The financing of stand-alone palliative Care Services in Uganda: analysis of the implications for sustainability

Jacinto Amandua,Melkizedeki Stephen Kimaro,Christine Atuhairwe,Ivan Mugisha Taremwa,Eddie Mwebesa

doi:10.1186/s12904-019-0434-5

Jacinto Amandua, Melkizedeki Stephen Kimaro + Show 3 more

Open Access

https://doi.org/10.1186/s12904-019-0434-5

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Abstract

BackgroundSustainable funding is key for ensuring the quality and coverage of palliative care services. This study examined the sources of funding for stand-alone palliative care services in Uganda as well as their services financial sustainability plans.MethodsResearchers conducted a cross sectional survey of all stand-alone palliative care organizations that have operated for five or more years. Researchers administered a questionnaire survey and interviews on the audited financial statements, services provided and sustainability plans.ResultsNine of the stand-alone palliative care organizations surveyed had operated for five to 25 years. 93% of the funding for palliative care services comes from donations; while 7% is from income generating activities. 94% of the donations are from external sources. The Government of Uganda’s major contribution is in the form of medicines, training and payment of taxes. All the organizations had good financial records. Six of the fifteen Hospices/palliative care providers had sustainability plans included in their operational manuals. The older organizations (those that had been operational for more than 10 years) had better resource mobilization capacity and strategies.ConclusionThe majority of stand-alone palliative care organizations in Uganda are largely donor funded. They have considerable financial sustainability and fund-raising capacity. Government support is in the form of medicines and training. Based on this study findings, the capacity of the stand-alone palliative care services to raise funds should be increased. The Government of Uganda should include palliative care in the national health system and increase funding for these services.

Highlights

Sustainable funding is key for ensuring the quality and coverage of palliative care services
World Health Organization (WHO) estimates that 9100 males and 9000 females die of cancer annually, 64% of whom would have benefited from palliative care [3]
Hospice Africa Uganda has served as a model for the development of hospice and palliative care services in Uganda and Africa [8]

Summary

Introduction

Sustainable funding is key for ensuring the quality and coverage of palliative care services. Though most patients are cared for at home, there is limited access to palliative care services especially pain and symptom control and supportive services at the community and health unit level [7]. The number of people in need of palliative care in Uganda is on the rise for example, an approximated 120,000 people are living with AIDS, and an estimated 90,000 have cancer with about 35,000 new cancer patients diagnosed yearly [3]. Despite the high incidence of cancer, the availability of morphine in low-income countries remains a challenge, with only three African countries (Uganda, South Africa and Tanzania) having palliative care integrated into their national health policies and strategies, while Swaziland, Rwanda and Zambia have developed draft policies, subject to approval by their respective Health Ministries. Despite the initiative of the Ugandan government, care provision remains disintegrated in national public health agendas and systems, and it continues to be heavily reliant on non-governmental, community-based and home-based care (HBC) models

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