Abstract
BackgroundMonitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda.MethodsThis study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10 and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.ResultsThe results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection.ConclusionThere is need for targeted interventions to reduce OOP, especially among those affected so as to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.
Highlights
Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments
UHC is about ensuring that the population has access to needed health services that are of adequate quality to be effective, without facing any financial risk that results from paying out-of-pocket (OOP) for health services [2,3,4]
The findings show that Ugandans still lack financial risk protection, and there has been a reversal of the trend in catastrophic expenditure and impoverishment rates
Summary
Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). In Uganda, OOP payments for health services are still dominant, contributing up to 40% of Uganda’s total health expenditure [6], even though user fees/cost-sharing in government facilities have been abolished since 2001. Safeguarding households from incurring financial risks and minimising the risk of falling into poverty, through ensuring that households’ consumption of other basic needs such as food and shelter are not compromised due to direct OOP payments is critical [3] This is even more important for a country like Uganda, where more than a quarter of the population (about 10 million Ugandans) in absolute poverty [8] and more than 40% of the population remains vulnerable to economic shocks [9].
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