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Exploring Partnership Opportunities to Achieve Universal Health Access 2016 Uganda Private Sector Assessment in Health

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Exploring Partnership Opportunities to Achieve Universal Health Access 2016 Uganda Private Sector Assessment in Health YES. ADD AEXPLORING PICTURE PARTNERSHIP OPPORTUNITIES TO ACHIEVE UNIVERSAL HEALTH ACCESS 2016 UGANDA PRIVATE SECTOR ASSESSMENT IN HEALTH February (September) 2017 DO WE CHANGE THE DATE? This report is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this report are the sole responsibility of Cardno Emerging Markets USA, Ltd. and do not necessarily reflect the views of USAID or the United States Government. EXPLORING PARTNERSHIP OPPORTUNITIES TO ACHIEVE UNIVERSAL HEALTH ACCESS 2016 UGANDA PRIVATE SECTOR ASSESSMENT IN HEALTH Authors: Barbara O’Hanlon[1], Angellah Nakyanzi1, Veronica Musembi1 Ivan Busulwa1, Rebecca Husband1, Robert Okumu1, Francis Zikusooka1, Joy Batusa1, Dithan Kiragga1,Dr. Sarah Byakika[2], Dr. Timothy Musila2, Andrew Kyambadde[3], Sandra Kebirungi Submitted by: Cardno Emerging Markets USA, Ltd. Submitted to: USAID/Uganda Contract No.: AID-617-C-13-00005 DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. [1] USAID/Uganda Private Health Support Program [2] Ministry of Health, Uganda [3] USAID/Uganda Exploring Partnership Opportunities to Achieve Universal Health Coverage: Uganda PSA 2016 TABLE OF CONTENTS ACRONYMS ................................................................................................................................................ X ACKNOWLEDGEMENTS ............................................................................................................................... XIV DEFINITIONS ............................................................................................................................................. XV EXECUTIVE SUMMARY ................................................................................................................................XVII 1 INTRODUCTION 33 STEWARDSHIP OF THE PSA ........................................................................................................................... 34 RATIONALE ............................................................................................................................................... 34 OBJECTIVES .............................................................................................................................................. 34 SCOPE OF PSA .......................................................................................................................................... 36 PSA TEAM ............................................................................................................................................... 36 OUTCOMES .............................................................................................................................................. 36 METHODOLOGY ......................................................................................................................................... 37 ORGANIZATION OF THE PSA REPORT .............................................................................................................. 38 2 OVERVIEW OF THE UGANDAN MIXED HEALTH SYSTEM AND THE PRIVATE SECTOR CONTRIBUTION 40 REFRAMING THE POLICY APPROACH: GOVERNMENT WITH, NOT VERSUS THE MARKET ................................................ 40 2.1.1 GROWING RECOGNITION OF MIXED DELIVERY SYSTEM ..................................................................................... 40 2.1.2 MANAGEMENT OF A MIXED DELIVERY SYSTEM ............................................................................................... 41 LANDSCAPE OF UGANDA’S MIXED DELIVERY HEALTH SYSTEM ............................................................................... 41 2.1.3 PUBLIC SECTOR .......................................................................................................................................... 44 2.1.4 PRIVATE HEALTH SECTOR: NOT-FOR-PROFIT (PNFP) ....................................................................................... 45 2.1.5 PRIVATE HEALTH SECTOR: PRIVATE HEALTH PROVIDERS (PHP) ......................................................................... 47 2.1.6 PRIVATE HEALTH SECTOR: TRADITIONAL AND COMPLEMENTARY MEDICINE PRACTITIONERS ................................... 49 2.1.7 CIVIL SOCIETY ORGANIZATIONS .................................................................................................................... 49 2.1.8 DEVELOPMENT PARTNERS ........................................................................................................................... 