FY 2023/24 BUDGET: FOWODE, other CSOs Advocate for Increased Women Empowerment, Health Funding

Forum for Women in Democracy (FOWODE), a non-governmental organisation that offers a platform for Ugandan women’s learning, networking, sharing experiences and advocating for gender equality and equity in decision-making process has tasked Ugandan government to safeguard the Health Sector Human Resources budget from cuts if it is to address the gaps identified in the budget strategy in relation to human resources for health.

Addressing the Media at the FOWODE Office in Ntinda Kampala in response to approved Budget Estimates for FY2023/24 under the Theme: Who is In, Who is Out: Women and the FY 2023/24 budget, FOWODE and sister CSOs tasked the Ugandan government to prioritize and allocate resources to close the 41% staffing gap in the Child health Department, increase funding to support Community Based Services Departments in local governments, fully fund the costed strategic plan of the gender unit under ministry of education in order to eliminate/reduce the gender inequalities among other recommendations .

HERE IS THE FULL STATEMENT

1. INTRODUCTION

The country has reached the climax of the budgeting process for FY2023/24, with the Minister of Finance set to unveil the budget tomorrow 15th June 2023. This comes on the backdrop of the “State of the Nation Address (SONA)” that was delivered by the President on 7th June 2023, debate and passing of the Annual Budget Estimates by Parliament, and consultative processes at national and sub-national levels.

Although the FY2023/24 budget has already been passed/approved by Parliament, advocacy on issues we feel are pertinent continues, with the view of influencing budget execution and pushing for inclusion of highlighted issues in the FY2024/25 budget process that will commence in August –September this year.

Forum for Women in Democracy (FOWODE) and the CSO community in general recognize the significance of the National Budget as a policy instrument that can be utilized to effect gender equality and equity. As an organisation that has been at the forefront of advocating for gender responsive budgeting since 1998, we strongly believe that sustainable development will only be achieved if policies including the National Budget are structured to redress the persistent gender imbalances that have for long left women and girls on the periphery of development processes.

FOWODE and sister CSOs gathered here today would like to commend the Government of Uganda for completing the FY2023/24 budgeting process in line with Public Finance Management Act 2015 and the Constitution of Uganda. We would also like to appreciate the government’s commitment to implement the provisions of Gender and Equity compliance, as evidenced by the gradual improvement in average CGE scores by MDAs and Local Governments (67% average score for MDAs and LGs against the FY2023/24 MPSs, compared to 65% for FY2022/23). We urge the government to maintain and build up on this positive momentum to ensure that Gender and Equity compliance become integral in planning processes.

The FY2023/24 budget has maintained the same theme from the previous year (Full Monetization of Uganda’s Economy through Commercial Agriculture, Industrialization, Expanding and Broadening Services, Digital Transformation and Market Access), with the major objectives of;

1. i) Restoring macroeconomic stability by ensuring a return to the medium-term growth path of 6% – 7%,

2. ii) Improving competitiveness of the economy, AND

iii)      Sustaining Uganda’s socio-economic transformation agenda

We commend this theme and the stated objectives, and confirm that these are in line with the country’s National Development Plan, Vision 2040 and the Sustainable Development Goals (SDGs).

We the members of Civil Society, specifically those promoting the rights of women and girls in all their diversity, having keenly followed the proceedings that led to the passing of the FY2023/24 Annual Budget Estimates by Parliament, and having reviewed other relevant documents such as Ministerial Policy Statements and sub-programme work plans, hereby highlight key concerns that we think have the most bearing on the lives of ordinary citizens, especially women and girls in the FY2023/24 budget that will be unveiled tomorrow.

