This study examines the delivery of health services by faith-based organizations (FBOs) as a possible alternative to privatization in Uganda, where these not-for-profit health providers have been servicing communities since the mid-19th century. Their facilities focus on primary care and operate in rural, under-serviced areas where they provide access to care without discrimination on the basis of religion or ethnic group, charging affordable user fees while also treating those who cannot pay.
Based on literature reviews and more than 30 key informant interviews, this research finds that FBOs promote solidarity through multi-stakeholder engagement and through cross-subsidization using mechanisms such as community health financing schemes that protect patients from catastrophic health expenditure. Thus, this ‘private not-for-profit’ sector fosters the development of a strong quasi-public ethos in service delivery, especially at the primary level of the Ugandan health system.
FBOs are key health policy implementation partners, receiving 7 per cent of the national health budget to offer services guided by the National Health Plan. The sector presently contributes to more than a quarter of all health services, including the training of health professionals. The various denominations’ medical bureaus also participate in policy formulation, planning and priority setting for the health sector.
Today, the sector faces challenges in attracting and retaining staff, and resource constraints due to reduced external funding following the global financial crisis. Yet they may be considered successful alternatives to privatization on the dimensions of equity, solidarity, quality of services, quality of the workplace, participation and transparency.