Health versus Other sectors: Resource Allocation Preferences in Uganda

  • Public health surveillance
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Background:
Limited health sector spending and investment is a perennial challenge in Africa. Most health services are geo- graphically specific and so a central policy issue in many countries is how national (often tax-based) funds should be allocated to localities. Rather than relying on arbitrary Methods: of solving this “resource allocation” problem, such as historical precedent or political patronage, many health systems are seeking to place greater emphasis on the use of systematic funding formulae.
This study elicited Ugandan citizens’ preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey and examined how their stated preferences compared with actual government expenditures.
Methods:
This was a cross sectional descriptive study with quantitative data collection techniques. Data in this study was collected using a BWS survey to elicit respondents’ preferences through face to face interviews with heads of house- holds in 432 households from both rural and urban areas of Mukono district in central Uganda. We elicited citizens’ preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose from a subset of four sectors in 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents’ preferences with actual government budget allocations
Results:
Ugandan citizens’ preferences for resource allocation showed that overall the health sector was the top ranked sector based on citizens’ preferences, but was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Water and environment were also largely underfunded, ranked second in citizens’ preferences for resource allocation but tenth (4.6%) in actual budget allocation. Works and transport were over-funded, ranked sixth by citizens’ preferences but ranked first (22.1%) in budget allocation.
Conclusion
Policy makers in Uganda should take citizens’ preferences into consideration when discussing resource allocation and meet their calls to create more fiscal space for the health sector. Greater investment in health would satisfy citizens’ preferences and needs based on their choice.

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