Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda.
Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the budget share of total household consumption expenditure. Health payments are impoverishing if they push the household below; the poverty line (using the US$1.90/day and Uganda’s national poverty lines). Logistic regression model is used to assess factors associated with household financial risk.
Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal and there is still a risk of reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. We show that the distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with households lacking financial risk protection.
Conclusion: To address the lack of financial risk protection, there is need for interventions aimed at reducing out-of-pocket payments especially among those most affected. In short term, it is important to ensure that there is increased funding for publicly financed services to enable effective coverage with quality health care. In the medium term, introducing mandatory prepayment through health insurance will further reduce the burden due to household expenditure.