Ugandan health systems reforms: miracle or mirage?


Poor health indicators in the 1990s prompted the Government of Uganda and development partners to embark on an extensive programme of health systems reforms to improve sector performance. This paper attempts to assess the significance of these changes. Is it a miracle of improved efficiency or a mirage unlikely to lead to improved health outcomes? The paper tries to identify the key reforms within health and across government which may be responsible for the changes in output performance. It highlights a number of supply side reforms, which have increased the availability of essential inputs. In addition, a major demand side policy (abolishing user fees) had a significant impact on the consumption of services. The paper concludes that increased utilisation of ambulatory services does signify improvements in consumer welfare and therefore health sector performance. However, stagnant maternity outputs indicate that key in-patient services are still not meeting the expectations of the population. Only reliable outcome data will resolve the debate about the significance of the changes in output indicators. Further research will also be required to disentangle the relative impact of the different components of the reforms.


In: Tashobya, C.; Ssengooba, F.; Oliveira-Cruz, V. (eds), Health systems reforms in Uganda: processes and outputs, London: Health Systems Development Programme, LSHTM, chp 1, pp 15-28, ISBN: 0 902657 77 1, 2006.

Ugandan health systems reforms: miracle or mirage?

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