POSITION PAPER
Position-paper-on-Health-Sector-2016-17
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<strong>POSITION</strong> <strong>PAPER</strong><br />
on the Health Sector<br />
BFP FY 2016/17<br />
C S B A<br />
G<br />
B udgeting for equity<br />
Civil Society Budget Advocacy Group<br />
(CSBAG)<br />
1
CSBAG position paper on the health sector BFP FY 2016/17 was produced by<br />
the Civil Society Budget Advocacy Group (CSBAG) with support from Democratic<br />
Governance Facility (DGF). The contents of this publication are the responsibility<br />
of CSBAG and not of our development partners.<br />
© February 2016<br />
Civil Society Budget Advocacy Group (CSBAG)<br />
P.O. Box 660, Ntinda<br />
Plot 11 Vubya Close, Ntinda Nakawa Rd<br />
Fixed Line: +256-755-202-154<br />
E-mail: csbag@csbag.org<br />
Web www.csbag.org<br />
| @CSBAGUGANDA CSBAG/Facebook.com<br />
All rights reserved. No part of this publication may be reproduced, or reprinted in any form by<br />
any means without the prior permission of the copyright holder. CSBAG encourages its use and<br />
will be happy if excerpts are copied and used. When doing so, however please acknowledge<br />
CSBAG.<br />
2
Table of<br />
Contents:<br />
About CSBAG......................................................................................4<br />
Introduction ........................................................................................5<br />
Compliance to NDP and Gender ........................................9<br />
Sectoral Issues....................................................................................10<br />
3
About CSBAG<br />
Civil Society Budget Advocacy Group (CSBAG) is a coalition<br />
formed in 2004 to bring together civil society actors at<br />
national and district Levels to influence Government<br />
decisions on resources mobilization and utilization for<br />
equitable, gender responsive and sustainable development.<br />
Since 2004, CSOs under the umbrella of CSBAG have<br />
engaged Government in influencing the budget process to<br />
ensure that both the local and national budgets address<br />
the needs and aspirations of the poor and marginalized<br />
groups of people in Uganda<br />
4
Introduction<br />
The health sector is critical in that it supports Human Capital Development<br />
and thus economic growth and development. The sector objectives that guide<br />
resource allocation are to reduce morbidity and mortality from the major causes<br />
of ill health and premature death and reduce disparities therein.<br />
The health sector budget in the FY 2016/17 is designed to help achieve the<br />
three sector outcomes of; i) Increased deliveries ii) Children under one year<br />
old protected against life threatening diseases and iii) Health facilities receive<br />
adequate stocks of essential medicines and health supplies.<br />
Uganda’s health sector has registered improvement in key health sector<br />
indicators. For instance, under five mortality rate has fallen from 169.5 per 1,000<br />
live births to 54.5 in the last two decades. The contribution of the health services<br />
activities to the total GDP at current prices was estimated at 3.5 percent in FY<br />
2014/15 compared to 3.3 percent in 2013/14.<br />
The health sector is expected<br />
to receive 1.3851 trillion in FY<br />
2016/17(7% of the FY budget)<br />
from UGX 1270.8 trillion in FY<br />
2015/16(7% of the FY budget)<br />
reflecting an 8.99% increase<br />
in budget allocation.<br />
NOTE: Exclusive of Non Tax Revenue<br />
5
The FY 2016/17 budget will focus on improving<br />
Health Service delivery in the following key areas:<br />
1. Continue with the provision of adequate essential drugs in all health centers;<br />
2. Health infrastructure development with specific attention on continued<br />
rehabilitation, equipping and functionalization of health facilities including<br />
