Fiscal space for health in Uganda:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Washington, DC
World Bank
2010
|
| Series: | World Bank working paper
186 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII, 76 S. graph. Darst. |
| ISBN: | 9780821382905 |
Staff View
MARC
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| 245 | 1 | 0 | |a Fiscal space for health in Uganda |c Peter Okwero ; Ajay Tandon ; Susan Sparkes ; Julie McLaughlin ; Johannes G. Hoogeveen |
| 264 | 1 | |a Washington, DC |b World Bank |c 2010 | |
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Record in the Search Index
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| adam_text | Titel: Fiscal space for health in Uganda
Autor: Okwero, Peter
Jahr: 2010
Contents
Preface......................................................................................................................................vii
Acknowledgments................................................................................................................viii
Acronyms and Abbreviations................................................................................................ix
Executive Summary..................................................................................................................xi
1. Background and Context......................................................................................................1
Objective and Purpose.......................................................................................................1
Overview of the Economy...........................................................................,.....................1
Overview of the Administrative System.........................................................................2
Overview of the Healthcare System.................................................................................3
Policy Environment............................................................................................................4
Health Policy and Strategy................................................................................................4
2. Assessment of HNP Outcomes.............................................................................;.............8
Health Status.......................................................................................................................8
Leading Causes of Disease Burden................................................................................13
Population and Fertility...................................................................................................15
3. Assessment of Health Sector Performance.....................................................................19
Healthcare Utilization, Coverage, and Outputs...........................................................19
Access and Availability of Healthcare Services............................................................22
Equity.................................................................................................................................24
4. Health Financing and Expenditure..................................................................................29
Total Health Expenditures...............................................................................................29
Government Health Expenditures..................................................................................30
Private Spending on Health............................................................................................33
Development Assistance for Health in Uganda...........................................................35
5. Drivers of Expenditures to Increase Fiscal Space for Health in Uganda...................38
Growing Population.........................................................................................................38
Service Standards and Norms...... ...................................................................................38
Rising Unit Cost of Treatment.........................................................................................39
Global Pressures to Increase Health Expenditure........................................................39
HIV/AIDS Remains a Major Driver of Health Spending.............................................40
6. Waste in the Health Sector.................................................................................................42
PHC Non-Wage Grant and District NGO PHC Grant Leakages...............................42
Questionable Expenditures in Reports by the Auditor General.................................42
Personnel Behavior and Management Practices...........................................................43
Waste and Leakage in the Pharmaceutical Subsector..................................................44
iii
iv Contents
Management of Procurement in the Health Sector......................................................45
Computing the Leakages in the Health Sector Fiscal 2005/06 Data...........................47
7. Fiscal Space Realities for the Ugandan Health Sector..................................................49
Understanding Fiscal Space............................................................................................49
Fiscal Space for Health by Increasing Health s Share of the Overall Budget........... 51
Fiscal Space for Health from Increasing Development Assistance for Health.........53
Fiscal Space for Health from Leveraging other Domestic Resources for Health.........54
Fiscal Space for Health by Increasing Outlay Efficiency.............................................55
8. Constraints to and Options for Increased Fiscal Space for Health in Uganda.........60
Employing External Grants to Increase Fiscal Space...................................................60
The Threat of Dutch Disease...........................................................................................63
The Role of Expenditure Ceilings...................................................................................64
Absorptive Capacity.........................................................................................................65