50 NUMBERS DESCRIBING THE PUBLIC-PRIVATE MIX DELIVERY SYSTEM ....................................................................... 51 2.1.9 PUBLIC-PRIVATE MIX OF HEALTH INFRASTRUCTURE ......................................................................................... 52 2.3.1 DISTRIBUTION OF PUBLIC-PRIVATE FACILITIES ................................................................................................. 53 2.1.10 PUBLIC-PRIVATE MIX OF HEALTH PERSONNEL .............................................................................................. 55 2.1.11 PUBLIC-PRIVATE MIX OF HEALTH TRAINING INSTITUTIONS .............................................................................. 55 KEY FINDINGS ........................................................................................................................................... 56 2.1.12 UGANDA’S MIXED DELIVERY SYSTEM REQUIRES CHANGE IN MOH’S GOVERNANCE STRUCTURE ............................ 56 2.1.13 PRIVATE SECTOR IS ACTIVE IN ALL ASPECTS OF THE UGANDA HEALTH SYSTEM ................................................... 57 2.1.14 THE PRIVATE SECTOR IS ACTIVE AT ALL LEVELS OF THE UGANDAN HEALTH SYSTEM ............................................. 58 2.1.15 PRIVATE HEALTH FACILITIES ARE LOCATED THROUGHOUT UGANDA .................................................................. 59 3 POLICY ENVIRONMENT SUPPORTING PRIVATE HEALTH SECTOR CONTRIBUTION TO UHC 63 HISTORICAL CONTEXT FOR PRIVATE SECTOR ENGAGEMENT .................................................................................. 63 POLICY FRAMEWORK FOR PRIVATE SECTOR ENGAGEMENT ................................................................................... 65 3.1.1 ECONOMIC DEVELOPMENT POLICIES ENCOURAGING PSE AND GROWTH ............................................................. 65 3.1.2 HEALTH SECTOR POLICIES THAT SET THE STAGE FOR PRIVATE SECTOR ENGAGEMENT ............................................ 66 FACTORS ENABLING / HINDERING PRIVATE SECTOR ENGAGEMENT ......................................................................... 68 3.1.3 POLICY CONDITIONS ................................................................................................................................... 68 3.1.4 PUBLIC-PRIVATE RELATIONS ......................................................................................................................... 73 3.1.5 MARKET CONDITIONS FOR HEALTHCARE BUSINESSES ....................................................................................... 74 3.1.6 SCORING OF ENABLING FACTORS .................................................................................................................. 74 RECOMMENDATIONS .................................................................................................................................. 75 4. THE ROLE OF HEATH FINANCING IN CREATING A SUSTAINABLE PRIVATE HEALTH SECTOR 80 Exploring Partnership Opportunities to Achieve Universal Health Coverage: Uganda PSA 2016 i INTRODUCTION TO HEALTH FINANCING IN UGANDA ............................................................................................ 80 3.1.7 HISTORICAL TRENDS ................................................................................................................................... 80 3.1.8 HEALTH FINANCING INDICATORS – REGIONAL COMPARISON ............................................................................. 81 3.1.9 OVERVIEW OF CURRENT HEALTH SECTOR FINANCES IN UGANDA ....................................................................... 82 TOTAL HEALTH EXPENDITURES BY FUNCTIONS ................................................................................................... 82 REVENUE COLLECTION FOR HEALTH FINANCING ................................................................................................. 83 3.1.10 PUBLIC FUNDS ......................................................................................................................................... 83 3.1.11 DEVELOPMENT PARTNERS ......................................................................................................................... 84 3.1.12 PRIVATE OOP FUNDS ............................................................................................................................... 88 3.1.13 4.3.4 POOLING OF HEALTH FUNDS (INSURANCE SCHEMES) ............................................................................ 89 STRATEGIC PURCHASING .............................................................................................................................. 96 3.1.14 THE PHC GRANT AS A MECHANISM TO PURCHASE HEALTH SERVICES ................................................................ 96 3.1.15 NASCENT BUT PROMISING EXPERIENCE IN PERFORMANCE BASED FINANCING ....................................................
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