district Hospitals and HCIIIs in all Sub counties;<br />
3. Strengthening Human resources for Health, including community extension<br />
workers and development of specialized care in heart and cancer;<br />
4. Strengthening the national referral system, including establishment of<br />
regional offices and operational structures and a fleet of ambulance vehicles,<br />
equipment and supplies;<br />
5. Enhancing preventive health care, with particular focus on mass malaria<br />
screening, testing, treatment and larviciding as well as investing in sanitation<br />
at household, community and institutional levels;<br />
6. Address the challenge of health financing, by fast tracking establishment<br />
of the National Health Insurance Scheme and provision of a Medical Credit<br />
Fund for private health sector players; and<br />
7. Provision of family planning services to address the challenge of high<br />
fertility rates and its implications on other health indicators such as infant<br />
and maternal mortality rates.<br />
6
Health sector Budget for FY 2016/17<br />
Table 1: Health sector Total budget by revenue source (Bn<br />
UGX)<br />
2014/15<br />
Outurn<br />
2015/16<br />
Approved<br />
budget<br />
MTEF<br />
Projections<br />
2016/17<br />
Recurrent Wage 273.916 330.916 330.916<br />
Non-wage 328.409 396.838 388.552<br />
Development GOU 69.695 86.214 86.714<br />
Ext. Fin 52.687 451.940 580.552<br />
GOU Total 672.020 813.969 806.182<br />
Total GOU +Ext<br />
Fin(MTEF)<br />
Non Tax<br />
Revenue<br />
724.707 1,265.909 1,386.735<br />
0.000 17.900 21.053<br />
Grand Total 724.707 1,283.808 1,407.788<br />
Source: National Budget Framework Paper FY 2016/17<br />
In the figure above, the wage budget remained constant from FY 2015/16<br />
at UGX 330.916bn and the non-wage budget reduced by 2.08% from UGX<br />
396.838bn to UGX 388.552bn.The GOU financing to the sector reduced slightly<br />
from UGX 813.969bn to UGX 806.182bn by 0.95%.The overall budget to the<br />
sector (inclusive of NTR) increased by 9.66% from UGX 1,283.808 in FY 2015/16<br />
to the projected budget for FY 2016/17 of UGX 1,407.788bn.Donor financing to<br />
the sector constitutes 72% of the sector’s development budget and thus places<br />
Government at the hands of donor terms and conditions as well as availability of<br />
funds to execute this FY’s budget.<br />
7
Past Expenditure and Medium Term Projections by<br />
Vote Functions<br />
2014/15<br />
Outturn<br />
2015/16 2016/17<br />
Vote 014:Ministry of Health 39.591 539.563 647.272<br />
Vote 107 :Uganda AIDS<br />
Commission<br />
5.266 7.748 7.748<br />
Vote 114:Uganda Cancer Institute 6.481 17.133 40.203<br />
Vote: 115 Uganda Heart Institute 4.909 14.491 17.265<br />
Vote: 116 National Medical Stores 219.374 218.614 218.614<br />
Vote: 122 Kampala Capital City<br />
Authority<br />
4.726 9.719 8.602<br />
Vote: 134 Health Service<br />
Commission 3.44 4.271 4.271<br />
Vote: 151 Uganda Blood<br />
Transfusion Service (UBTS)<br />
Vote: 161 Mulago Hospital<br />
Complex<br />
3.234 8.703 8.703<br />
35.793 11.461 47.123<br />
Vote: 162 Butabika Hospital 8.306 9.77 10.27<br />
Referral Hospitals 64.258 85.875 81.412<br />
Vote: 500 501-850 Local<br />
Governments-Primary Health care<br />
276.643 319.155 316.303<br />
Total Sector Budget 672.02 1,283.81 1,407.79<br />
Source: National Budget Framework Paper FY 2016/17<br />
From the table above, the Ministry of Health will receive a 20% increase in<br />
health budget from UGX 539.563bn to UGX 647.272bn in FY 2016/17.Uganda<br />
AIDS Commission and Health Service Commission budgets remain the same in<br />
FY 2016/17.Notably Uganda Cancer Institute will receive the greatest increase<br />
in the sector budget with a 135% increase in budget allocation in FY 2016/17<br />
from UGX 17.133bn in FY 2015/16 to UGX 40.203bn in FY 2016/17. The Ministry<br />