9. Conclusions and Recommendations................................................................................69
Conclusions.......................................................................................................................69
Recommendations............................................................................................................70
References.................................................................................................................................74
Tables
Table 1.1. Trends in Health PEAP Indicators (fiscal 2000/01-2006/07)..............................6
Table 2.1. Inequalities in Under-five (per 1,000) and Infant Mortality (per 1,000
live births) in Uganda, 2005............................................................................................10
Table 2.2. Uganda s Attainment of Under-five and Infant Mortality versus
Selected Comparators, 2006............................................................................................12
Table 2.3. Major Causes of Death and Disease Burden in Uganda, 2002.........................14
Table 2.4. Causes of Under-five Deaths................................................................................15
Table 2.5. Fertility-related Indicators in Uganda: 1995, 2000, and 2006...........................16
Table 3.1. Percent Distribution of Health Facilities by Region..........................................19
Table 3.2. Uganda s Health System Service Delivery indicators vs. Selected
Comparators, 2006...........................................................................................................21
Table 3.3. Average Distance from Health Facility by Wealth Quintile and Region.......22
Table 3.4. Availability of Basic Service by Type of Facility................................................23
Table 3.5. Health Expenditure and Catastrophic Spending by Wealth Quintile in
Uganda, 2006....................................................................................................................26
Table 3.6. Healthcare Utilization Patterns by Income Quintile in Uganda, 2006 (in
%).......................................................................................................................................27
Table 3.7. Participation Incidence by Wealth Quintile in Uganda, 2006..........................27
Table 4.1. Health Expenditure Indicators in Uganda and Selected Comparator
Countries, 2006.................................................................................................................29
Table 4.2. Government Budget on Health Sector (U Sh billion)........................................31
Table 4.3. Health Expenditure and Catastrophic Spending by Wealth Quintile in
Uganda, 2006....................................................................................................................34
Table 4.4. Household Health Expenditures 2002 and 2006 (in U Sh)...............................35
Table 4.5. Sources of Funds in Uganda and Selected Comparator Countries, 2006.......36
Table 6.1. Audits of Procurement Contracts in the Health Sector....................................46
Table 6.2. Calculations of Waste, Fiscal 2005/06 Data.........................................................47
Table 7.1. Fiscal Space for Health Projections Based on Economic Growth, 2007-15.... 51
Table 7.2. Official DAH, Gross Disbursements, 2006 (US$ millions)...............................53
Table 8.1. Sector Public Expenditure as Percentage of Overall Budget (Including
Donor Projects).................................................................................................................65
Figures
Figure 2.1. Trends in Life Expectancy and Income in Uganda, 1960-06............................8
Figure 2.2. Trends in Under-five and Infant Mortality Rates for Uganda, 1960-06..........9
Figure 2.3. Elasticity of Under-five and Infant Mortality with Respect to Income in
Uganda.................................................................................................................................9
Figure 2.4. Wealth-related Inequalities in Under-five and Infant Mortality Trends
in Uganda, 1995-05..........................................................................................................11
Figure 2.5. Life Expectancy and Under-five Mortality vs. Income, 2006.........................12
Figure 2.6. Maternal Mortality Ratio in Uganda, 1990-15.................................................13
Figure 2.7. Estimated and Projected Adult HIV Prevalence and Incidence,
Uganda, 1981-10..............................................................................................................14
Figure 2.8. Total Fertility Rate in Uganda, Kenya, and Tanzania, 1960-05.....................16
Figure 2.9. Age Distribution in Uganda 2005 and 2025......................................................17
Figure 3.1. Utilization Rates in Uganda, 1996-06................................................................20
Figure 3.2. Trends in DPT3 Immunization and Skilled Birth Attendance in
Uganda, 1980-06..............................................................................................................21
Figure 3.3. Global Comparison of Life Expectancy Rates in Ugandan Districts,
2006....................................................................................................................................25
Figure 3.4. Global Comparison of Infant and Under-five Mortality Rates in
Ugandan Districts, 2006..................................................................................................25
Figure 4.1. Total Health Expenditure and Government Health Expenditure Per
Capita vs. Income in Uganda and Comparator Countries, 2006...............................30
Figure 4.2.Government Health Expenditure per Capita in Uganda, 2000-05.................31
Figure 4.3. Composition of Health Sector Budget (Excl. Donor Projects). Fiscal
2003/04 to 2005/06............................................................................................................32
Figure 4.4. Health Sector Recurrent Budget, Fiscal 1997/98 to 2006/07............................33
Figure 4.5. Health Expenditure as Percentage of Total Expenditure and
Catastrophic Health Expenditure in Uganda, 2000-05...............................................35
