KAMPALA – Uganda is set to read the national budget of about UGX. 53 trillion on 15 June 2023. The budget that takes effect on 01 July 2023, will be read by the finance minister, breaking down the approved budget into quarterly spending limits for Ministries, Departments and Agencies.
Commenting on the approved budget estimates ahead of the highly-anticipated budget reading, a group of Civil Society Organisations and female leaders in the Parliament of Uganda expressed fear about less financing in some areas especially in health and mindset change.
Forum for Women in Democracy – FOWODE, Center for Health, Human Rights and Development – CEHURD and in collaboration with Hon Flavia Kabahenda and Hon Flavia Nabagabe, and Hon Sarah Opendi noted that although the budget has already been passed, advocacy on issues they feel are pertinent continues, with the view of influencing budget execution and pushing for the inclusion of highlighted issues in the FY2024/25 budget process that will commence in August –September this year.
“We the members of Civil Society, specifically those promoting the rights of women and girls in all their diversity, having keenly followed the proceedings that led to the passing of the FY2023/24 Annual Budget Estimates by Parliament, and having reviewed other relevant documents such as Ministerial Policy Statements and sub-programme workplans, hereby highlight key concerns that we think have the most bearing on the lives of ordinary citizens, especially women and girls in the FY2023/24 budget that will be unveiled tomorrow,” said Patricia Munabi – Executive Director – Forum for Women in Democracy.
Budget cuts in the health sector amidst a Human Resource Crisis
The leaders agreed with the government for surpassing the NDP-III financing target for the Human Capital Development Programme, but showed the fear that the health sub-programme continues to suffer budget cuts.
According to the approved Annual Budget Estimates for FY2023/24, votes in the health sub-programme are set to suffer a UGX 181.6bn budget cut (excluding LG grants and KCCA) when compared to the FY2022/23 budget [UGX 338.6bn budget cut at MoH and UGX 25.5bn cut for Regional Referral Hospitals].
Munabi said that adequate staffing levels are a key element for ensuring effective healthcare delivery but there is an overall health system staffing gap of 35%.
She also highlighted the lack of blood transfusion services in at least 87 HC-IV’s and insufficient Comprehensive Emergency Obstetric and New-born Care at Health Centre-IV level caused by staffing gaps and inadequate equipment.
In spite of the highlighted gaps, the FY 2023/24 National Budget Framework paper (NBFP) indicated that the wage bill for the for delivery of Primary Health Care will be cut by UGX 3.483bn (from UGX 751.822bn in FY 2022/23 to UGX 748.339bn in the FY 2023/24).
The leaders say that these budget cuts come amidst an already escalating Human resource crisis with non-deployment of Medical Pre-Interns, salary delays for health workers, and already striking nurses in some health facilities.
“The absence of health staff disproportionately affects women and girls who have been found to heavily rely on public service delivery due to their weaker economic standing and gender roles.”
These want the government to safeguard the Health Sector Human Resources budget from cuts if it is to address the gaps identified in the budget strategy in relation to human resources for health.
They also urged the Ministry of Health to develop and submit a costed human resource plan elaborating how it intends to progressively cover the highlighted human resource gaps to the optimal levels that were set in the NDP-III framework.
Insufficient financing for Reproductive Maternal, New-born, Child and Adolescent Health (RMNCAH)
CSOs and female leaders commended the government for putting in place the RMNCAH Sharpened Plan II 2022/23–2027/28, which clearly stipulates the sector’s funding and policy priorities but noted that the sector continues to suffer challenges in staffing and inadequate funding for Reproductive Health supplies.
“The Reproductive and Child health Department currently has a 41% staffing gap, and the proliferation in number of districts has not helped the situation. About 50% (65 districts) of the districts in Uganda lack a substantive Assistant DHO- Maternal Child Health (ADHO-MCH), which constrains oversight and planning for Maternal health,” said Munabi.
“We would like to further commend the government for increasing allocation to Reproductive Health supplies in the forthcoming FY (from UGX 22bn in FY2022/23 to UGX 25.11bn in the FY 2023/24). This allocation notwithstanding, there is a big and persistent problem of stock outs for maternal lifesaving health commodities. For instance, the days of stock out of oxytocin have steadily increased since 2020 from 186,435 to 467,066. This means that many mothers must go out of government facilities and privately source these medicines and for many who may not afford and those in hard-to-reach areas, it propagates maternal death. This partly speaks to why at the NDP-III midterm target for Maternal Mortality Ratio (MMR) was not realised.”
They tasked the government to prioritize and allocate resources to close the 41% staffing gap in the Child health Department.
According to them, the National Medical Stores needs to target zero stock-out for maternal life-saving commodities through increased support to districts to adequately forecast and order the needed commodities but also have and deliver the requested commodities on time.
They also underscored the need for MoH to map out and explicitly link the RMNCAH sharpened plan II interventions to the Budget Framework to provide traceability of the maternal funding interventions as guided by the plan.
Declining Support for Gender Equality in Education
CSOs and female leaders say that while the gender unit has a critical role to play in planning for and monitoring the implementation of gender-responsive policies within the education sector, the unit is poorly funded and thus unable to fulfill its mandate.
“Funding for the gender unit has steadily been reduced over the years from UGX 154,435,203 in FY2019/20, to UGX 93,000,000 in FY2023/24, representing an over 39% reduction.”
Non-Prioritization of GBV/SGBV and Mindset Change Financing
Despite the presence of an elaborate legal and policy framework for Gender Based Violence (GBV) prevention and response in Uganda, the leaders say GBV is still widely spread with 56% of women having experienced physical violence at some point in their life and more than 1 in 5 women aged 15-49 (22%) report that they have experienced sexual violence compared with 1 in 10 (8%) men.
Nonetheless, the leaders expressed fears that the government still has not seen GBV/SGBV prevention, mitigation and management as a priority.
“The government is not investing enough in mindset change programming to eliminate negative cultural practices that drive up these numbers. The over 80% funding gap for the Community Mobilization and Mindset Change (CMMC) Programme (actual allocation compared with NDP-III funding targets), is a testimony to how little government values the programme’s contribution to National development.”
They urged the Government to urgently increase funding to support Community-Based Services Departments in local governments to facilitate coordination of GBV actors, sensitization of communities, protection of GBV survivors and running of the GBV information management system.
They commended the Government for continually improving its practice in gender-responsive allocation of resources although they say several areas where gender priorities have been allocated grossly inadequate funding, something they say risks undoing some of the gains made in promoting gender equality and equity.
