A microsimulation of the Uganda tax system (UGATAX) and the poor from 1999 to 2003

Like most developing countries, Uganda faces serious fiscal challenges in her effort to mobilize and effectively use resources for poverty reduction. however, the tax base remains small as reflected in the low tax-to-GDP. the government is under internal and external pressure to increase its domestic revenue collection and i turn, reduce its dependency on donors. In response to the pressure the government endeavored to maintain fiscal discipline, partly by raising taxes. the consequences of this move on the poor remains unclear. the main purpose of this paper is to throw light on the effects of alternative reforms to existing tax system on those households living in poverty. The analysis was carried out using the nationally representative Uganda national household survey of 1999/00 (UNHS I) using micro-simulation techniques. the key findings emerging from the analysis are: Increasing value added tax (VAT) other taxes unchanged will increase the tax burden of the poor but the non-poor households will continue paying more taxes relative to their expenditures that the poor households; Zero rating of the key taxable consumer items consumed by the poor would have little fiscal consequences. the amount of revenue forgone is less than the graduated tax (head tax) forgone; and the largest portion of the tax burden born by the poor households originates from VAT followed by excise duties and graduated tax.Taxation, Ssewanyana, Okidi, economic policy research center, Domestic revenue, Taxing systems, Poverty reduction, Consumer/Household Economics, Demand and Price Analysis, Financial Economics, Industrial Organization, Labor and Human Capital,

Gender and incidence of indirect taxation: Evidence from Uganda

Since the 1990's, Uganda system has undergone various reforms. However, both tax policies and reforms have been formulated without clearly indication the channels through which gender impacts on these policies/reforms. Using the national household survey of 2005/06, this paper provided insight into how tax policies and reforms on indirect taxes impact differently on women and men. The incidence rate of tax gender-based household typologies controlled by expenditure quintile brings out interesting findings. The incidence rate of indirect tax is significantly greater on households headed by male compared to their female counterparts regardless of income level. This also holds after controlling for the presence of children. More importantly, the impact on different households typologies is largely influenced by differences in consumption patterns. future tax reforms should take these gender differences in account as a means of improving the social welfare of every Ugandan.Tax policies, Tax reforms, Household expenditures, Ssewanyana, Economic policy research center, Community/Rural/Urban Development, Consumer/Household Economics, Demand and Price Analysis, Institutional and Behavioral Economics, Labor and Human Capital,

Linkages between poverty and land management in rural Uganda: evidence from the Uganda National Household Survey, 1999/00

"This study investigates the impacts of rural poverty on farmers' land management decisions, crop production and incomes, based upon analysis of data from the 1999/2000 Uganda National Household Survey. We find that the impacts of rural poverty on land management, crop production and income depend upon the type of poverty (i.e., what asset or access factor is constrained) and the type of land management considered...Our results suggest that improvement in smallholders' access to land, other assets, education, extension, market information, credit, roads, and off-farm opportunities can help to break the downward cycle of poverty and land degradation, and put farmers on a more sustainable development pathway. Access to land (area and quality), other assets, education and off-farm opportunities appear to be particularly important in addressing poverty directly, while other interventions are likely to have more indirect impacts, as they influence land management, crop choice, and other livelihood decisions. Given the importance of land as the major asset owned by poor rural households in Uganda, investing in land quality maintenance and improvement is a critical need. However, we found low marginal returns to investments in organic or inorganic fertilizer and other land management practices, suggesting that it will be difficult to get farmers to make such investments in the present environment. Improvements in the market environment as well as development of more profitable land management technologies appears essential to address this need." from Authors' Abstract

Demand for health care services in Uganda: Implications for poverty reduction

Using the 2002/03 Uganda National Household Survey data we empirically examine the nature and determinants of individuals’ decisions to seek care on condition of illness reporting. The major findings include: first, cost of care is regressive and substantially reduces the health care utilization for any formal provider by the poorer individuals after controlling for other factors. In other words, even among public facilities cost of care remains a barrier to utilization of these services. Second, there is no doubt that putting in place strategies aimed at increasing the income of the poor will increase their utilization of the health facilities, though the impact will be higher for private care. Third, besides income and cost of care, other factors, in particular education and physical access proxied by distance to the facilities are important determinants of health care utilization

Burden of sickle cell trait and disease in the Uganda Sickle Surveillance Study (US3): a cross-sectional study

