Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

Document Type : Original Article


1 Department of Economics and Management, University of Florence, Florence, Italy

2 Doctors with Africa CUAMM, Padova, Italy


As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme.
This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. 
The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector.

We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship.
By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.



Commentaries Published on this Paper


  •  Beyond “Lack of Political Will”: Elaborating Political Economy Concepts to Advance “Thinking and Working Politically”; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  •  How to Achieve Universal Health Coverage: A Case Study of Uganda Using the Political Process Model; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  • Health Financing Reforms in Uganda: Dispelling the Fears and Misconceptions Related to Introduction of a National Health Insurance Scheme; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  • COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  • A Historical Legacy for Universal Health Coverage in the Republic of Korea: Moving Towards Health Coverage and Financial Protection in Uganda; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  •  Comparative Politics, Political Settlements, and the Political Economy of Health Financing Reform; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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  • Advancing Empirics and Theory for a Deeper Political Economy Analysis; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

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Volume 11, Issue 9
September 2022
Pages 1894-1904
  • Receive Date: 06 August 2020
  • Revise Date: 06 August 2021
  • Accept Date: 23 August 2021
  • First Publish Date: 29 August 2021