of Health will receive the highest funding at UGX 647.272 (45.98%) and Local<br />
Governments are proposed to receive the second largest share 22.26 %( UGX<br />
316.303bn) funding in the sector.<br />
8
Compliance to<br />
NDP and Gender<br />
The sector does not specifically detail its gender mainstreaming priorities for FY<br />
2016/17 and performance for FY 2015/16.However in FY 2015/16, the sector<br />
immunized 102.4% of children under one year with the 3rd dose of Pentavalent<br />
vaccine while those immunized against measles was 90% contributes to reduced<br />
health care by parents majority of whom are women due to their unpaid care<br />
work role.<br />
FY 2016/17 Performance Targets<br />
• As part of its FY 2016/17 performance targets under Outcome 1, the sector<br />
intends to increase the proportion of deliveries in health facilities (including<br />
health centres and hospitals, public and private Not For Profit) from 33 in<br />
2013 to 56 in 2016/17.<br />
• Number of family planning users attended to in all the referral hospitals2 will<br />
increase from 98,176 users from 2015/16 to 122,615 users in FY 2016/17.<br />
Alignment of BFP 2016/17 Financing to NDP II Public<br />
Costing<br />
Bn shs Wage Non-wage Devt Total<br />
NDP II 520 357 1,069 1,946<br />
BFP<br />
330.916 388.552 667.266 1,407.788*<br />
2016/17<br />
Source: National Budget Framework Paper FY 2016/17<br />
*Inclusive of Non Tax Revenue<br />
Considering the forecast spending for NDP II, the FY 2016/17 budget falls<br />
short of the NDP II public costing by UGX 401.734(26.64%).The major cause<br />
for discrepancy is financing for development that falls short by UGX 401.734bn<br />
(37.6%).CSBAG recommends that this funding for the sector be made<br />
commensurate to stipulated NDP II costing to achieve the medium term sector<br />
objectives.<br />
9
Allocations to Class of Output over the Medium Term<br />
2015/16 2016/17<br />
Bn Uganda shillings<br />
Allocation<br />
Sector<br />
share<br />
Allocation<br />
Sector<br />
share<br />
Consumption<br />
Expenditure(outputs<br />
provided)<br />
Grants and<br />
Subsidies(outputs<br />
funded)<br />
Investment(capital<br />
Purchases)<br />
662.4 68.7% 693.8 63.6%<br />
16.9 1.8% 16.2 1.5%<br />
285.4 29.6% 381.5 34.9%<br />
Total 964.7 100.0% 1,091.5 100.0%<br />
In expenditure terms, in FY 2015/16, the sector plans to spend UGX 964.7bn in FY<br />
2015/16 with 68.7% in consumption expenditure, 1.8% (UGX 16.9bn) for grants<br />
and subsidies; and UGX 285.4bn for investment (29.6%). In 2016/17, Government<br />
plans to utilize the bulk of its expenditure-UGX 693.8bn for consumption<br />
expenditure, translating into 63.6% of Government expenditure; UGX 16.2bn<br />
(1.5%) for grants and subsidies and UGX 381.5bn for capital purchases.<br />
10
SECTORAL ISSUES<br />
1. Limited staffing in the sector<br />
Low staffing remains a challenge in the sector. The current staffing needs in<br />
the sector amount to 60,384 personell for MoH headquarters, National Referral<br />
Hospitals, 3 central specialized institutions, 14 Regional Referral Hospitals (RRH),<br />
47 General Hospitals (GH), 166 HC IVs, 962 HC IIIs and 1,321 HC IIs according to<br />
the Annual Health Sector Budget Performance Report FY 2014/15.<br />
The current staffing in the sector is 42,530 amounting to 17,854 staffing gap.<br />
In FY 2015/16, Government planned for recruitment of 800 health workers in<br />
Central Government Health Institutions to cope with the rising population, of<br />
which 55 health workers had been recruited by September 2015. In FY 2016/17,<br />
Government also plans to undertake recruitment of 850 health workers for<br />
Government health institutions that would only reduce the staffing gap to 16,734.<br />
Recommendation<br />
CSOS urge Government to prioritize recruitment of<br />
