The economics of Uganda's health service sytem: implications for health and economic planning

Abstract

The major purpose of this atudy is to analyse the economic inplications of tge health service system of Uganda. An analytical framework is constructed in order to (a) isolate the economic implications of resource allocation decisions made in the several components of the health service system and (b) analyze the macro-economic impact of the health service system. The thesis focuses on the output of the health service of Uganda, the differences in the alternative curative health service prodution processes and the conomic inplications of the choices available to health and economic planners involved in the development of haelth service throughut the country. The analysis begins with information as to the economic context in which health services are provided in Uganda. The manpower, financial and institutional characteristics of the health service sytem are described. Analysis is made of the changing pattern of demand for curative health services, away from the predominance of infectious and parasitic diseases toward a demand which increasingly includes health problems related to malnutrition and maternal and child health. The focus of the studyshifts from the emperical setting o Uganda's health service sytem to a major theoretical issue in medical economics. Prevalent conceptualizations of the output of a curative health service system are examined and found lacking. An alternative conceptualization of output is developed , with particular attention to the non-homogenous and qualitative nature of the output. A methodology is proposed for the development of an ampirical measure of health service sytem output. A linear programming framework is then developed, incorporating the output conceptualization , in order to examine the relationships between resources utilizad in the production of health services and the number of successfully treate persons. The framework developed, also accounts for the multi- product nature of Uganda's health facilities. In addition, a methodology is developed for examining the long-rum affect of socio-econimic and health variables on (a) the resources available for the prodution of health services, (b) the number of persons, with given age, sex and disease characteristics, demandinf health services, and (c) the probability of successful treatment. An empirical comparative analysis utilizing the linear programming framework is made of three subsectors of Uganda's health service system: (1) government hospitals, (2) mission hospitals, and (3) government rural health facilities with inpatient services. Using an objective function derived fram the government's atated health objectives, the analysis reveals that despite a commom assumption that doctors , nurses and beds are in short supply, considerable excess capacity exixts in those factors in both hispital sectors and , to some extent, in rural units as well. The most biding supply constraints apper in such specialized disgnostic resources an lab and radiographic technicians. At the macro level, the analysis focuses on the inpact of the health service system on (a) the rate of population grouth, (b) the rate of change in the age structure, (c) the balance of payments, (d) employment and its distribution, and(e) the extent to which the resources used in the delivery of health services were equitably distributed. Finding related to the demographic variables were weak but generally consistent within the theory of demographic transition. Concluding remarks highlight the health and economic policy implications of the study, particularly with respect to Uganda's health manpower training atrategy. Future research activities having health policy relavance in Uganda and similar ountries are suggested.