The 2013/14 National budget falls short of promoting access to health facilities by the poor

The 2013/14 National budget falls short of promoting access to health facilities by the poor

Investment in the health sector is considered to be key for a country’s economic development. In 2013/2014 financial year, the government under the health sector will focus on reducing morbidity and mortality from the major causes of ill health and premature death and to reduce the disparities in the provision of health services. To achieve this, a number of interventions have been proposed, some of which include; recruitment of key health personnel to ensure adequate staffing, provision of staff housing for health workers with special attention to under-served areas, and improving the governance and efficiency in health service delivery through joint supervision and monitoring in collaboration with non-Governmental health institutions among others.
In the next financial year, the budget for the health sector is projected to rise from Ushs 852.2billion in FY 2012/13 to 940.4 billion in FY 2013/14, implying an increment of Ushs 88.2billion in nominal terms. Despite the nominal increment, the health sector share proportion of the national budget is projected to decline from 7.8% in 2012/13 to 7.4% next financial year, which is far below the Abuja declaration target of 15%. The increment in the sector budget is largely due to the increase in the recurrent budget which is projected to increase by about Ushs 45.6 billion. This increase is projected to consume over 63% of the sector budget, implying that the administrative costs remain high as a proportion of the sector budget, which is a major concern for the much needed investment required in the sector infrastructure, since less of these resources will be spent on actual service delivery. This perhaps explains why some health indicators are still poor. For instance, deliveries in health centres currently stand at about 40%, still below the 50% HSSIP target for 2011/12, infant and  maternal mortality are still high in the country among others.

With new tax proposals announced by the Finance Minster, the situation in the health sector is likely to worsen especially for those living in rural areas. The proposals to increase excise duty on petrol and diesel by 50/= and the increase in motorcycle registration fees by 70,000/= will affect access to health facilities by rural poor households since it will translate into an increase in bodaboda fares as the tax will be transferred to the final customer. Since boda bodas are the most common means of transport used in most rural areas to transport patients and expectant mothers to health facilities, this will affect access to health facilities by the poor households. Hence, the 88.2billion increment in the health sector is virtually meaningless to communities if they cannot access health facilities.

Government should invest more in Referral Hospitals FY 2013/14

Government should invest more in Referral Hospitals FY 2013/14

By Adellah Agaba

The National Health Policy is driven by the National Development Plan (NDP) which provides thematic areas of development including health, education, water and sanitation, agricultural production and human resources development and management.

The mission of the health sector is to attain a good standard of health for all people in Uganda. Sadly, geographical access to health care has been limited to about 49% of the population.

As a strategy to bring health services closer to the people, decentralization of health services was encouraged with an aim of taking services closer to the people and improve geographical access, particularly to the rural poor. The aim was further to lead to improved options for target group oriented health service delivery, and more transparency and accountability through closer responsibilities by the poor in rural areas.

However, the poor health facilities in health centres have left patients with no alternative but to go to referral hospitals leading to overcrowding and easy spread of disease. On a daily Mulago referral hospital among others receive an overwhelming number of patients’ per-day most of them from rural areas. This has taken a heavy toll on health service delivery at referral hospitals in Uganda. Any hospital, including a district hospital, will receive referrals from lower levels of care.  Referral hospitals come into play where health care providers at lower levels of the health system, lack the skills, the facilities, or both to manage a given clinical condition hence seek the assistance of providers at the referral hospitals.

Shockingly with the day to day increasing number of patients in the referral hospitals in Uganda, working conditions of health workers have become very difficult, characterized by poor infrastructure, lack of staff accommodation, inadequate equipment and supplies, work overload and inadequate remuneration. These poor working conditions do not attract staff nor motivate them to stay making it hard to have services adequately delivered to the intended beneficiaries in the hospitals.

It should be remembered that health is a key element of social and economic growth and its one of the major sectors that can directly impact on poverty eradication. With the budget for the health sector projected to rise from Ushs 852.2billion in FY 2012/13 to 940.4 billion in FY 2013/14, a lot of expectations from the citizens will have to be put into consideration. The health sector share proportion of the national budget is projected to decline from 7.8% in 2012/13 to 7.4% next financial year, and is far below the threshold of 15% agreed upon by African leaders in the Abuja declaration of 2001.

In Financial Year 2013/14, Government should invest more in referral hospitals and equip them with the basic drugs and facilities and ensure services are easily accessible to all citizens.

Vehicle maintenance and the process of disposing off of government vehicles

Vehicle maintenance and the process of disposing off of government vehicles

By Adellah Agaba

Uganda Debt Network is a policy advocacy organization working to promote and advocate for poor and marginalized people to participate in influencing poverty-focused policies, demand for their rights and monitor service delivery to ensure prudent, accountable and transparent resource generation and utilization. UDN is at the forefront of monitoring the utilization of government resources to the benefit of people of Uganda.

The government policy instrument on vehicles provides for the standardization of vehicles of government officials. However, this policy instrument continues to suffer abuse by the same officials who are obligated to keep government property in good condition. The fuel guzzling, costly vehicles end up making their maintenance costly to the disadvantage of tax payers in the country who still receive poor service delivery at the end of the day.

With the ever-increasing fleet of government vehicles, maintenance costs equally escalate in terms of garage costs, fuel, oils and lubricants. This then bears an implication on Government expenditure and consequently hikes our already huge domestic debt. When all is said and done, Uganda finds herself locked in this vicious cycle of debt and debt repayment. Fiscal indiscipline is one of the main causes of debt arrears as indicated in the Auditor General’s Report of 2010.

