Health expenditure, maternal health outcomes and inequalities in maternal healthcare utilisation in Uganda

Abstract

Uganda’s current maternal mortality rate of 189 per 100,000 live births remains far above the global target of 70 per 100,000. Increasing health expenditure and reducing inequalities in utilisation of maternal health services are key in addressing the high rate of maternal mortality. This study examines the effect of health expenditure on maternal mortality, and the nature and extent of inequalities in utilisation of maternal health services in Uganda. Annual time series data from the World Development Indicators for the period 1990-2022 were used to explore the short run and long run effect of health expenditure on maternal mortality using an autoregressive distributed lag model. The Uganda Demographic Health Survey 2006, 2011 and 2016 were used in equity analysis for utilisation of antenatal care, skilled birth attendance, postnatal care, and a continuum of care, using equity ratios, concentration indices and regressions-based estimations. The results show that domestic government expenditure on maternal health conditions is the most impactful in reducing maternal mortality. Out-of-pocket health expenditures is associated with a decline in maternal mortality. Increasing nurses and reduction in female alcohol consumption significantly reduces maternal mortality. Inequalities in utilisation of maternal health services including quality antenatal care have reduced since 2006 but remained pro-rich. Wealthier women, the more educated and those living in urban areas were more likely to utilize maternal health services compared to their disadvantaged counterparts. Government should increase budget allocations specific to maternal health conditions; invest in training and posting nurses at health facilities to increase access to care. Government should also hold health campaigns against alcohol consumption during pregnancy in order to reduce maternal mortality. Interventions such as targeted vouchers schemes for the poor women; mobile health clinics for antennal care in hard-to-reach rural areas, and provision of quality antenatal care can increase access to maternal health care and subsequently reduce maternal mortality among disadvantaged groups.