The 2013/2014 budget allocations to the health sector could see lower level health centers and district hospitals provide inadequate services to the majority rural poor.
With a large majority of Ugandans living up country, on average some health facilities will have a budget of 120,000 shillings per month to deliver required services.
The health sector received 8.7 percent share of the total national budget amounting to government funding of 707.02 billion shillings and donors will contribute 416.6 billion shillings.
A coalition of health civil society organisations are however disappointed that the Ministry of Health headquarters will be bagging a whopping 462.6 billion shillings especially out of the donor funding.
Denis Odwe, the executive Director Action Group for Health, Human Rights and HIV/AIDS, points out that only 41.1 billion shillings has been allocated as recurrent budget to run health service delivery in 137 local governments with 56 general hospitals, 61 Private not-for-profit hospitals and 4,205 lower level health units.
Odwe notes that investment in capital development has not been followed by commensurate increments in the maintenance budgets. Also, the bulk of medical equipment and other health infrastructure procured over years remain unmaintained and under-utilized.
The health organisations cite the maintenance contract for the imaging equipment such as X-ray machines and ultra sound scanners for 18 hospitals and 30 health centre fours expired in the financial year 2011/12.
Under primary health care, Odwe in his presentation to the Health Committee of Parliament notes that local government financing to deliver maternal and child health outputs is likely to be affected by reductions in the budget. The budget for clinical and public health will reduce by 1.9 billion shillings yet it is responsible for monitoring the roadmap for maternal health, performing independent maternal death audits, and establishing surgical camps for family planning and fistula repair activities.
In addition, the allocation to cover only 60 districts is responsible to ensure compliance with standards for new born and child health care.
Samuel Senfuka, a project officer with Uganda White Ribbon Alliance, points out that the budget for health service commission will remain the same as that of the 2012/2013 at 3.58 billion shillings to facilitate recruitment of 800 health workers of all categories. However, the target of 800 has been the same since the financial year 2004/2005.
During the financial year 2012/2013 the health ministry attempted to fill vacant posts at Health centres Three and Four totalling to 10,210. There was also enhancement for wages for Doctors at Health Centers Four to 2.5 million shillings per month.
However only 8,079 health workers were recruited and 6,839 reported for work. Of those who reported to work only 5,037 accessed the payroll which means the lower level health centres have a human resource gap of 3,371.
The health CSOs thus recommend that government should provide additional 20 percent funds across the board to enhance salaries for midwives and nurses. Others include critical cadres such as enrolled midwives, Anesthetist officers and assistants and laboratory technicians totalling to 5234.
They also recommend provision of a development budget for district hospitals to improve the referral system and increase capacity of local government. They want government to also provide additional 2.5 billion shillings to renew maintenance contracts for imaging equipment among others.