2. GENDER AND EQUITY CONCERNS IN THE FY2023/24 BUDGET

2.1.    Budget cuts in the health sector amidst a Human Resource crisis

While we would like to commend the government of Uganda for meeting and even surpassing the NDP-III financing target for the “Human Capital Development (HCD)” Programme, we note with concern that the health sub-programme continues to suffer budget cuts. According to the approved Annual Budget Estimates for FY2023/24, votes in the health sub-programme are set to suffer a UGX 181.6bn budget cut (excluding LG grants and KCCA) when compared to the FY2022/23 budget. [UGX 338.6bn budget cut at MoH and UGX 25.5bn cut for Regional Referral Hospitals]

Adequate staffing levels are a key element for ensuring effective health care delivery. As such, the FY2023/24 budget strategy highlighted some key gaps that needed to be addressed. These included an overall health system staffing gap of 35%, lack of blood transfusion services in at least 87 HC-IV’s and insufficient Comprehensive Emergency Obstetric and New-born Care at Health Centre-IV level caused by staffing gaps and inadequate equipment.

In spite of the highlighted gaps, the FY 2023/24 National Budget Framework paper (NBFP) indicated that the wage bill for the delivery of Primary Health Care will be cut by UGX 3.483bn (from UGX 751.822bn in FY 2022/23 to UGX 748.339bn in the FY 2023/24). These budget cuts come amidst an already escalating Human resource crisis with non-deployment of Medical Pre-Interns, salary delays for health workers, and already striking nurses in some health facilities (a strike by all health workers in Kawolo Hospital announced on 12th June 2023). The absence of health staff disproportionately affects women and girls who have been found to heavily rely on public service delivery due to their weaker economic standing and gender roles. The absence also contributes to increased cases of maternal and infant mortality owing form???? the time sensitive nature of childbirth and delicate nature of infants.

Recommendations:

The government needs to safeguard the Health Sector Human Resources budget from cuts if it is to address the gaps identified in the budget strategy in relation to human resources for health. These gaps disproportionately affect women especially in rural areas, who completely rely on public health service delivery.

The Ministry of Health (MoH) also needs to develop and submit a costed human resource plan elaborating  how it intends t0 progressively cover the highlighted human resource gaps to the optimal levels that were set in the  NDP-III framework.

Insufficient financing for Reproductive Maternal, New-born, Child and Adolescent Health (RMNCAH)

We would like to appreciate the Ministry of Health and the government in general for putting in place the RMNCAH Sharpened Plan II 2022/23–2027/28, which clearly stipulates the sector’s funding and policy requirements/priorities. The plan has also been enhanced by implementation of the Uganda Inter-governmental Fiscal Transfer (UgIFT) project and integration of Performance Based Financing (PBF) for Local Governments.

Amidst all these improvements though, the sector continues to suffer challenges in staffing and inadequate funding for Reproductive Health supplies. The Reproductive and Child health Department currently has a 41% staffing gap, and the proliferation in number of districts has not helped the situation. About 50% (65 districts) of the districts in Uganda lack a substantive Assistant DHO- Maternal Child Health (ADHO-MCH), which constrains oversight and planning for Maternal health.

We would like to further commend the government for increasing allocation to Reproductive Health supplies in the forthcoming FY (from UGX 22bn in FY2022/23 to UGX 25.11bn in the FY 2023/24). This allocation notwithstanding, there is a big and persistent problem of stock outs for maternal lifesaving health commodities. For instance, the days of stock out of oxytocin have steadily increased since 2020 from 186,435 to 467,066. This means that many mothers must go out of government facilities and privately source these medicines and for many who may not afford and those in hard-to-reach areas, it propagates maternal death. This partly speaks to why at the NDP-III midterm target for Maternal Mortality Ratio (MMR) was not realised.

Recommendations:

The government needs to prioritize and allocate resources to close the 41% staffing gap in the Child health Department. The RMNCAH review in FY2020/21 identified at least 1,125 priority recruitments necessary to support effective delivery of PHC essential services.

The National Medical Stores needs to target zero stock-out for maternal life-saving commodities through increased support to districts to adequately forecast and order the needed commodities but also have and deliver the requested commodities on time.

There is also need for MoH to map out and explicitly link the RMNCAH sharpened plan II interventions to the Budget Framework to provide traceability of the maternal funding interventions as guided by the plan.

2.3.    Declining Support for Gender Equality in Education

We acknowledge that there have been some notable achievements in the Education sub- programme, including improved education outcomes and achieving parity in primary school enrolment. Additionally, the establishment of a dedicated Gender Unit in the Ministry of Education, with committed resources to support girls’ education, has improved gender mainstreaming within the sub-programme.

