Obstacles to multisectoral maternal and child healthcare financing in Uganda: insights from policy bureaucrats.

Maternal and child healthcare (MCH) financing is a global priority, and it is one of the core components of the health systems building blocks. Ensuring adequate MCH financing is critical for better MCH outcomes, but it remains challenging for most developing countries, including Uganda. The country's major structural limitation is its over dependence on donor funding for MCH, which is increasingly shrinking and threatens the current healthcare financing approaches. This study investigates the barriers to effective multisectoral financing for maternal and child health (MCH) in Uganda. To deepen the understanding of these challenges, the research adopted a qualitative methodology, combining semi-structured in-depth interviews with a focused literature review. A total of eight interviews were conducted with key MCH stakeholders. These interviews were complemented by a review of 19 authoritative documents related to MCH financing in Uganda. The study employed thematic analyses to comprehensively present the data. The study identifies several challenges to multisectoral MCH financing, including the absence of a specific and explicit MCH framework on MCH financing, poor understanding of the meaning of multisectoral collaboration in MCH financing, low acceptance of prepayment forms of financing, and failure to fulfill pledges and government commitments. Moreover, the lack of clear and streamlined stakeholders' roles and responsibilities, the failure to prioritise and include MCH issues in all national policies, and fragmentation and vertical funding limit the leveraging of MCH resources. Delays in approving the financing frameworks have hindered the implementation of the financing instruments, thus affecting the pooling of MCH funds in Uganda. This study concludes that, considering the diminishing MCH financial resources due to gaps in current financing frameworks, the Government of Uganda should strengthen and enhance its legal and policy financing instruments.