more staff in the health sector particularly qualified<br />
health workers to enhance sectoral performance.<br />
2. Delays in Institutionalizing the National Health<br />
Insurance Scheme<br />
A National Insurance Scheme is necessary for providing much needed affordable<br />
access to health care particularly by poor persons in Uganda; diversification<br />
of health care financing and bridging the financing gap for health care in the<br />
sector. Despite Government plans to institute a compulsory public Social Health<br />
Insurance (SHI) scheme ,the National Health Insurance Bill 2007,still awaits<br />
issuance of a certificate of financial implication by the Ministry of Finance as of<br />
2015.<br />
11
Recommendation<br />
Urge Government to fast track the institutionalizing of<br />
the National Insurance Scheme to provide affordable<br />
health care to all Ugandans.<br />
3. Failure to prioritize Hospital Rehabilitation and<br />
Machinery Repair<br />
Rehabilitation and maintenance of equipment is critical in ensuring sustainability<br />
of machinery to prevent unnecessary stalling of provision of health care to<br />
citizens. In FY 2016/17, UGX 33.18 bn is required as additional funding for<br />
counterpart funding and VAT obligations for Government arising out of MOU<br />
agreements between Government and development partners.<br />
These include:<br />
• UGX 2.6bn for VAT incurred on rehabilitation of hospitals and supply of<br />
medical equipment in the Western region of Uganda<br />
• UGX 15.9bn arising out of the change in VAT policy and Ushs 4.8 bn<br />
counterpart funding obligations for Support to Mulago rehabilitation<br />
(kawempe, kirudu) which is scheduled to end in December 2016.<br />
• Ushs 9.88bn is for Counterpart funding on civil works during construction of<br />
Maternal and Neonatal health care unit at Mulago.<br />
In addition, delays in the recruitment process of the necessary staff by the Health<br />
Service Commission has resulted in failure to fully operationalize and maintain<br />
the specialized equipment.<br />
Recommendation<br />
Government should impose a VAT exemption in on<br />
hospital rehabilitation and equipment maintenance in<br />
the new Government policy on payment of VAT on<br />
Government projects.<br />
We recommend that Government prioritizes allocation<br />
to footing counterpart funding in accordance with MOU<br />
agreements signed with development partners.<br />
12
4 Limited Transfers to Local Governments for<br />
Provision of Primary Health Care Services<br />
Only Ushs 44.99bn has been allocated as recurrent budget to run Health service<br />
delivery through provision of Primary Health care services in 137 LGs with 56<br />
General Hospitals, 61 PNFP Hospitals and 4,205 Lower Level Health Units. Despite<br />
rising inflation resulting in increased cost of utilities; PHC funding has not been<br />
matched by commensurate increases in the budgets of the health institutions.<br />
This is further compounded by the fact that a number of health facilities have<br />
a budget of less than Ushs 90,000 per month (excluding medicines) to deliver<br />
all the required services including utility payment, community outreaches, and<br />
health centre maintenance and support staff salaries.<br />
A short study undertaken by the Ministry indicates that to enhance health service<br />
delivery in the Local Governments, an additional Ushs 39.5 bn is required to<br />
make the current facilities to operate at a reasonable level. While Government<br />
provided an additional Ushs 4.7bn in FY 2015/16, LGs need another Ushs 35bn<br />
to be provided.<br />
Recommendations<br />
CSOs urge Government to allocate UGX 35bn to<br />
Local Governments to cater for provision of adequate<br />
Primary Health Care Services<br />
6 Limited financing to curb HIV/AIDS prevalence<br />
