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The challenge to restoring basic health care in Uganda


  • Okello, D. O.
  • Lubanga, R.
  • Guwatudde, D.
  • Sebina-Zziwa, A.


This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilites, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.

Suggested Citation

  • Okello, D. O. & Lubanga, R. & Guwatudde, D. & Sebina-Zziwa, A., 1998. "The challenge to restoring basic health care in Uganda," Social Science & Medicine, Elsevier, vol. 46(1), pages 13-21, January.
  • Handle: RePEc:eee:socmed:v:46:y:1998:i:1:p:13-21

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    Cited by:

    1. Kasirye, Ibrahim & Ssewanyana, Sarah & Nabyonga, Juliet & Lawson, David, 2004. "Demand for health care services in Uganda: Implications for poverty reduction," MPRA Paper 8558, University Library of Munich, Germany.
    2. Habtom, GebreMichael Kibreab & Ruys, Pieter, 2007. "The choice of a health care provider in Eritrea," Health Policy, Elsevier, vol. 80(1), pages 202-217, January.
    3. Habtom, G., 2006. "Health Care Governance in Developing Countries : The Case of Eritrea," Other publications TiSEM 289e6243-bb73-4d66-a6a1-8, Tilburg University, School of Economics and Management.
    4. Muyinda, Herbert & Mugisha, James, 2015. "Stock-outs, uncertainty and improvisation in access to healthcare in war-torn Northern Uganda," Social Science & Medicine, Elsevier, vol. 146(C), pages 316-323.
    5. Reinikka, Ritva & Svensson, Jakob, 2004. "Working for God?," CEPR Discussion Papers 4214, C.E.P.R. Discussion Papers.
    6. Reinikka, Ritva & Svensson, Jakob, 2003. "Working for God? evualuating service delivery of religious not-for-profit health care providers in Uganda," Policy Research Working Paper Series 3058, The World Bank.


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