Government resource contributions to the private-not-for-profit sector in Uganda: evolution, adaptations and implications for universal health coverage
| Autor: | Freddie Ssengooba, Aloysius Ssennyonjo, Ronald Kasyaba, Justine Namakula, Sam Orach, Sara Bennett |
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| Rok vydání: | 2018 |
| Předmět: |
Financing
Government National Health Programs Organizations Nonprofit media_common.quotation_subject Qualitative property 03 medical and health sciences 0302 clinical medicine Resource (project management) Universal Health Insurance Universal health coverage Humans Uganda 030212 general & internal medicine Complex adaptive system Health policy Primary health care media_common Government Government subsidies Public economics Research lcsh:Public aspects of medicine 030503 health policy & services Health Policy Financing Organized Public Health Environmental and Occupational Health Health services research Complex adaptive systems lcsh:RA1-1270 Subsidy Private-not-for-profit Non-state providers Service (economics) Private Sector Business 0305 other medical science |
| Zdroj: | International Journal for Equity in Health, Vol 17, Iss 1, Pp 1-12 (2018) International Journal for Equity in Health |
| ISSN: | 1475-9276 |
| DOI: | 10.1186/s12939-018-0843-8 |
| Popis: | Background A case study was prepared examining government resource contributions (GRCs) to private-not-for-profit (PNFP) providers in Uganda. It focuses on Primary Health Care (PHC) grants to the largest non-profit provider network, the Uganda Catholic Medical Bureau (UCMB), from 1997 to 2015. The framework of complex adaptive systems was used to explain changes in resource contributions and the relationship between the Government and UCMB. Methods Documents and key informant interviews with the important actors provided the main sources of qualitative data. Trends for GRCs and service outputs for the study period were constructed from existing databases used to monitor service inputs and outputs. The case study’s findings were validated during two meetings with a broad set of stakeholders. Results Three major phases were identified in the evolution of GRCs and the relationship between the Government and UCMB: 1) Initiation, 2) Rapid increase in GRCs, and 3) Declining GRCs. The main factors affecting the relationship’s evolution were: 1) Financial deficits at PNFP facilities, 2) advocacy by PNFP network leaders, 3) changes in the government financial resource envelope, 4) variations in the “good will” of government actors, and 5) changes in donor funding modalities. Responses to the above dynamics included changes in user fees, operational costs of PNFPs, and government expectations of UCMB. Quantitative findings showed a progressive increase in service outputs despite the declining value of GRCs during the study period. Conclusions GRCs in Uganda have evolved influenced by various factors and the complex interactions between government and PNFPs. The Universal Health Coverage (UHC) agenda should pay attention to these factors and their interactions when shaping how governments work with PNFPs to advance UHC. GRCs could be leveraged to mitigate the financial burden on communities served by PNFPs. Governments seeking to advance UHC goals should explore policies to expand GRCs and other modalities to subsidize the operational costs of PNFPs. |
| Databáze: | OpenAIRE |
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