PATH is a global nonprofit dedicated to achieving health equity. With more than 40 years of experience forging multisector partnerships, and with expertise in science, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales up innovative solutions to the world’s most pressing health challenges.

INTRODUCTION 

Uganda’s health care system is still characterized by a high burden of disease amidst low functionality of health facilities. While the Uganda health sub-program was still grappling with a persistently high burden of common infections, maternal, child health, adolescents’ health, and nutrition complications, the health system was further burdened by the surge in the Covid-19 pandemic amidst the already existing health service delivery gaps.  

The Government of Uganda committed over the years to improving primary health services through adopting international and regional instruments and standards like the Sustainable Development Goals (SDGs) which provide for Universal Health Coverage and a number of policies and strategies at the national level which include Uganda Vision 2040, the National Development Plan  (NDP III) (2020/21 – 2024/25) , Health Sector Strategic and Investment Plan (2015/2016 – 2019/2020), Ministry of Health Strategic Plan (2021/2022 – 2025/2026), the Gender Policy, the Health Financing Strategy (2015/16 – 2024/25) among others.

The transition from sector-based planning and budgeting with the commencement of NDP III moved health to the Human Capital Development Program which requires resources of UGX 25,404 billion for the five years of implementation (FY 2020/21 – FY2024/25). The Ministry of Health Strategic Plan (2021/2022 – 2025/2026), requires funding of UGX 9.416 trillion for the 5 years of its implementation. However, the plan already has a financing gap of UGX 1.5 trillion and ranges between 12% to 31% annually over the five-year period of its implementation. More still, per capita health spending went down to USD 28 in 2019, showing a downward trend from USD 50 in 2014. The health out of pocket expenditure as a share of current health expenditure for Uganda was 38.4 % in 2018. The total current health expenditure per capita is estimated at $36.9 compared to the minimum recommended $86 by the World Health Organisation for low-income countries.

While the annual health sector performance reports show progress in implementation of commitments in the Ministerial Policy statements, gaps remain in overall sector performance against the targets set for each financial year and trends in performance gaps are mostly attributable to inadequate financing of the health sector. According to the National Budget Framework Paper (NBFP) 2020/21, a total of 5.1% of the national budget was allocated to the health sector. In FY 2021/2022 with the shift from sector to program-based budgeting, the health sector now falls within the Human Capital Development Program (HCDP) according to the NDP III framework.

The current budget for FY 2021/22 reduced to UGX 2,523.20 trillion down from UGX 2,781.84 trillion in FY 2020/21 indicating a reduction of UGX 258.64 bn. Current health financing is skewed towards curative health care with UGX 1,020.86 proposed for the FY 2021/22 as compared to UGX 11.40 bn for public health services, with the health program heavily reliant on external financing which has not been adequately tracked and analyzed. These inadequate allocations and investments subsequently negatively impact access to quality health care services by citizens in the key thematic areas; immunization, RMNCAH, medical oxygen and PHC.

In 2019, PATH conducted a study on Primary Health Care Financing trends in Uganda which indicated that the PHC Non-Wage grant was either reducing or remained constant.  More still, it observed major funding gaps at all levels of care. A case in point in June 2017, the PHC Non-Wage funding gaps were estimated to be 59% at District Health Offices, 63% at Health Centre IV level, 72% at Health Centre III level and 71% at Health Centre II level. Furthermore, as of FY 2018/19, the funding gaps in Credit and Non-Credit Line commodities of the Essential Medicines and Health Supplies were estimated to be 42% and 22% respectively. The funding gaps, however, were mostly seen to arise from the PHC funds allocation formulae which put much emphasis on population in determining district specific PHC allocations.

The follow-on study in 2020 on Utilization of Public Health Financing in Uganda’s Primary Health Care Program key findings indicated that; while spending at the central government level suffered from budget cuts, as demonstrated by shortfalls in the funds released to them, local governments and health facilities received most, if not all, of the funds in their approved budgets during the reference period. More still, while the MoH had issued Sector Guidelines for Budgeting and Utilizing PHC grants to health facilities, most actors at that level remained unaware of the guidelines or did not use them hence PHC budgeting and expenditure remained inconsistent at facility level.

PATH and partners in the recent past successfully advocated for changes in PHC grants allocation formulae; increased government investment in traditional vaccines; strengthened coordination of PHC implementing partners Partners, (one example being the Uganda CSO PHC Think Tank); and the revitalization of the Uganda Parliamentary Forum on Immunization (UPFI) to advance policy and financing for immunization at parliamentary level. However, gaps still exist in terms of evidence to inform budget advocacy for the health sub program in Uganda. It is on this basis that there is urgent need for analysis of financial resources to the Uganda health sub program (budget allocation for 2021/2022 to 2022/2023, and GOU supplementary budget allocation from March 2020 to June 2022). The above-mentioned study will provide evidence to inform effective advocacy for an improved budgetary allocation and mobilization of addition resources for the health sub program in the FY 2023/2024.  

It’s upon this background that PATH is seeking the services of a consultant to track financial resources to the Uganda health sub program (budget allocation for FY 2021/2022 to 2022/2023, and GOU supplementary budget allocation from March 2020 to June 2022). The study will provide evidence to engage different stakeholders including MOH, Ministry of Finance, Parliament, CSOs and development partners on key health program budget priorities and needs for FY2023/24. The analysis will also take stock of the unfunded health sub program priorities in the current health budget and generate recommendations that will influence policy makers to address the shortfalls in FY2023/2024.

GENERAL OBJECTIVE OF THE ASSIGNMENT  

To conduct analysis of financial resources to Uganda Health Sub Program (budget allocation and intra allocations for FY 2021/2022 to 2022/2023, and GOU supplementary budget allocation from March 2020 to June 2022) with a focus on; immunization, RMNCAH, medical oxygen and PHC to strengthen current evidence base for effective policy advocacy.

SPECIFIC OBJECTIVES

1. To conduct in-depth analysis of financial resources allocations and intra-allocations to the health sub program budget allocation for FY 2021/2022 to 2022/2023 with a focus on; immunization, RMNCAH, medical oxygen and PHC.
2. To conduct in-depth GOU supplementary budget allocation from March 2020 to June 2022 with a focus on; immunization, RMNCAH, medical oxygen and PHC.
3. To identify the current key bottlenecks to adequate budget allocation and investment in the health sub program with a focus on; immunization, RMNCAH, medical oxygen and PHC.
4. To develop a communique/policy brief of priority actions, potential impactful solutions, and recommendations in terms of specific budget allocations that policy makers can consider increasing funding for the health sub program in FY 2023/2024 with a focus on; immunization, RMNCAH, medical oxygen and PHC.

Required Skills Required Experience

SCOPE OF THE ASSIGNMENT

Analysis, through literature reviews of; National Budget Framework Papers, Budget speeches, Ministry of Health Ministerial Policy Statements, supplementary budgets to the health sub program, financial support from different development partners, NMS budget allocation, among other budget and policy documents. The consultant should also consider reviewing other budget-related policy documents not listed above to inform his/her analysis report.

The consultant will conduct targeted key informant interviews (KIIs) with officials from development partners, key decision makers within line ministries (Health, Finance, Local Government, etc) and other Ministries, Departments and Agencies (MDAs) to validate some of the information they will come across during the desk/literature review.

OUTPUTS/DELIVERABLES_  _

This assignment has the following deliverables:

1. Inception report prepared including methodology and tools submitted to PATH.
2. Draft study report submitted to PATH for input.
3. Final study report submitted to PATH.
4. Power point presentation/slide deck of the abridged version of the report.
5. Present the report in two PATH-organized virtual or physical meetings with stakeholders.
6. Prepare an issue paper/policy brief that can be published in the print media, using the data from the report to rally, sensitize and engage different stakeholders and development partners on the key issues.

SUPERVISION

The selected Consultant will work under the supervision of the Esther Nasikye (Advocacy and Policy Manger) and Deogratias Agaba (Senior Communications Officer).

DURATION

The entire assignment is expected to be completed within 20 working days. The consultant will be expected to provide a work plan schedule that fits within this plan.

QUALIFICATIONS AND EXPERIENCE REQUIRED.

The consultant will have proven experience of having carried out such an assignment before and shall have at least five years of experience conducting research, policy and budget analysis, evaluation, assessment, data analysis and reporting

• They must have at least a bachelor’s degree in Statistics, Economics, Social Sciences, Public Health and with significant exposure to conducting social research.
• Should have conducted similar assignments before with evidence of how effective their previous methods were.
• Should be available to start work in 30 days’ time.
• Should be fluent in English and have strong ability to produce a quality report.
• The consultant’s experience should be proven by at least two similar works (Completion certificates, testimonials, or recommendation letters). Greater weight will be on policy and budget advocacy/campaigning experience.

EXPRESS YOUR INTEREST

If you meet the requirements, submit your technical (Not more than 5 pages) and financial proposal by close of business 15TH APRIL, 2022  by email to: enasikye@path.org and copy to: ugprocurement@path.org

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