The World bank estimates the HIV/AIDS prevalence rate for people aged 15–49<br />
years in Uganda as slowly rising from 6.5% in 2009 to 7.3% in 2014.Despite<br />
the growing HIV/AIDS prevalence ,the sector in FY 2016/17 has grossly under<br />
prioritized financing for HIV/AIDS alleviation. It has a funding gap of 350m for<br />
research on HIV Therapy resistance, UGX 600m for the Population HIV Impact<br />
assessment Survey and a funding gap for Anti- Retroviral (ARVs) amounting<br />
to UGX 151bn to roll out 2013 treatment guidelines that shifted the treatment<br />
starting point from 350 to 500 CD4 cells starting point from 350 to 500 CD4 cells.<br />
Under Ministry of Health, in FY 2016/17 plans to institute an AIDS Trust Fund<br />
based on the Regulations as passed by Parliament are underway.<br />
13
Recommendations<br />
Government should allocate<br />
more funding for curbing the HIV<br />
prevalence rate in the country.<br />
Government should fast track<br />
efforts to operationalize the AIDS<br />
Trust Fund by FY 2016/17 whose<br />
regulations were being discussed by<br />
MoH as of September 2015.<br />
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OUR TEAM:<br />
The Civil Society Budget Advocacy Group (CSBAG) since its launch in 2004 has made<br />
major leaps towards ensuring that the Ugandan budget making process is more participatory,<br />
transparent and citizens’ concerns are prioritized in government budget allocations and<br />
implementation.<br />
Our membership is comprised of the following 75 institutions:<br />
Action Aid International Uganda | (AA - IU)<br />
Website: www.actionaid.org/Uganda<br />
ABICWA<br />
District: Abim<br />
African Centre for Trade and Development (ACTADE)<br />
Website: www.actade.org<br />
African Centre for Treatment and Rehabilitation of<br />
Torture Victims (ACTV)<br />
Website: www.actvuganda.org<br />
Advance Afrika<br />
Advocates Coalition for Development and Environment<br />
(ACODE)<br />
Website: www.acode-u.org<br />
Anti-Corruption Coalition Uganda (ACCU)<br />
www.accu.or.ug<br />
Agago NGO Forum<br />
District: Agago<br />
Action Group for Health Human Rights and HIV/<br />
AIDS (AGHA)<br />
Website: www.agha.or.ug<br />
African Youth Development Link (AYDL)<br />
Website: www.aydl.org<br />
African Women's Economic Policy Network<br />
(AWEPON)<br />
Website: www.awepon.net<br />
Ashay Razyn foundation limited<br />
Web: www.arfuganda.org<br />
Awotid – Uganda<br />
District: Abim<br />
Caritas Kampala<br />
Website: www.caritaskampala.org<br />
Center for African Policy<br />
Website:<br />
Center for Domestic Violence (CEDOVIP)<br />
Website www.preventgbvafrica.org<br />
Center for Governance, Peace and Security<br />
Website: www.gasuganda.com<br />
Center for Policy Research and Development Initiatives<br />
Website: www.cepordi.org<br />
Centre for Women in Governance (CEWIGO)<br />
Website: www.cewigo.org<br />
Community Restoration Imitative Project<br />
Website:<br />
Development Network of Indigenous Voluntary<br />
Associations (DENIVA)<br />
Website: www.deniva.or.ug<br />
Development Research and Training (DRT)<br />
Website: www.drt-ug.org<br />
Development Watch ( DEMWatch)<br />
Deutsche Stiftung Weltbevölkerung- Uganda<br />
Website: www.dsw-online.org<br />
Eastern and Southern Africa Small Scale Farmers<br />
Forum (ESAFF- Uganda)<br />
Website: www.esaff.org<br />
Environmental Alert (EA)<br />
Website: www.envalert.org<br />
Food Rights Alliance (FRA)<br />
Web: www.fra.ug<br />
Forum for Women in Democracy (FOWODE)<br />
Website: (www.fowode.org)<br />
Forum for Kalongo Parish Women Association<br />
District: Agago<br />
FOWODE Young Leaders Alumni Association (FYLAA)<br />
Website: www.fylaa.org<br />
Hope after Rape<br />
Website: www.har.interconnection.org<br />
Hunger Fighters Uganda<br />
Website: www.hungerfightersuganda.org<br />
