Tafara Ngwaru, Adrian Gheorge, Tomas Lievens, Wu Zeng
Improving the effectiveness of available health resources in low- and middle-income countries has increasingly become important, as many countries attempt to map out their paths towards achieving universal health coverage (UHC). For many of these countries, a combination of increased health coverage targets, an increase of both communicable and non-communicable diseases, and (in some instances) a reduction in global support towards the health sector has enhanced the need to improve value for money (VFM) in this sector.
HIV programmes in Uganda have historically been largely funded by external donors. However, HIV programmes, and especially their scale up, will have to be increasingly funded out of domestic resources going forward. Uganda has sufficient available options to close the HIV funding gap, expected to arise with decreasing donor funding, with a mix of efficiency savings, increased public spending for HIV and earmarked funding from innovative sources, such as mobile, airline and alcohol levies.
However, these sources are not independent, as increased public spending is expected to have a positive impact on sector efficiency and effectiveness. As such, any proposed funding mix must take into consideration the impact on the effectiveness and efficiency of HIV service delivery. For Uganda, this raises a specific challenge: doubts about the effectiveness and the efficiency lead to key stakeholders being unwilling to increase public spending on HIV, despite the potentially large economic impact of not scaling up the HIV response. Even though scaling up the response will have to be predominantly financed out of domestic resources, efficiency savings might not prove to be sustainable, as they are notoriously complex to achieve and they take time to filter through to the budgeting process.
Our work will help inform the decision making process in establishing a sustainable approach to achieving access to universal health coverage in Uganda. Through reviewing available literature on VFM in health and HIV services, collecting data from health facilities, key service providers and suppliers, as well as conducting stakeholder workshops, we will develop an analytical framework on how to achieve efficiency savings in the HIV/AIDS subsector in Uganda.
This will help us address the following:
- Identify technical areas and activities to help improve the economy, efficiency and cost-efficiency of the Ugandan HIV response;
- Provide an indication of how these can be achieved, and within which timeframe;
- Provide an estimate of the financial savings they would generate, and when;
- Develop a number of key performance indicators that allow to track progress made in achieving these efficiency savings.
The results of this analysis will help provide the information on constructing a multi-year accountability framework to key HIV stakeholders in Uganda, mainly the Ministry of Health, the NAC and the Ministry of Finance.