While the gender unit has a critical role to play in planning for and monitoring the implementation of gender responsive policies within the education sector, we note with concern that the unit is poorly funded and thus unable to fulfil its mandate. Funding for the gender unit has steadily been reduced over the years from UGX 154,435,203 in FY2019/20, to UGX 93,000,000 in FY2023/24, representing an over 39% reduction.

Uganda has been grappling with high school dropout rates especially for the girl-child, as a result of the unfriendly environment that is dominated by poor menstrual hygiene management in schools, lack of senior women teachers and sexual abuse among others. The girls that leave school at such an early stage are more likely to end up as child/teenage mothers, which perpetuates poverty in the communities and also contributes to high ratios of maternal mortality.

Insufficient funding for this Unit undermines efforts to mainstream gender into all education activities, potentially leading to a decline in achieving gender-responsive outcomes in the sector. This in-turn puts at risk the country’s potential of harnessing the demographic dividend.

Recommendations:

Government needs to fully fund the costed strategic plan of the gender unit under ministry of education in order to eliminate/reduce the gender inequalities that have persistently failed the achievement of sector and development plan objectives, as well as SDG 4 targets.

2.4.    Non-Prioritization of GBV/SGBV and Mindset Change financing

Despite the presence of an elaborate legal and policy framework for Gender Based Violence (GBV) prevention and response in Uganda, GBV is still widely spread. 56% of women have experienced physical violence at some point in their life. More than 1 in 5 women aged 15-49 (22%) report that they have experienced sexual violence compared with 1 in 10 (8%) men.

GBV/SGBV has a huge cost on the government in terms of lost productivity, treatment and management of victims and case management. Concurrent??? Police Crime reports have highlighted worrying GBV numbers for the country (17,533 domestic violence cases, 1,486 rape, 14,570 defilement, 8,681 child-related offenses and 16,373 sex related crimes in 2022).

Despite the dismal picture painted by these numbers, we are concerned that the government still has not seen GBV/SGBV prevention, mitigation and management as a priority. The government is not investing enough in mindset change programming to eliminate negative cultural practices that drive up these numbers. The over 80% funding gap for the Community Mobilization and Mindset Change (CMMC) Programme (actual allocation compared with NDP-III funding targets), is a testimony to how little government values the programme’s contribution to National development.

While we applaud the slight increment in the budget for the response to GBV from UGX 100 million to UGX 161 million in the FY2023/24 period, the amount allocated remains dismal compared to the outlined needs. According to MGLSD, the Male Involvement Strategy for combating GBV/SGBV and harmful practices alone needs an average of UGX 3 billion per financial year.

Recommendations:

Government needs to urgently increase funding to support Community Based Services Departments in local governments (with focus on the Gender Office, Probation & Welfare) to facilitate coordination of GBV actors, sensitization of communities, protection of GBV survivors and running of the GBV information management system.

We recommend that a specific budget code be introduced in the Government Chart of Accounts where all resources and expenses for GBV can be tagged and traced. This will greatly improve on the ability to plan for and track GBV resources for consistent reporting.

There is also a need to exponentially increase funding for the Child and Family Protection Unit (CFPU) of police to improve access to justice for GBV/SGBV victims through proper investigation and prosecution of cases. .

We would like to once again commend the Government of Uganda for continually improving its practice in gender responsive allocation of resources. We however note that there are several areas where gender priorities have been allocated grossly inadequate funding, and this risks undoing some of the gains made in promoting gender equality and equity.

We call upon the government to prioritize the redress of these gaps and enhance inclusivity in the budget. The Women’s Movement calls for stronger collaboration between civil society organizations, government entities, and development partners in the planning and budgeting cycle to identify and harmonise strategies that will strengthen gender-responsive budgeting and ensure the effective implementation of policies that promote the rights and well-being of women and girls in Uganda.

FOWODE and the women’s movement in Uganda in general, remain committed to advocating for gender equality and women’s empowerment, and we urge the government to prioritize the concerns that we have highlighted. By working together, we can achieve a more inclusive and equitable society that provides equal opportunities for all.