%0 Journal Article %T Is health care financing in Uganda equitable? %A CM Zikusooka %A R Kyomuhang %A JN Orem %A M Tumwine %J African Health Sciences %D 2009 %I Makerere University Medical School %X Introduction: Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on: financial protection, progressive financing and cross-subsidies. This paper describes Uganda¡¯s health care financing landscape and documents the key equity issues associated with the current financing mechanisms. Methods: We extensively reviewed government documents and relevant literature and conducted key informant interviews, with the aim of assessing whether Uganda¡¯s health care financing mechanisms exhibited the key principles of fair financing. Results: Uganda¡¯s health sector remains significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending. At 9.6 % of total government expenditure, public spending on health is far below the Abuja target of 15% that GoU committed to. Prepayments form a small proportion of funding for Uganda¡¯s health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms, mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance, Uganda has limited pooling of resources, and hence minimal cross-subsidisation. Although tax revenue is equitable, the remaining financing mechanisms for Uganda are inequitable due to their regressive nature, their lack of financial protection and limited cross-subsidisation. Conclusion: Overall, Uganda¡¯s current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes, enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms. African Health Sciences 2009; 9(S2):S52-S58 %U http://www.ajol.info/index.php/ahs/article/view/48655