In Africa, particularly sub-Saharan Africa, poor health of the population is generally a known reality and Uganda is no exception. The healthcare delivery systems remain too inadequate to meet the needs of the ever-growing population. This has raised concerns by policy makers and planners on whether health services are being delivered efficiently by hospitals.
The health sector in Uganda is already constricted by a number of challenges; funding gaps amid an ever growing population, human resource gaps, shortage of health facilities, financial impropriety, corruption and mismanagement of funds among others. While the health budget is still below the 15% of the national budget as per the Abuja declaration, the biggest impediment bedeviling our health system has been poor utilization and management of the meagre resources made available to health centers.
In 2014 the Auditor General carried out a value for money audit on the Uganda Health Systems Strengthening Project (UHSSP) project, administered under the Ministry of Health (MoH). UHSSP was established as an enabler to achieving the Uganda National Minimum Health Care Package (UNMHCP) with a focus on maternal health, new born care and family planning, through improving human resource for health; physical health infrastructure; and management, leadership and accountability, for health service delivery. UHSSP, is a five year project, which was established in 2010, commenced operations in February 2011 and ended on on 31st July 2015. The project was worth $130M over a 5 year period.
It was discovered that medical supplies delivered were lying unutilised in some health centres, there were no safety and space requirement prior to supply, procurement delays, equipment in some cases were not delivered as per contract terms and there was no user training in some cases. A proper needs assessment prior to the purchase of equipment was not undertaken to determine the actual user needs so as to create greater impact; this, in some cases, resulted in supply of non-priority equipment. A lot of money worth of equipment was lost.
This was one of many cases of poor utilization of resources affecting the health sector. Worse still, the 2013/14 Auditor General’s report also highlighted gross financial impropriety in the health sector where 2.4 billion shilling was unaccounted for, of which 2.2 billion alone relates to regional referral hospitals; 5.1 billion shillings was discharged and spent on activities other than those budgeted for. In some cases funds were un-utilized with the ministry of health – Ugx 112m, Global fund HSS -Ugx 1.1bn, Global fund for malaria -Ugx 119m, Butabika hospital Ugx 323 M, Uganda Cancer Institute 13M, China –Uganda friendship hospital 1.5Bn. Wasteful expenditure in the Ministry of health alone was 2.1 Bn.
The declining quality of health services in the country is mainly attributed to the lack of drugs/ stock outs, shortage of health workers, delays in accessing healthcare services in every referral hospital, mismanagement of hospital infrastructure, overcrowding of hospital facilities, among others; with dire consequences, including avoidable deaths of patients. There has been growing concern as to whether these hospitals are operating efficiently with the resources availed to them.
The results of the efficiency study of the operations of Regional referral hospitals also indicate that 50% of the hospitals were relatively efficient in utilisation of resources. Appropriate interventions need to be made to address the slacks in the utilization of the key inputs such as medicines, infrastructure / equipment and human resource.
While appearing before the Parliamentary Public Accounts Committee on 27th August 2015, the Permanent Secretary Ministry of Health, Lukwago Asuman concurred with the Committee members that a lot the population is losing out on crucial and life saving services on account of this mismanagement. “We acknowledge the risks and the losses incurred…..We apologise to the country,” He said.
Transforming the health system in Uganda to meet the growing needs of the population would require prudent financial management, effective and efficient management of the meagre resources. There is need for government to act on the issues raised in the various Auditors General’s reports; combat corruption as well as re-evaluate the policies and interventions in order to improve the health delivery systems.
 Auditor General’s Value for money report, 2014