A heated session of Parliament’s Public Accounts Committee (PAC) has exposed deep cracks in Uganda’s health financing system, with lawmakers questioning why patients continue to pay for critical services despite the Ministry of Health nearly exhausting its budget.
Officials from the Ministry, led by Permanent Secretary Dr. Diana Atwine, appeared before the committee on Thursday to respond to the Auditor General’s report for the financial year ending December 2025.
The meeting stretched into the evening, reflecting the weight of concerns raised by legislators. Despite the Ministry utilising 99.9 percent of its Shs228.8 billion budget, Members of Parliament highlighted persistent out-of-pocket payments, underfunded immunisation programmes, and weaknesses in procurement planning.
Kassanda North MP Patrick Nsamba Oshabe questioned the continued reliance on Non-Tax Revenue (NTR) collected from patients seeking specialised services such as X-rays and scans at regional referral hospitals.
“These are services our people cannot easily access elsewhere. If we already know how much is collected annually, why can’t government budget for them so that patients receive them free of charge?” he asked.
Nsamba argued that integrating such costs into the national budget would ease the financial burden on citizens and advance Uganda’s commitment to Universal Health Coverage.
In response, Ministry officials said NTR projections are centrally controlled, limiting the ability of health facilities to plan independently.
Dr. Atwine acknowledged the funding gaps, noting that government allocations often fall short of the actual cost of delivering services. She cited dialysis treatment at Kiruddu National Referral Hospital as an example. “A single dialysis session costs about Shs400,000.
The government contributes Shs215,000, leaving the patient to pay about Shs150,000. Yet a patient needs at least three sessions per week,” she explained.
This translates to roughly Shs1.2 million per week per patient, highlighting the heavy financial burden on individuals with chronic illnesses.
She noted that ideally, such services should be fully subsidised but emphasised the need for a sustainable financing mechanism.
“There is no country that can fully fund all healthcare needs without a strong pooled financing mechanism like a National Health Insurance or heritage fund,” she added.
The debate comes amid continued delays in implementing Uganda’s proposed National Health Insurance Scheme.
PAC Chairperson Gorett Namugga also raised concern over funding gaps in immunisation programmes, particularly as Uganda now vaccinates against at least 14 diseases under the Expanded Programme on Immunisation (EPI).
Dr. Atwine revealed that some vaccines remain underfunded, forcing the Ministry to seek supplementary budgets.
“We have quantified the gaps and engaged the Ministry of Finance, but often the funding comes late, affecting implementation,” she said.
Kalungu West MP Joseph Gonzaga Ssewungu questioned the Ministry’s reliance on external donors, noting declining and inconsistent support over the past five years.
Uganda’s immunisation programme has historically depended on partners such as Gavi, the Vaccine Alliance, but shifting donor priorities have increased pressure on domestic financing.
The Auditor General’s report paints a mixed performance picture. While budget absorption was high, only 36 out of 51 planned outputs were fully implemented, accounting for Shs148.3 billion.
The remaining 15 outputs worth Shs80.2 billion were only partially executed.“Failure to fully implement all activities hinders timely delivery of services and negates the purpose for which funds were availed,” the report states.
The audit also flagged non-compliance with procurement laws, citing failure to prepare multi-year procurement plans for projects worth Shs3.43 billion. Affected projects include the refurbishment of X-ray rooms in 20 hospitals, the construction of an incinerator at Fort Portal Regional Referral Hospital, and the disposal of obsolete equipment.
Auditors warned that such gaps could lead to delays or cancellation of critical projects. In its defence, the Ministry attributed some shortcomings to earlier limitations in the Electronic Government Procurement system and pledged improvements in planning and monitoring.
Dr. Atwine assured MPs that corrective measures, including strengthened work-plan tracking, will be implemented in the 2026/27 financial year.
Uganda’s health sector remains underfunded, with public health expenditure still below the 15 percent target set under the Abuja Declaration—leaving patients to shoulder a significant share of healthcare costs. URN