Learning from failed health reform in Uganda

doi:10.1136/bmj.329.7475.1173

BMJ 2004;329:1173-1175 (13 November), doi:10.1136/bmj.329.7475.1173

Education and debate

Learning from failed health reform in Uganda

Sam Agatre Okuonzi, secretary general¹

¹ National Council for Children, PO Box 21456, Kampala, Uganda sokuonzi@infocom.co.ug

Evaluation of health care in developing countries from a Westernperspective is masking the failures of market based reforms

The first 150 words of the full text of this article appear below.

Introduction

Health reforms based on market principles have been introducedwidely in both developed and developing countries over the past20 years. In developing countries, international donors haveinsisted on health reform as a precondition of providing externalaid. The reform packages that have been introduced have beenstrikingly similar across countries as wide apart as Uganda,Bolivia, and Russia. Uganda embarked on market based healthreforms in 1994. These reforms have not only failed to improvehealth services and the health of the population but have arguablybeen the key factor behind their deterioration. What can welearn from Uganda's experience?

Health sector reforms in Uganda

Uganda introduced health sector reforms, defined by the WorldBank as market reforms, in 1994.¹ The reforms were based onfour cardinal market principles²:

Individuals, charities, and private organisations should bemade responsible for health care
Public funding of healthcare should be restricted to healthpromotion and . . . [Full text of this article]