Rampant rising out-of-pocket healthcare costs are becoming a problem for Africa’s Uganda, the country’s Ministry of Health has warned. With 30% of the country’s 47 million people living below the poverty line, one single medical emergency could bring financial ruin to millions.
The burden of healthcare costs is not simply a health issue; it is a pressing economic concern. The World Bank estimates that having to bear the cost of healthcare pushes almost one million Ugandans into poverty every year.
Rising financial burden on Ugandans
Between 2019-2021, health spending in Uganda increased by about Shs88.3 billion (US$23.7 million), the Ministry of Health reported. This represents an increasing burden on households that, in the last two fiscal years, collectively incurred Shs2.30 trillion (US$753 million) in direct healthcare payments for services that were not covered by government resources and for essential self-medication.
Many families in Uganda are barely able to absorb this financial strain and worry that a single medical emergency could lead to financial ruin. The Ministry of Health has expressed concerns that these escalating costs are deterring individuals from seeking necessary medical treatment, especially lower-income families who cannot afford such expenses. The high cost of medical care is leading people to delay or completely forego seeking treatment which is concerning, according to pediatrician and Ugandan Cabinet Minister of Health, Jane Ruth Aceng.
“This is a recipe for worsening public health and could eventually lead to more serious health issues.”
The Ministry of Health’s concerns have been confirmed by the locals who DevelopmentAid interviewed.
Felicia Mutesi, a single mother, stated:
“I had to decide whether to buy my daughter’s medication or to pay for our daily food when she was sick. For days, I watched her suffer because I couldn’t afford the necessary care.”
“I have resorted to natural medicines to control my diabetes. The hospital expenses are so high and I cannot manage it. I have sold off almost all my animals in order to pay for the medical expenses,” 65-year-old farmer and father of 12, Abdul Mutebi, stated.
Ronald Wamale’s seven-year-old son suffered a gash on his tongue that split it in two. He took his son to a private hospital where he was informed that before any treatment, they must pay a US$500 medical fee.
“When I arrived with my son at 9:00 am, I was informed that my son’s medical costs totaled $500 and that I needed to pay the full amount before they could treat him,” Ronald recounted. “Most of us in Uganda, where medical insurance is practically nonexistent, are at risk when we fall ill.”
Government’s challenge with health funding
The Ugandan government continues to grapple with inequitable public health financing. The allocation of Shs5.85 trillion, or 8% of the overall budget, to the health sector is a 5.2% increase over the Shs5.56 trillion allocated in the previous year. However, a significant portion of healthcare expenditure is still derived from donor funding, which accounted for an alarming 50.9% in 2020/2021. The reliance on this mode of financing raises concerns about sustainability and the long-term viability of the healthcare system.
A World Bank report highlights the need for increased domestic spending to achieve universal health coverage. Currently, Uganda spends approximately US$50 per person annually which is in stark contrast to the recommended US$112 for low-and-middle-income nations.
As overnight hospital stays can cost as much as US$20, plus more for additional treatment or prescriptions, less well-off people can barely afford healthcare services even in emergency situations.
Commenting on the matter, Kenneth Mwehonge, Executive Director at Coalition for Health Promotion and Social Development, Uganda, noted:
“This state of things demands that domestic health spending be increased. Without a strategic shift in funding priorities, healthcare costs will continue to push vulnerable populations further into poverty.”
What is pushing the cost so high?
Stuart Raymond Kasule, a mental health advocate and suicide prevention trainer, argued that the rising costs of healthcare in Uganda are largely due to limited infrastructure, the increasing costs of essential drugs and supplies, economic challenges such as inflation and stagnant wages, underfunding of public health services, and the lack of medical insurance.
“Patients in Uganda seek out private services at greater charges as a result of the inadequate infrastructure in Ugandan healthcare facilities. Families are still required to pay for medical bills out of pocket because a sizable section of the population lacks health insurance, despite considerable improvement in this regard.”
Uganda’s health insurance program is not universally applicable and lacks a legislative foundation while it awaits the National Health Insurance Bill 2019 to be signed into law by the country’s President, Yoweri Kaguta Museveni. Therefore, while people working in the informal sector often have access to community-based health insurance, the employers of permanent employees and other organizations usually offer private medical insurance.
See also: Africa’s Uganda reports shrinking foreign aid, healthcare to be badly hit
The anticipated decline in reliance on donor support is another critical factor in the growth of the health insurance sector. As Ugandans look for proactive solutions to manage healthcare costs, there is a growing call for the establishment of a robust National Health Insurance Scheme which could not only reduce the financial burden faced by individuals but also serve to unify healthcare financing in a more equitable way.
