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. 2020 Aug 12;20(1):741.
doi: 10.1186/s12913-020-05500-2.

What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments

Brendan Kwesiga  1 , Tom Aliti  2 , Pamela Nabukhonzo  3 , Susan Najuko  2 , Peter Byawaka  3 , Justine Hsu  4 , John E Ataguba  5 , Grace Kabaniha  6
Affiliations

What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments

Brendan Kwesiga et al. BMC Health Serv Res. .

Erratum in

Abstract

Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda.

Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10 and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda's national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.

Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection.

Conclusion: There is need for targeted interventions to reduce OOP, especially among those affected so as to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.

Keywords: Catastrophic health payments; Financial protection; Health; Health financing; Impoverishment; Trends; Uganda; Universal health coverage.

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Conflict of interest statement

All authors declare no competing interests.

References

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