With continuous grumbling with the bill and policy of social health insurance, the Ugandan health system still seems hard to fix if political and health leaders fail to address some vital failures in the public health sector.........we need to remember that; to adequately respond to the significant costs of financing public health provision, many developing nations around the world have adopted several mechanism included tax funded or health insurance (WHO, 2001). These two mechanisms of health care financing are recognized to be the more dominant methods, in particular to achieve universal healthcare coverage for low income earners (Carrin, Waelkens and Criel, 2005). User fees in form of out of pocket charges are also another source of health care financing (Russell S, and Gilson L, 1997). The increasing application of user fees is due to the fact that most low income countries lack sufficient public resources and such countries are also beset by low institutional capacity to effectively utilize domestically generated resources to finance development objectives including improved healthcare outcomes. In addition, health insurance has also been limited mostly to formal sector workers.
The Government of Uganda abolished health care user fees in 2001 in the general wings of public-owned hospitals and lower level health facilities, but retained them in the private wings of public hospitals. This has contributed to stagnation in achievement of health outcomes particularly infant and maternal mortality. For instance, infant mortality, at 76 deaths per 100,000 live births in 2006, though lower than 122 deaths in 1991 is still short of the MDG target. Maternal mortality is also still high at 435 in 2006. Further, country medicines surveillance data reveals that only 28% of the sampled health facilities surveyed in 2007 had continuous availability of the six tracer medicines (Ministry of Uganda, GoU, 2009). Consequently, there is a need to examine the various options for healthcare financing so as to identify practical and complementary ways of enhancing public provision of healthcare in Uganda.