Why ignore the role of third sector in health service provision?

The Structural Adjustment Programmes have been fully implemented in Uganda since 1987. They aimed at, among other things, to increase the role of the market mechanism (the automatic and self-regulating market force of demand and supply) in allocating all resources, including the very essential social services such as health or education and the promotion of the private sector-driven economy, and to redefine the role of the State in provision of services such as defence and security, law and order, policy formulation, international relations and other public goods.

In the health sector, this implied greater roles of the private and the third sector (civil societyvoluntary sector). Much of the recent debate on service provision in Uganda has focused on the need for privatisation and cost-sharing. Unfortunately, this has paid little attention to three important components of service provision. One is that the provision of vital life-supporting services to the majority of the poor population depends on the collective action by the State, the private sector and the third (voluntary) sector.

The second is that the links between the voluntary sector and the State are becoming more important for service provision. The third feature is the growing dependence on foreign aid mainly through international NGOs, civil society and religious organisations in ensuring equity and efficiency in the provision of essential services as well as enhancing employment and improved livelihoods. Aid has also made it possible for the State to maintain – and recently increase its role in service provision in Uganda. These three features are important but they are largely ignored, especially at the policy level.

As the third sector increasingly intervenes to offer a helping hand to redeem the health sector, let me share an interesting case by one international voluntary establishment - Humanity Direct - working with Healthcare Volunteers (Uganda) who have done a lot in reducing maternal and child mortality among the poor or disaantaged communities, enabling them to access free medical services and empowering them to participate and get involved in managing sustainable primary healthcare at the community level.

Mr Dickson Kasozi, the programme manager of Healthcare Volunteer Uganda reveals that “too many children suffer or die from a lack of medical care simply because their families cannot afford the cost of treatment they need. We are changing that by enabling donors to directly fund life-changing surgeryoperations and life-saving treatment for the most vulnerable children”. The Health Care Volunteers are working in partnership with Humanity Direct to mobilise donors and provide a team of medical professionals especially surgeons to save children from very poor families who cannot afford even the very basic medicine. Many delay seeking medical care until the conditions worsen or get into debt they can never repay.

At first glance, the increasing role played by the voluntary sector in healthcare service provision may be considered a private ventures, but the living conditions in Uganda and people’s needs and priorities in terms of social services such as healthcare, housing, education or feeding, reveals this sector’s role is vital.

It is clear that NGOs are often more efficient in mobilising resources in cash and kind than State agencies. We only need a friendly legal and institutional framework to regulate, supervise and monitor them in order to match their promises with performance.

Mr Majwala is the president of Sustainable World Initiative-East Africa.




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