Figure 4.6. Official DAH to Uganda, 2000-06......................................................................36
Figure 7.1. Representation of Fiscal Space by a Fiscal Space Diamond...........................49
Figure 7.2. Elasticity of Government Health Expenditure re: GDP in Uganda, 2000-
06........................................................................................................................................50
Figure 7.3. Health Expenditure per Capita in Low-income Countries; Health Share
of Government Budget in sub-Saharan Africa, 2005...................................................52
Figure 7.4. External Funds as Share of Total Health Expenditure vs. Income, 2006......54
Figure 7.5. Rank Correlation among District-level Life Expectancy, HDI, and DLT.....55
Figure 7.6. District-level Output Indicators.........................................................................56
Figure 7.7. District-level Input and Output Indicators.......................................................57
Figure 8.1. Disbursements vs. Commitments in Official Development Assistance
for Health in Uganda, 1996-06.......................................................................................61
Figure 8.2. ODA for Health versus ODA for HIV/AIDS....................................................61
Figure 8.3. Time it Would Take for MoFPED to Fully Finance Existing Donor
Commitments...................................................................................................................62
Figure 8.4. Evolution of Government Medical Staff and Total Health Resources
Available...........................................................................................................................66
Figure 8.5. Health Production Functions: Total Health Output Constrained in
Short Term by Labor Availability..................................................................................67
Boxes
Box 1.1.The Third PEAP...........................................................................................................5
Box 7.1. Linking Outputs to Inputs.......................................................................................58
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| geographic | Uganda (DE-588)4061457-8 gnd |
| geographic_facet | Uganda |
| id | DE-604.BV039540410 |
| illustrated | Illustrated |
| indexdate | 2024-07-10T00:05:50Z |
| institution | BVB |
| isbn | 9780821382905 |
| language | English |
| lccn | 2009054375 |
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| owner_facet | DE-703 |
| physical | XII, 76 S. graph. Darst. |
| publishDate | 2010 |
| publishDateSearch | 2010 |
| publishDateSort | 2010 |
| publisher | World Bank |
| record_format | marc |
| series | World Bank working paper |
| series2 | World Bank working paper Africa human development series |
| spelling | Fiscal space for health in Uganda Peter Okwero ; Ajay Tandon ; Susan Sparkes ; Julie McLaughlin ; Johannes G. Hoogeveen Washington, DC World Bank 2010 XII, 76 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier World Bank working paper 186 Africa human development series Public health Uganda Medical economics Uganda Health Expenditures Uganda Cost Control economics Uganda Efficiency, Organizational Uganda Financing, Government Uganda Health Care Sector organization & administration Uganda Steuersystem (DE-588)4183215-2 gnd rswk-swf Finanzierung (DE-588)4017182-6 gnd rswk-swf Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Uganda (DE-588)4061457-8 gnd rswk-swf Uganda (DE-588)4061457-8 g Gesundheitswesen (DE-588)4020775-4 s Finanzierung (DE-588)4017182-6 s Steuersystem (DE-588)4183215-2 s DE-604 Okwero, Peter Sonstige oth Tandon, Ajay Sonstige oth Sparkes, Susan Sonstige oth McLaughlin, Julie Sonstige (DE-588)142287180 oth Hoogeveen, Johannes 1968- Sonstige (DE-588)17182072X oth Erscheint auch als Online-Ausgabe 978-0-8213-8295-0 World Bank working paper 186 (DE-604)BV018160274 186 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024392505&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Fiscal space for health in Uganda World Bank working paper Public health Uganda Medical economics Uganda Health Expenditures Uganda Cost Control economics Uganda Efficiency, Organizational Uganda Financing, Government Uganda Health Care Sector organization & administration Uganda Steuersystem (DE-588)4183215-2 gnd Finanzierung (DE-588)4017182-6 gnd Gesundheitswesen (DE-588)4020775-4 gnd |
| subject_GND | (DE-588)4183215-2 (DE-588)4017182-6 (DE-588)4020775-4 (DE-588)4061457-8 |
| title | Fiscal space for health in Uganda |
| title_auth | Fiscal space for health in Uganda |
| title_exact_search | Fiscal space for health in Uganda |
| title_full | Fiscal space for health in Uganda Peter Okwero ; Ajay Tandon ; Susan Sparkes ; Julie McLaughlin ; Johannes G. Hoogeveen |
| title_fullStr | Fiscal space for health in Uganda Peter Okwero ; Ajay Tandon ; Susan Sparkes ; Julie McLaughlin ; Johannes G. Hoogeveen |
| title_full_unstemmed | Fiscal space for health in Uganda Peter Okwero ; Ajay Tandon ; Susan Sparkes ; Julie McLaughlin ; Johannes G. Hoogeveen |
| title_short | Fiscal space for health in Uganda |
| title_sort | fiscal space for health in uganda |
| topic | Public health Uganda Medical economics Uganda Health Expenditures Uganda Cost Control economics Uganda Efficiency, Organizational Uganda Financing, Government Uganda Health Care Sector organization & administration Uganda Steuersystem (DE-588)4183215-2 gnd Finanzierung (DE-588)4017182-6 gnd Gesundheitswesen (DE-588)4020775-4 gnd |
| topic_facet | Public health Uganda Medical economics Uganda Health Expenditures Uganda Cost Control economics Uganda Efficiency, Organizational Uganda Financing, Government Uganda Health Care Sector organization & administration Uganda Steuersystem Finanzierung Gesundheitswesen Uganda |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024392505&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV018160274 |
| work_keys_str_mv | AT okweropeter fiscalspaceforhealthinuganda AT tandonajay fiscalspaceforhealthinuganda AT sparkessusan fiscalspaceforhealthinuganda AT mclaughlinjulie fiscalspaceforhealthinuganda AT hoogeveenjohannes fiscalspaceforhealthinuganda |