Health Coverage and Financial Protection in Uganda: A Political Economy Perspective - Nannini et al (2022)

This paper analyses whether health financing policies can support progress towards universal health coverage (UHC) in low- and middle-income countries. It is based on a case of the abolition in 2001 by the government of Uganda of user-fees to improve accessibility to health services for the population. The paper finds that the incidence of catastrophic health expenditures is still very high after 20 years. Using a political economy perspective to examine the negotiation process for health financing reforms, it explains why the current political situation is not yet conducive for implementing a UHC system with widespread financial protection in Uganda: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship.