The Funding Conundrum of a Typical Rural Health Centre

Two weeks back, News-Hapa received an announcement from a citizen who was happy that her local health centre IV had passed a budget of sh200m for the 2013/2014 financial year. The citizen was Obadia Kisembo of Kyabarungira sub-county in Kasese. The facility; Rwensande Health Centre IV.

The sh200m a year figure struck the News-Hapa editorial team as interesting for two very contrasting reasons; modesty and outlandishness.

The figure appears modest because a health centre IV is a major facility that should include; outpatient and inpatient services, wards, operating theatre, laboratory and blood transfusion services. A typical one in Uganda serves a population of about 187,000 people according to the 2011 Health System Assessment by USAID. At sh200m, a year, such a facility was banking on being able to offer all these services at a total operating expense of sh546,000 a day or setting aside UGX1,069 a year for each of its potential patients. We were further intrigued when we contacted the doctor in charge of the health centre and he refuted our figure saying the budget is actually lower. "It is about sh120m," said Seth Shirenda.

On the other hand, the figure is outlandish when seen from the perspective of the government's resource basket. Data from the government's budget website shows that last year, "UGX10,795,638 was allocated to Rwesande H/C IV." Where then would the more than 10 fold figure budgeted for this year come from? "We usually have development partners who come in to assist us and also cost share with patients." He cites NGOs like Baylor Uganda which is supporting HIV/AIDS care and a USAID project named STRIDES that is delivering family health services including family planning. Nonetheless, the rural often poor patient, still has to pay out of their own pockets, " for example by paying for consultation and operation expenses," as the medic explains.

As for you dear reader, when the local health centre is budgeting to spend UGX1,069 on your rural relative for a whole year, and your government is likely to contribute about UGX58 to that, yes, you definitely have to send them that mobile money whenever they fall ill.

- July 19, 2013
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