Healthcare Funding in UK and Uganda

Healthcare Funding is one of those polarising topics that generates a lot of debate; people tend to feel quite strongly about their particular view on how this should be done. Just consider the debates raging today in the USA about Obamacare, in the UK about NHS reforms and in Uganda about the recent cut in the share of government budget allocated to the healthcare sector (down to 7.6% from 9.8% last year).

The Guardian recently presented data showing the spend on healthcare for 193 countries. Now we may have seen these data before but this time I noticed that the UK and Uganda spend almost the same when measured as a percentage of GDP.

Health spending as a % of GDP

Such a measure or that showing the comparative per capita spend will of course highlight just parts of a complex whole. These are measures of Input and do not tell us about the resulting Outcomes.

One of the problems in measuring just the spend is that we cannot easily tell how such spend is shared across the whole population. We know that the rich tend to access more than a fair share of the healthcare services and we can also see that in each country there are many who cannot always afford necessary care.

UK Uganda
Healthcare spending,
% of GDP
                  9.6                   9.0
Government spending on health as % of all health spending                    84                    22
Private spending on health as % of all health spending                    16                    78
Per capita total spending on health
(PPP int. $)
              3,480                  124
Nurses and midwives per 10,000 population                  101                    13
Doctors per 10,000 population                    27                      1

The Guardian says that it intends to add indicators of Outcomes that may help to make useful comparisons and give some sense of which country is doing best or which approach to healthcare funding is most effective.

In the meantime it has published the number of doctors, nurses and midwives per 10,000 population. Now this is not a direct measure of outcome but one would hope that it is a significant driver of good outcomes?

What I don’t understand is how these two countries can be spending similar percentages of GDP and yet the numbers of clinical staff being provided are very different.

It must mean that the budget is being allocated across various costs in very different ways. Perhaps the cost of drugs and treatments requires a higher percentage allocation in Uganda? Perhaps more of the budget is spent on central administration or on capital developments? Perhaps there is just a general lack of cost efficiencies or insufficient management and accountability of the monies being allocated.

In September 2011, in response to the UN General Assembly held in New York, the Uganda Ministry of Health stated that the country had a gap of more than 2,000 midwives, needed to help improve maternal and child health. Adding such a number would simply move the number of nurses and midwives per 10,000 population to 14.

If you would like to access the WHO data for Healthcare Funding in 193 countries and the comparative indicators discussed above then please use this link:

The BBC has a good explanation of what GDP is and how it is measured.

About Kevin Duffy

Interim Management and Consulting - Global Healthcare Development. Kevin has over ten years of senior management experience in the delivery of healthcare services in Africa and South Asia. His current focus is on the strategic development of policy, guidance, and tools to help healthcare organisations achieve sustainable impact – balancing the need to become financially sustainable, with the mission of ensuring equitable access to affordable healthcare services.
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