Ssali, who is also a Global Public Health specialist, says Ugandan citizens have been turned into clients whose access to healthcare is determined by their own ability to pay, their location and socio-economic status.
Associate Professor Sarah Ssali, a senior lecturer of Gender
Studies at Makerere University has criticised government for absconding from
its responsibility of providing quality health care to citizens.
Ssali, who is also a Global Public Health specialist, says
Ugandan citizens have been turned into clients whose access to healthcare is
determined by their own ability to pay, their location and socio-economic
In her research, Ssali notes that despite the reforms made in
the health sector for the last 30 years, they are eroded the by little state
responsibility in providing healthcare to citizens who are now exposed to vagaries
of the market.
Ssali contends that the health sector in Uganda
continues to be elitist, urban based and serves those with the ability to pay.
In her paper titled; “Neoliberal health reforms and citizenship in Uganda” Ssali says
that Health sector restructuring has contributed to the exclusion and
marginalisation of wider sections of the population from accessing medical care.
She advises that if equity concerns are to be achieved, the
state and not the market, needs to be responsible for the citizen’s health.
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She notes that the current free market economy has created winners
and losers as well as re-fashioning citizens into clients in their own country.
“The winners, who with their newly acquired wealth can
afford state-of-the-art diagnostic healthcare in and outside the country from
facilities whose consultations are not less than UGX 60,000; and the losers,
the under-privileged, who cannot even access the most basic of health services
without depleting their few household resources,” Prof. Ssali observes.
Adding that; “The demographic majority of Ugandans are losers
in this health system. They are stuck with poor quality services or can only
access healthcare from private facilities by engaging in catastrophic
According to Ssali, out-of-pocket health expenditure
continues to rise from 91% in 1997 to 97.3% in 2015.
“This high household expenditure and limited insurance cover
could explain the increasing catastrophic health expenditures and subsequent
household poverty and impoverishment that have been noted by the Ministry of
Health,” she argues.
A 2014/15 Annual Health Sector Performance Report indicated
that while the Ministry of Health had registered improvement in all impact
factors, they were yet to register improvement in the percentage of households
experiencing catastrophic expenditures on health services.
A breakdown of households’ out-of-pocket payments shows that
most of it went to medicines, followed by hospital clinic charges,
consultations and traditional doctors’ fees/medicines.
Ssali notes that as a result of the rising cost of health
care especially consultation fees and high hospital or clinic charges, majority
of citizens are resorting to self-medication or cheaper public
healthcare, devoid of quality.
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A regional disaggregation shows that household healthcare
costs increased for all regions. However, the increment was highest in the
central Uganda, followed by western, eastern and northern region.
The study reveals that the rich and those residing in the
central region, with more privileged access to income and healthcare, were more
able to pay for the ever-rising costs of healthcare compared to those residing
in the more rural and post-conflict northern regions.
Ssali discloses that donor funds have been directed towards
sectoral programmes – typically for communicable diseases like HIV and Malaria
– rather than preventive healthcare.
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Government expenditure on health continues to be less than 10
per cent (or US$27 per capita) below the 15 per cent (or US$44 per capita)
recommended by the Abuja Declaration.
Donors remain the main source of financing for the health
sector. While about 97 per cent of healthcare costs are borne by households,
which makes these expenses one of the most burdensome for the poor.
The limited funding for Primary Health Care –PHC activities
could according to Ssali partly explain why several years after the reforms,
preventable illnesses such as malaria, malnutrition, respiratory tract
infections, AIDS, tuberculosis, perinatal and neonatal conditions remain the
leading causes of the disease burden, as was the case in 1988.
She contends that the neglect of preventive healthcare has
had a negative effect on the poor and it partly explains the sustained high
incidences of preventable diseases and associated high mortality rates.
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