Tracking resource and policy impact in Uganda : Incorporating millennium development goals & indicators and poverty reduction strategy paper monitoring across sector

This report, prepared by Uganda Bureau of Statistics and Statistics Norway, demonstrates how the effects of allocations of resources in Uganda within the health, education and water and sanitation sectors might be monitored. The information presented aims at allowing the reader to follow resource allocation from policy decisions towards human welfare and poverty reduction. Using indicators from the Uganda Poverty Eradication Action Program and the Millennium Development goals, the report provides information for policy makers in Uganda and elsewhere. Available data show different trends in the three sectors. Five main recommendations are presented: 1) Consider establishing a database and publish yearly reports for tracking resource and policy impact at the national level, 2) Coordinating definitions, indicators and the statistical system, 3) Strengthening capacity within line ministries to develop indicators for performance in all sectors, 4) Improving the system of data compilation on the district - and not only regional - level and 5) Improving the compilation of data on private expenditures

Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda

There is currently considerable discussion between governments, international agencies, bilateral donors and advocacy groups on whether user fees levied at government health facilities in poor countries should be abolished. It is claimed that this would lead to greater access for the poor and reduce the risks of catastrophic health expenditures if all other factors remained constant, though other factors rarely remain constant in practice. Accordingly, it is important to understand what has actually happened when user fees have been abolished, and why. All fees at first level government health facilities in Uganda were removed in March 2001. This study explores the impact on health service utilization and catastrophic health expenditures using data from National Household Surveys undertaken in 1997, 2000 and 2003. Utilization increased for the non-poor, but at a lower rate than it had in the period immediately before fees were abolished. Utilization among the poor increased much more rapidly after the abolition of fees than beforehand. Unexpectedly, the incidence of catastrophic health expenditure among the poor did not fall. The most likely explanation is that frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies. Informal payments to health workers may also have increased to offset the lost revenue from fees. Countries thinking of removing user charges should first examine what types of activities and inputs at the facility level are funded from the revenue collected by fees, and then develop mechanisms to ensure that these activities can be sustained subsequently.User charges Service utilization Catastrophic expenditure Uganda