High-Level Forum on the Health Millenium Development Goals
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High-Level Forum on the Health Millenium Development Goals Harmonization and MDGs: A perspective from . TANZANIA and UGANDA By Hon. Capt. G M Mukula Minister of State for Health - UGANDA. B. The future: Challenges and opportunities. Summary of the presentation

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High-Level Forum on the Health Millenium Development GoalsHarmonization and MDGs:A perspective from

TANZANIA and UGANDA

By Hon. Capt. G M Mukula

Minister of State for Health - UGANDA


B the future challenges and opportunities l.jpg
B. The future: Challenges and opportunities

Summary of the presentation

  • Best tool for setting national sector targets

  • Costs of reaching health MDGs

  • Can health MDGs be achieved with the resources available ?

  • How to scale up resources if macro-economic stability is more important than socio-economic development ?

  • Main bottlenecks in achieving health MDGS

  • Conclusion


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1. What is the best tool for setting national sector targets such as MDGs ?

  • Health MDGs should be addressed within comprehensive development framework including the national macro-economic framework

    • E.g. in Uganda and Tanzania – Vision 2025, PEAP/PRSP and HSSP

  • Different time horizons exist for PRSP/PEAP and MDGs indicators. And nationally set targets for MDGs may be different from global targets, in order to be realistic.


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1. What is the best tool for setting national sector targets such as MDGs ?

  • PRSPs are part of the national development plans and part of the process to achieve MDGs

  • The PAF tool in the Uganda and Output based budgeting.

  • MTEFs and LTEFS

  • SWAPs


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2. The costs of reaching the health MDGs such as MDGs ?

  • Detailed costing of MDGs:

    • should take into account local constraints, other related sectors and opportunities. It is complex.

    • Disease-specific costing exercises alone is not sufficient. Costing should take into account delivery of an integrated package of services.

  • Cost of delivery of the minimum package is estimated at US$ 30 to 40 per capita.

  • Cost of delivery of MDGs will be much higher.


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3. Can the health MDGs be achieved with the resources currently available ?

  • NO!! Resource gap exists.

  • GOU spends $7 per capita. Minimun package requires $28.

  • Attaining the MDGs requires a lot more additional resources.

  • Increasing efficiency of present use of resources is possible, but will not be sufficient without additional resources.

  • Achieving health MDGs is about “doing more of what we are doing now and doing it better”. This includes:

    • Building health systems, scaling up interventions

    • Reducing MMR requires improved access to emergency obstetric care and technically competent staff (which is expensive)

    • “CMR” requires well targeted multisectoral interventions


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Scenario currently available ?

  • GoU total budget grows at 6% per annum in real terms with health’s share increasing to 15% in five years.

  • Donor project funding remaining constant in real terms with global health funds replacing other project,

  • Therefore in order to close the gap by 2010, Uganda will need significant donor inflow and increased national budgetary allocation to the health sector.


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4. How to scale up if macroeconomic stability is more at stake than socio-economic development ?

Limits set to social sector budgets is the most important constraint for delivery of the minimum health package and the attainment of the MDGs.


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KEY QUESTION stake than socio-economic development ?

  • “How many more Maternal and Child deaths can we just accept for the sake of private sector development or the value of local currency?”

  • There is evidence that health actions (e.g immunisation coverage, HIV/AIDs, better malaria management and increased utilisation of health facilities) have contributed to the observed increase life expectancy in Uganda in the face of rising poverty.


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5. What are the main bottlenecks ? stake than socio-economic development ?

  • Financial resources gap and unpredictability of ODA

  • Weak Human resource base and management.

  • Teething problems of decentralisation.

  • Weak intersectoral collaboration.

  • Under developed private sector.


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6. Conclusion stake than socio-economic development ?

  • Achieving MDGs requires substantially more financial resources and predictability of ODA. Whereas there is clarity on the cost of funding the minimum health care package, the cost of delivering MDGs is high and not very clear,

  • Additional financial inflow should be directed at building health systems including human resources and increased allocation to health of budget support, with flexibility for project funding,

  • PRSPs are a process for achieving MDGs. They should be holistic and cross sectoral.

  • Recipient countries should be assisted to generate own resources through fair trade, debt relief etc.


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