Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America.
Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda.
PLoS One. 2020 Jul 30;15(7):e0235250. doi: 10.1371/journal.pone.0235250. eCollection 2020.
To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents' preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations.
We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens' preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents' preferences with actual government budget allocations.
The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents' preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents' preferences.
Among respondents from Mukono district in Uganda, we found that citizens' preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents' strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens' needs and preferences, but also to meet the government's health goals to improve health, strengthen health systems, and achieve universal health coverage.
了解乌干达公民对国家预算资源分配的偏好，考察受访者对卫生相对于其他部门的偏好，并将这些偏好与实际政府预算分配进行比较。
我们在乌干达中部穆科诺区的城乡地区调查了 432 户家庭。我们使用最佳最差分级（BWS）调查来了解公民对所有部门资源分配的偏好。BWS 调查由 16 个部门组成，对应乌干达国家预算项目。受访者从 16 项选择任务中的四个部门子集中选择他们认为最需要和最不需要分配资源的部门。我们利用相对最佳减去最差评分法和条件逻辑回归来获得跨部门资源分配的优先排序偏好。然后，我们将受访者的偏好与实际政府预算分配进行了比较。
卫生部门是排名最高的部门，82%的受访者选择卫生作为政府资助的最重要部门，但在国家预算分配中排名第六，占总预算的 6.4%。除卫生部门外，水和环境、农业和社会发展部门的资金远远低于受访者的偏好。与受访者的偏好相比，工程和交通、教育、安全以及司法、法律和秩序部门获得了更大份额的国家预算。
在乌干达穆科诺区的受访者中，我们发现公民对跨部门资源分配的偏好，包括对卫生部门的偏好，与当前政府预算分配存在根本上的不一致。受访者强烈希望将资源分配给卫生部门的证据，可以帮助利益相关者为增加卫生部门的拨款提出理由。增加对卫生部门的投资不仅对满足公民的需求和偏好至关重要，而且对实现政府改善卫生、加强卫生系统和实现全民健康覆盖的卫生目标也至关重要。
