding channelled through the national budget process in a sector wide approach (SWAp) [9,10]
Summary
Uganda implemented health sector reforms to make services more accessible to the population. Some of the main reasons in favour of reforms for the health sector included failure to make appreciable progress towards the primary health care (PHC) goals of equitable health care, fragmentation of the health sector, and inability of the MOH to take charge of the health sector through sound policy and legislation [7]. These reforms took place along with other changes in the public sector consisting of liberalization and privatization, constitutional reforms, civil service reforms, and broader decentralization efforts [8]. In one response to reduce this problem and better harmonise resource inflows for planning in the health sector, budget support mechanisms were introduced with significant amounts of donor funding channelled through the national budget process in a sector wide approach (SWAp) [9,10]
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