Abstract
ObjectivesTo elicit citizen preferences for national budget resource allocation in Uganda, examine respondents’ preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations.MethodsWe surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens’ preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents’ preferences with actual government budget allocations.ResultsThe health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents’ preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents’ preferences.ConclusionsAmong respondents from Mukono district in Uganda, we found that citizens’ preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents’ strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens’ needs and preferences, but also to meet the government’s health goals to improve health, strengthen health systems, and achieve universal health coverage.
Highlights
Low health sector spending and investment is a perennial challenge, especially in low and middle-income countries (LMICs) [1]
Among respondents from Mukono district in Uganda, we found that citizens’ preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations
Evidence of respondents’ strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations
Summary
Low health sector spending and investment is a perennial challenge, especially in low and middle-income countries (LMICs) [1]. Many LMICs consistently allocate resources to the health sector at levels that are well below what is considered optimal by various multilateral conventions [2]. Despite governments of Africa committing to allocate at least 15% of their budgets toward the health sector in the Abuja declaration, public financing of the health sector remains much lower in Africa [3, 4]. External donor funding and development assistance has long supplemented the health financing gaps caused by low domestic spending. Growth in external funding for health has recently slowed [5], and there is need for governments to mobilize more domestic resources for health. Inadequate investment in health has been linked with slower economic growth and lower levels of human capital [8]
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