title: An exploratory study on equity in funding allocation for essential medicines and health supplies in Uganda's public sector.
abstract: To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care.
  
  
  
  We collected data on EMHS allocations and availability of selected vital medicines from 43 purposively sampled hospitals and the highest level health centers (HC IV), 44 randomly selected lower-level health facilities (HC II, III), and from over 400 facility health information system records and National Medical Stores records. The data were analyzed to determine allocations per patient within and across levels of care and the effects of allocations on product availability.
  
  
  
  EMHS funding allocations per patient varied widely within facilities at the same level, and allocations per patient between levels overlapped considerably. For example, HC IV allocations per patient ranged from US$0.25 to US$2.14 (1:9 ratio of lowest to highest allocation), and over 75 % of HC IV facilities had the same or lower average allocation per patient than HC III facilities. Overall, 43 % of all the facilities had optimal stock levels, 27 % were understocked, and 30 % were overstocked. Using simulations, we reduced the ratio between the highest and lowest allocations per patient within a level of care to less than two and eliminated the overlap in allocation per patient between levels.
  
  
  
  Inequity in EMHS allocation is demonstrated by the wide range of funding allocations per patient and the corresponding disparities in medicines availability. We show that using patient load to calculate EMHS allocations has the potential to improve equity significantly. However, more research in this area is urgently needed.
  
  
  
  The article does not report any results of human participants. It is implemented in collaboration with the Uganda's Ministry of Health, Pharmacy Division.
authors: Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda.
authors: Donna
authors: D
authors: Kusemererwa
authors: Faculty of Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark.
authors: Anita
authors: A
authors: Alban
authors: Ministry of Health, Pharmacy Division, Lourdel Road, Wandegeya, Kampala, Uganda.
authors: Ocwa Thomas
authors: OT
authors: Obua
authors: Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda. btrap@msh.org.
authors: Birna
authors: B
authors: Trap
mesh_terms: D018954:Drugs, Essential / Q000191:economics* / Q000600:supply & distribution*; D005380:Financing, Government; D006268:Health Facilities / Q000706:statistics & numerical data*; D063005:Health Information Systems; D006297:Health Services Accessibility; D006801:Humans; D017150:Public Sector; D014454:Uganda
chemical_list: D018954:Drugs, Essential
keywords: Equity; Essential medicines; Horizontal equity; Medicines funding; Resource allocation; Uganda; Vertical equity