We acknowledge Government’s efforts to ensure that the country’s debt is sustainable. However, we also note that though the current Debt Strategy stipulates purposes for which the country should borrow, it does not provide for limits on the amount that the country should borrow. This puts the country in a precarious situation with the exaggerated expenditure that the government exhibits, which includes maintenance of government vehicles. 

Government’s unbalanced expenditure has led to increased instances of hefty allocations to public administration in the annual budgets and more stringent allocations to service delivery say in hospitals, where the common man benefits and this questions government capacity in setting its priorities. As per the Public Service Standing Orders, in addition to the maintenance of inventories for vehicles, plant and other equipment; log books or operating records must be maintained by recording a vehicle’s history, performance, servicing, overheads, and repairs in sufficient details for periodic assessments to be made of its performance, compared to its cost of upkeep. A public officer shall be held financially responsible for losses incurred on Government property which are due to his or her neglect or fault. 

Where a Responsible Officer considers that inventories, vehicles, plant, equipment etc, have reached the end of their useful life and are beyond economical repair; or are unserviceable; or have become redundant through obsolescence, he or she shall draw a list of the items giving details of the articles, and where appropriate, their age and approximate value. This list shall be submitted to the Accounting Officer requesting for appointment of a Board of Survey to inspect the items and make recommendations as to their condemnation and disposal. Hence, disposal of Government assets and property shall be in accordance with the law on Public Procurement and Disposal of Assets.

There is need for the reduction on the numbers of government vehicles so as to reduce on the cost of public administration. Government officials should adhere to the Public Service Standing Orders on the use and care of government vehicles and we encourage all ministries to monitor their respective vehicles as they carry out official work to avoid embarrassments that could injure their reputation in the public eye.

The main purpose of this campaign is to ensure the government expenditure is in line with its priorities of improving service delivery and the officials who hold government offices are accountable to the people they represent at all levels. A good public official is one who leads with integrity, transparency and is accountable to the citizens at all times. Let’s lead by example by being law abiding and protect government assets at all times.

 The writer works with Uganda Debt Network.

Money spent on Government Vehicles can change the face of Service Delivery in Uganda

Money spent on Government Vehicles can change the face of Service Delivery in Uganda

By Adellah Agaba

In the year 2012, the rising corruption scandals raised eye­brows in the donor world including Norway, Ireland, Denmark and United Kingdom among others, which led to donor suspension of aid to Uganda. This was a big blow to a country that has a large part of its national budget funded by donors. Mixed reactions from the public could not go unnoticed as everyone was concerned about what was going to happen to the different programmes in health, peace and restoration, education, to mention but a few that run on donor money.

This highly affected ministries whose bud­gets had to be cut to match the avail­able resources. However, there is a government expendi­ture that is hardly given attention yet it takes a big chunk of the bud­get if well analyzed and that is the day-to-day running of government vehicles.

According to the Audi­tor General’s Report of June 2010, government was spending Shs100bn annually to service the fleet of vehicles in all ministries. Everyone will agree that this money is a lot – not to be thought about as extravagant spending- making citizens lose faith in government’s capacity to spend public money responsibly for the benefit of all Ugandans.

Looking at the state of our social services in Uganda, it raises eyebrows as to whether anything is being done for the Wanainchi back at the grassroots. As a Ugandan, I am greatly concerned about the plight of primary school teachers, who have continued to dedi­cate their services to the people of Uganda yet have remained grossly underpaid. Most of these teachers continue to devotedly educate children of the rich while their own remain in poor schools, since they cannot afford to take them to decent schools.

In the health sector, the acute shortage of medi­cal personnel has affected the performance of clini­cal officers and nurses in that they have inevitably been called upon, from time to time, to assume tasks that are beyond their competence and which would have been carried out by doctors; leading to disastrous consequences often times. These and many more such mishaps arise due to the lack of even the most basic resources to cater for these social services that are essen­tial to all citizens.

With all this money being spent on vehicle maintenance in govern­ment institutions, it’s very disheartening to see public officials misuse their mandate and dis­regard laws that govern them in ensuring that gov­ernment property, which is maintained by tax pay­ers’ money, is taken care of efficiently. According to the Public Service Standing Orders, all public officers are bound by this law and ignorance of any provi­sion cannot in itself be accepted as an excuse for infringement of any part in the Standing Or­ders. A public servant is supposed to conduct his duties with dedication, diligence and integrity and is responsible for the property under his control or custody.

We are well aware that the state cannot carry out its activities without adequate transportation, especially in ensuring that services reach the in­tended beneficiaries. Thus, the fact that those vehicles must be serviced regularly is totally agreeable and logical. However, using government property outside work­ing hours – and worse still, to carry unofficial merchandise – makes one wonder if there is value for money, especially when government spends over Shs100bn on ve­hicle maintenance. This money, from a citizen’s point of view would rather be invested in ensuring quality service delivery, rather than on the huge fleet of government vehicles that are mismanaged by the responsible officers, loading the accruing burden on the tax payer.

It’s the duty of the relevant ministries to monitor the movement and use of their respective ve­hicles to avoid future embarrassments that could arise as a result of not obliging to the Public Service Standing Orders which is the “Bible” of all public officials. It’s also the duty of every citizen to monitor the use of government property because, together, we can encourage the officials to be account­able to the people they serve. The demand for accountability and pru­dent service delivery starts with you.

The Writer Works with Uganda Debt Network