Background Sickle cell disease contributes substantially to mortality in children younger than 5 years in sub-Saharan Africa. In Uganda, 20 000 babies per year are thought to be born with sickle cell disease, but accurate data are not available. We did the cross-sectional Uganda Sickle Surveillance Study to assess the burden of disease. Methods The primary objective of the study was to calculate prevalence of sickle cell trait and disease. We obtained punch samples from dried blood spots routinely collected from HIV-exposed infants in ten regions and 112 districts across Uganda for the national Early Infant Diagnosis programme. Haemoglobin electrophoresis by isoelectric focusing was done on all samples to identify those from babies with sickle trait or disease. Findings Between February, 2014, and March, 2015, 99 243 dried blood spots were analysed and results were available for 97 631. The overall number of children with sickle cell trait was 12 979 (13·3%) and with disease was 716 (0·7%). Sickle cell numbers ranged from 631 (4·6%) for trait and 23 (0·2%) for disease of 13 649 in the South Western region to 1306 (19·8%) for trait and 96 (1·5%) for disease of 6581 in the East Central region. Sickle cell trait was seen in all districts. The lowest prevalence was less than 3·0% in two districts. Eight districts had prevalence greater than 20·0%, with the highest being 23·9%. Sickle cell disease was less common in children older than 12 months or who were HIV positive, which is consistent with comorbidity and early mortality. Interpretation Prevalence of sickle cell trait and disease were high in Uganda, with notable variation between regions and districts. The data will help to inform national strategies for sickle cell disease, including neonatal screening

Quantification of anti-parasite and anti-disease immunity to malaria as a function of age and exposure.

Fundamental gaps remain in our understanding of how immunity to malaria develops. We used detailed clinical and entomological data from parallel cohort studies conducted across the malaria transmission spectrum in Uganda to quantify the development of immunity against symptomatic P. falciparum as a function of age and transmission intensity. We focus on: anti-parasite immunity (i.e. ability to control parasite densities) and anti-disease immunity (i.e. ability to tolerate higher parasite densities without fever). Our findings suggest a strong effect of age on both types of immunity, not explained by cumulative-exposure. They also show an independent effect of exposure, where children living in moderate/high transmission settings develop immunity faster as transmission increases. Surprisingly, children in the lowest transmission setting appear to develop immunity more efficiently than those living in moderate transmission settings. Anti-parasite and anti-disease immunity develop in parallel, reducing the probability of experiencing symptomatic malaria upon each subsequent P. falciparum infection

Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy-Experienced Ugandans With Virologic Failure.

BACKGROUND: Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus-positive persons with CD4 count <100 cells/μL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown. METHODS: We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (≥1000 copies/mL) using leftover plasma after viral load testing during September 2017-January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review. RESULTS: Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10-84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8-19.8]; P = .001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among those with viral loads <5000 copies/mL. CONCLUSIONS: In addition to the CD4 threshold of <100 cells/μL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL

Impact of COVID-19 on routine malaria indicators in rural Uganda: an interrupted time series analysis.

BACKGROUND: In March 2020, the government of Uganda implemented a strict lockdown policy in response to the COVID-19 pandemic. Interrupted time series analysis (ITSA) was performed to assess whether major changes in outpatient attendance, malaria burden, and case management occurred after the onset of the COVID-19 epidemic in rural Uganda. METHODS: Individual level data from all outpatient visits collected from April 2017 to March 2021 at 17 facilities were analysed. Outcomes included total outpatient visits, malaria cases, non-malarial visits, proportion of patients with suspected malaria, proportion of patients tested using rapid diagnostic tests (RDTs), and proportion of malaria cases prescribed artemether-lumefantrine (AL). Poisson regression with generalized estimating equations and fractional regression was used to model count and proportion outcomes, respectively. Pre-COVID trends (April 2017-March 2020) were used to predict the'expected' trend in the absence of COVID-19 introduction. Effects of COVID-19 were estimated over two six-month COVID-19 time periods (April 2020-September 2020 and October 2020-March 2021) by dividing observed values by expected values, and expressed as ratios. RESULTS: A total of 1,442,737 outpatient visits were recorded. Malaria was suspected in 55.3% of visits and 98.8% of these had a malaria diagnostic test performed. ITSA showed no differences between observed and expected total outpatient visits, malaria cases, non-malarial visits, or proportion of visits with suspected malaria after COVID-19 onset. However, in the second six months of the COVID-19 time period, there was a smaller mean proportion of patients tested with RDTs compared to expected (relative prevalence ratio (RPR) = 0.87, CI (0.78-0.97)) and a smaller mean proportion of malaria cases prescribed AL (RPR = 0.94, CI (0.90-0.99)). CONCLUSIONS: In the first year after the COVID-19 pandemic arrived in Uganda, there were no major effects on malaria disease burden and indicators of case management at these 17 rural health facilities, except for a modest decrease in the proportion of RDTs used for malaria diagnosis and the mean proportion of malaria cases prescribed AL in the second half of the COVID-19 pandemic year. Continued surveillance will be essential to monitor for changes in trends in malaria indicators so that Uganda can quickly and flexibly respond to challenges imposed by COVID-19

The Global Financial Crisis and Developing Countries: Phase 2 Synthesis

When the global financial crisis broke out in earnest in September 2008, it quickly became clear that developing countries would also be affected, but that the impacts would vary markedly. The Overseas Development Institute (ODI) coordinated a multi-country study over January-March 2009 involving developing country teams in 10 countries. This showed that, while the transmission mechanisms were similar in each (trade, private capital flows, remittances, aid), the effects varied by country, and much was not yet visible. As such, further country-specific monitoring was required. Most findings suggested that, as a result of time lags, the worst effects were yet to come. This synthesis of the effects of the global financial crisis on developing countries updates the description of the economic and social situation during the course of the crisis in 11 countries