世界银行-增加乌干达卫生财政空间的可行性（英）-2025_45页_814kb

Summary of the Feasibility of Increasing Fiscal Space for Health in Uganda

Core Content

This report evaluates the feasibility of increasing fiscal space for health in Uganda, focusing on five key areas: Conducive Macroeconomic Conditions, Reprioritization for Health, Health Sector-Specific Domestic Resources, External Resources, and Improved Efficiency. The goal is to support the expansion of health financing to achieve Universal Health Coverage (UHC) and address the country's health challenges.

Main Findings

1. Conducive Macroeconomic Conditions

• Uganda's macroeconomic outlook from 2025 to 2029 is positive, with an average annual real GDP growth rate of 7.6%.
• The GDP per capita is projected to reach US$1,025.28 annually by 2029/30.
• With improved economic conditions, Uganda has the potential to increase the tax-to-GDP ratio from the current 12.5% to 16%.
• The share of general government revenue (excluding grants) as a percentage of GDP is expected to rise to 18% by 2029/30, which could be allocated to the health sector.
• The general government gross debt as a percentage of GDP is projected to be 42.4%, indicating a potential for increased government spending, including on health.

2. Reprioritization for Health

• Increasing the government health budget (GHB) as a share of the total national government budget (TGB) presents the largest short-term potential for increasing fiscal space.
• Currently, GHB constitutes 8% of TGB, and raising it to 10%, 12%, or 15% could generate US$326 million, US$783 million, or US$1,468 million annually by 2029/30.
• The study emphasizes the need to align economic growth with increased public health spending.

3. Health Sector-Specific Domestic Resources

• Health taxes: A 20% increase in taxes on cigarettes, beers, spirits, wines, and soft drinks could generate US$156.6 million annually by 2029/30, equivalent to US$2.8 per capita.
  • This would result in a 5% reduction in beer consumption and 3% reduction in cigarette and soft drink consumption.
  • These measures are expected to reduce premature deaths and increase health system funding.
• Motor vehicle accident fund: A 5% levy on gross third-party motor vehicle insurance premiums could generate US$1.3 million annually by 2029/30, or US$0.02 per capita.
  • This would help cover costs associated with road traffic injuries, which account for 45% of all hospital admissions.
  • A dedicated Motor Vehicle Accident Fund could be established to manage these funds effectively.
• National Health Insurance (NHI): While not quantified in this study, the report suggests that Uganda should gather more evidence on the feasibility of NHI, including an actuarial evaluation.
  • The NHI could focus on strategic purchasing and targeted health services.
  • It would require funding from both contributory and non-contributory sources.

4. External Resources

• Development Assistance for Health (DAH) currently constitutes 42% of total current health expenditure (CHE), which is high.
• Due to global events such as the Israel-Palestine and Russia-Ukraine conflicts, and a shift in USG aid policy, DAH is expected to decline by 40-50% over the period 2025/26-2029/30.
• Uganda is one of the top recipients of USG health funding, which may be adversely affected by policy changes.
• The report recommends transitioning to domestic funding and implementing a comprehensive transition plan to reduce dependency on external resources.

5. Improved Efficiency

• The health sector in Uganda faces allocative and technical inefficiencies, including:
  • Low execution and absorption of funds, especially from external financing.
  • Fragmentation and duplication of DAH.
  • High absenteeism and low productivity among health workers.
  • Corrupt procurement practices.
• These inefficiencies are estimated to cost US$660 million annually by 2029/30, or US$11.8 per capita.
• Improving efficiency does not directly increase health funding but enhances value-for-money and effectiveness.

Key Recommendations

• Implement tax reforms to improve tax revenue collection and increase the tax-to-GDP ratio.
• Maintain fiscal discipline and a stable economic environment to sustain growth and revenue generation.
• Raise the GHB as a share of TGB from 8% to 10%, 12%, or 15% to increase domestic health funding.
• Increase health taxes on unhealthy products by 20%, with potential for 50% increases in the medium term.
• Introduce a 5% levy on third-party motor vehicle insurance premiums to fund road accident victims.
• Establish a Motor Vehicle Accident Fund to ensure efficient allocation of funds.
• Gather evidence on the feasibility of National Health Insurance (NHI) and conduct actuarial evaluations.
• Strengthen Public Financial Management (PFM) systems to reduce inefficiencies and corruption.
• Develop a transition plan to shift from DAH to domestic funding, including on-budget support and virtual pooling mechanisms.
• Improve procurement and supply chain management, and scale up digital health to enhance performance and reduce waste.

Estimated Fiscal Space by 2029/30

• Total potential fiscal space: US$1,626 million annually, or US$29.1 per capita.
• This assumes an ambitious scenario across all five areas.
• However, efficiency improvements are not included in the fiscal space estimate, as they do not directly increase funding but improve resource utilization.

Conclusion

Uganda has the potential to increase its fiscal space for health through a combination of macroeconomic growth, budget reprioritization, and domestic resource mobilization. However, efficiency improvements are critical to ensuring that the additional funds are used effectively to meet the growing health needs of the population. The study underscores the importance of strategic planning, policy reforms, and governance improvements in achieving Universal Health Coverage (UHC) and strengthening the health system.