Human Rights Network Uganda (HURINET- U)<br />
Website: www.hurinet.or.ug<br />
Initiative for Social and Economic Rights - Uganda<br />
Website: www.iser-uganda.org<br />
Institute of social transformation (IST)<br />
Website: www.ist-tft.org<br />
Innovations for poverty action (IPA)<br />
website: www.poverty-action.org<br />
Isis-WICCE<br />
Website: www.isis.or.ug<br />
Jenga Afrika<br />
Website: www.jengaafrika.org<br />
Muti Community Based Development Initiative<br />
District: Abim<br />
National Association of Women Organisations in<br />
Uganda (NAWOU)<br />
Website: www.nawouganda.org<br />
National Forum for People Living with HIV/AIDS<br />
Network in Uganda (NAFOPHANU)<br />
Website: www.nafophanu.org<br />
National Union of Women with Disabilities of Uganda<br />
(NUWODU)<br />
National Union of Disabled Persons Uganda (NUDIPU)<br />
www: www.nudipu.org<br />
Nen Anyim Community Based Group<br />
District: Agago<br />
Participatory Ecological Land Use Management<br />
(PELUM)<br />
Website: www.pelumuganda.org<br />
Patongo Counseling Community Outreach<br />
District: Agago<br />
Passion for community development organization<br />
District: Agago<br />
People Living with HIV/AIDS Network<br />
District: Abim<br />
Platform for Citizen Participation and Accountability<br />
(PLACA)<br />
Website: www.placaug.org<br />
Regional Associates for Community Initiatives (RACI)<br />
Website: www.raciug.org<br />
Spinal Injuries Association- Uganda<br />
District: Kampala<br />
Shelter and Settlements Alternatives-Uganda<br />
Website: www.ssauganda.org<br />
Southern and Eastern African Trade Information and<br />
Negotiations Institute (SEATINI-U)<br />
Website: www.seatiniuganda.org<br />
Real Agency for Community Development<br />
Website: www.racd-uganda.org<br />
Rwenzori Consortium for Civil competence (RWECO)<br />
Website: www.rweco.org<br />
Toro Development Network-Toro-Dev<br />
Website: www.torodev.kabissa.org<br />
Uganda Debt Network (UDN)<br />
Website: www.udn.or.ug<br />
Uganda National Health Consumers’ Organization<br />
(UNHCO)<br />
Web: www.unhco.or.ug<br />
Uganda National NGO Forum.<br />
Website: www.ngoforum.or.ug<br />
Uganda Network of AIDS Service<br />
Organization (UNASO)<br />
Website: www.unaso.org<br />
Uganda Parliamentary Forum on Youth Affairs<br />
Website:<br />
Uganda Road Sector Support Initiative (URSSI)<br />
Website: www.ugandaroadsector.org<br />
Uganda Women Entrepreneurs Association Limited<br />
Web: www.uweal.co.ug<br />
Uganda Joint Christian Council (UJCC)<br />
www.ujcc.co.ug<br />
Uganda Women’s Network (UWONET)<br />
Website: www.uwonet.or.ug<br />
Uganda Youth Network (UYONET)<br />
Web: www.info.or.ug<br />
Volunteer Efforts for Development Concerns (VEDCO)<br />
Website: www.vedcouganda.org<br />
Water Aid Uganda<br />
Website: www.wateraid.org/uganda<br />
Wagwoke WUnu<br />
District: Agago<br />
Women and Girl Child Development Association<br />
Website: www.wegcda.org<br />
Widows and Orphans Support Organisation<br />
District: Agago<br />
Save for Health Uganda (SHU)<br />
Website: www.shu.org.ug<br />
Kiyita Family Alliance for Development (KIFAD)<br />
Rwenzori consortium for Civic Competence (RCC)<br />
15
VISION<br />
A Uganda with a people centered budget<br />
that dignifies humanity<br />
MISSION<br />
Working towards ensuring that budgets at local and naional<br />
level are financed, designed, implemented and monitored<br />
to promote prudent and transparent allocation of national<br />
resources for the benefit of marginalized groups.<br />
C S B A G<br />
B udgeting for equity<br />
Civil Society Budget Advocacy Group (CSBAG)<br />
P.O. Box 660, Ntinda,<br />
Plot 11 Vubya Close, Ntinda Nakawa Rd<br />
Fixed Line: Mob: +256-755-202-154<br />
E-mail: csbag@csbag.org<br />
Web www.csbag.org<br />
@CSBAGUGANDA CSBAG/Facebook.com<br />
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