Ambassador Malac’s full speech at the East African Healthcare Federation Conference

As prepared for delivery

Remarks for East African Healthcare Federation Conference
U.S. Ambassador Deborah R. Malac
Monday, June 6, 2016, 8:45 AM
Sheraton Hotel, Kampala

  • Hon. Minister of Health, Elioda Tumwesigye,
  • Honorable Ministers from Rwanda and Tanzania,
  • Government representatives from Kenya,
  • Uganda Government representatives,
  • Non-governmental Organizations and Faith-based Organizations present,
  • Members of the Private Sector and Civil Society,
  • Distinguished Guests,
  • Ladies and Gentlemen,

    All Protocols Observed.

    Good morning, and thank you for inviting me to join you here today for the opening session of the 5th East African Health Federation Conference. It is good to see so many of you here from various countries in the region. This is a clear sign of the strong partnerships formed within the private health sector.

    Public-private partnerships are an important part of making development efforts successful and sustainable. Business objectives and development objectives converge especially well in the health sector. The theme of this conference, “The role of the private sector in attaining healthcare Sustainable Development Goals,” is both timely and relevant to our shared goals and objectives.

    Let me share with you some facts about the health care economy in Uganda, which will likely sound familiar to those you face in your own countries. Both the trends and challenges in Uganda highlight the opportunities for greater private sector involvement.

    Business Monitoring International ranks Uganda at 27 out of 50 on its risk/reward rating index for Africa and the Middle East. Population growth and increasing healthcare needs are creating a growing demand for pharmaceuticals and services. Unfortunately, a sizeable counterfeiting industry, poor health care funding, corruption and significant regulatory deficiencies are impeding Uganda’s progress in the short-term.

    Health spending in 2015 was about 2.1 billion dollars, of which about $400 million was on pharmaceuticals. The U.S. government also injects more than $100 million annually into drug procurement for anti-retroviral treatment. In addition, the United States provides $40 million for family planning, laboratory support, and other medical supplies.

    Per capita public spending for health care in Uganda is about $13 per person. The WHO recommends that public spending be $33 per person to provide a basic health care package. That disparity leaves the health sector here significantly underfunded. The human resources for health are also in a critical state, with only 58% of public sector positions filled, according to the Ministry of Health. Staffing shortages are even more acute given the high rate of absenteeism. The recent Global Fund for HIV, Malaria and Tuberculosis audit of funds found, among other things, pervasive stock-outs of key medicines and funds that could not be accounted for.

    Despite a public sector that is underfunded, understaffed and underperforming, Ugandans find better health care services in facilities run by faith-based organizations and the private sector. More than 62% of Ugandans pay for health services out of pocket because of the poor quality of services in public facilities. In fact, the private sector, including for-profit, non-governmental and faith-based organizations, plays a critical role in the delivery of health services, covering about 50% of reported outputs. Much of the private sector remains unregulated, leading to great variability in the capacity of providers, and quality and availability of services.

    Given these realities, how can public-private partnerships help bring better health care to Ugandans? Both sides need to do their part. From the public sector, there needs to be a renewed commitment to improving service delivery across the board. Like it or not, institutional reforms in the Ministry of Health and National Medical Stores are urgently needed to instill a new culture of accountability, transparency and service.

    The private sector can also play a role by advocating for reform and demanding accountability for its investments in the health care sector. Achieving public policy reform is never easy; it requires a persistent approach to build a constituency for positive change. We can all agree that Ugandans deserve better health services. The private sector can and should play a pivotal role in shaping government programs so they are more market oriented with the right incentives, not underfunded give-aways where standards deteriorate due to insufficient funds.

    Improving health care in Uganda is critical to achieving the aspirations of the Ugandan people as laid out in the new Sustainable Development Goals.

    This conference, sponsored by the Uganda Healthcare Federation, provides an opportunity for countries in the East Africa Community to learn from each other and identify new ways to accelerate progress. All five EAC partner states are affected by similar health problems, such as HIV/AIDS, malaria, and tuberculosis. Your time here is a unique opportunity for collaboration and integration.

    I applaud all that you have accomplished, and I am optimistic about what can be accomplished over the coming years. Your dedication and expertise are valuable and effective weapons in addressing the serious health challenges that confront Uganda and the region.

    As the world’s leading global health donor and the largest single nation provider of health assistance to Uganda, the United States is ready to work in true partnership with the Government of Uganda and the private sector. With this partnership, let us show by our actions and our own dedication that we are serious about serving the public and saving lives.

    Let me close by expressing appreciation, on behalf of the U.S. Government, for the partnerships we have formed with many of the private sector entities in this room. I thank you for your commitment to meeting the health needs of the public that access your facilities, your employees, and the surrounding community. We consider these partnerships to be global best practices and encourage you to continue to become a role model to others in the region.

    When we work together, our success is multiplied. That is my wish for all of you attending this conference: a productive and successful exchange that benefits the people of Uganda and the region.

    Thank you very much.