Health Promises

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Human Resources for Health
Human resource is a critical pillar to quality health service delivery. Uganda’s Health system has failed to attract, motivate and retain a skilled workforce even with the 500 doctors, 128 specialists and 15,000 nurses and midwives exiting training institutions every year. 56% of district health leadership positions are substantively filled, 80% of doctors are attending to 20% of the population in urban centres. For the last 10 years staffing levels in the healthcare system have only increased by 23% (to the current 76%). Remuneration of Uganda’s Health workforce is the worst in the region.
Staffing Levels
Raise the staffing levels of the health workforce to 95% in the next five years by the following interventions;

Working with the Medical Associations, my government will roll out remuneration packages (including 20% salary raise in year one, hard-to-reach top-up allowances, provision of housing, access to financing, among others), opportunities for capacity-building and career progression. In my government, it will be difficult for health workers to shun upcountry/rural postings or migrate to other countries.

Establishing an electronic/digital Human Resource Management System to facilitate optimal outputs by reduction of absenteeism and ghost workers as well as improve performance. This will improve effectiveness and efficiency in the management of human resource.
Health Financing
My government will champion the policy shift that creates a hybrid of Government funding coupled with National Health insurance. The health insurance scheme will be for those who are economically productive and then my government will make a contribution to cover the deficit to care for the poor. This hybrid is expected to reduce the out of pocket expenditure that adversely affects the poor and vulnerable.

Financially liberated communities in my government will be able to afford Community Based Health Insurance Schemes (CBHIS) within one year (happening at low scale in Kisiizi and Nyakibale) for both formal and informal sectors. Social health insurance will be easily acceptable and affordable when more people have decent incomes. While the previous regime has spent over 6 years failing to roll this out, Rwanda increased coverage of health insurance from 3% to 96% within the same period.

This is expected to reduce the catastrophic out-of-pocket expenditure on health care.

Secondly, I propose to increase health expenditure that has stagnated at 7.5% to at least 12% of the total annual budget with-in the two year.

I will also shift to Results-Based Financing (RBF) as a new modality of purchase of health services. This modality is expected to improve efficiency in service delivery and also reduce on wastage and pilferage of precious resources
Leadership and Governance
Governance in Health involves giving strategic direction as well as making policies and regulations. I will work towards re-establishing Government Responsibility to steer the designing and implementation of policies and coordinating the implementation of the latter.

I will provide the following options to improve health governance;

Appoint and empower technocrats in key health leadership positions, quickly fill all substantive positions of district health officers, and relegating more powers to local governments in decision making for improved health services.

Policy shift from disease/medical-based to planning and budgeting for health to ensure Universal Health Coverage (UHC). The new focus would reduce health risk by integrating health components in other sectors such as education, water and sanitation, agriculture and environmental sectors.

Shift away from vertical programming for health interventions to more integrated health systems strengthening. This support to the health will be through the central government system and not stand-alone programs.
Commodity and supplies, technologies for Health
I believe that commodities and supplies for health are critical in maintaining a high quality of service. Constant stock out of essential drugs in public facilities are largely due to monopolized politics of one supply chain entity located in Kampala. There is the potential of this gap being closed by local manufacturers of generic medical products but no support has been given to them.

To immediately eliminate delays in drugs reaching health centres, we shall contract out the functions of our national medical stores like warehousing and distribution of medical products at regional level to eliminate monopoly, structural delays and increase efficiency. We shall work swiftly to provide market incentives and facilities for supporting local manufacturers of medical products.
Infrastructure
My government will continue with the modernization of existing public hospitals, upgrading infrastructure with the latest technologies. Several health facilities have been constructed but they remain unequipped let alone offer quality services. My government will work on 100% functionalization of health centre level IVs and higher to offer all services for all levels including but not limited to Emergency Obstetric and Neonatal services, Surgical services, and Child health. These facilities will be able to offer all services required for the level of the health facility.

Uganda has one of the biggest burdens of Road Traffic Incidents (RTIs) at 28.9 per 100,000 populations. Additionally, there are high maternal and perinatal deaths at 336 per 100,000 live births and 27 deaths per 1,000 live births respectively. Many of these deaths and adverse outcomes are due to big delays in accessing quality care. My government will build a referral and ambulance infrastructure that will include regional hubs to cover the major highways for emergency response to Road Traffic Accidents (RTA). The hubs will also take care of the inter-health facility referrals including those related to maternal health. Quick referral system will contribute to the 50% reduction to be achieved in the next 5 years.