1. Introduction
Uganda’s healthcare system mirrors a marketplace that serves those that can afford it and excludes those who cannot. A 2025 study spotlights that out-of-pocket (OOP) healthcare expenditure account for 38% of current health expenditure in the country, leaving thousands of households just one hospital bill away from poverty. This crisis is not accidental. It is a creation of the government’s diminishing capacity to provide quality public services, a proliferation of unregulated profit-driven health facilities, declining Official Development Assistance (ODA), and rising debt. The above notwithstanding, the government’s ideological push for private sector financing as a preferred model for healthcare delivery, has excluded thousands of people from accessing life-saving healthcare and exposes patients to rights violations like detention of mothers and new-borns due to inability to pay and denial of emergency care without effective accountability or remedy. This article examines why an exploration of this crisis matters and proposes practical steps to reconstruct a health system that centres equity and justice as critical building blocks for achieving universal healthcare.
2. Health: Public good or private profit?
Uganda’s broader ideological shift in which it has retreated from its primary obligation to provide equitable healthcare and instead embraced market logic as the default solution to system delivery gaps has led to arise in commercialisation of health. This orientation has accelerated commercialisation of health and effectively made access to dignified quality care a distant dream for the poor and disadvantaged segments of the population. Private actors, whether through corporate hospital chains, international financing intermediaries, insurance schemes, or Public-Private Partnership (PPP) arrangements are strategically framed as efficient, innovative, and necessary.
National policy frameworks reinforce this health financing narrative. The fourth National Development Plan (NDP IV), the National Health Policy II and the Health Sector Development Plan (2010/11-2020/30), all position the private sector as a strategic investment instrument for unlocking the country’s development potential and a vehicle for achieving universal health coverage. Yet, emerging evidence reveals that the private-sector-driven model creates more barriers than guarantees to the promise that every Ugandan should access quality healthcare.
"Ensuring that every Ugandan can access quality healthcare is both a policy choice and moral imperative, because health justice is, at its core, economic justice."
Labila Sumayah Musoke
This raises a fundamental question: Can a system designed and driven by private interests deliver equitable health care for all? Whose interest does it operate to serve?
This question is particularly critical within the broader development health financing context. International Finance Institutions (IFIs) such as the International Finance Corporation (IFC), the private-sector arm of the World Bank Group, continue to promote the private sector. As global and national priorities converge around market-led health investment, private actors increasingly shape Uganda’s health infrastructure and service delivery models. This approach raises critical questions about equity, accessibility, affordability, accountability, and quality of care.
Increasingly, Uganda has taken a backseat in the delivery of its primary obligation, fallen short in regulating the private sector, and effectively reduced health to an investment opportunity rather than a public good. This logic is premised on a capitalistic belief that the private sector is more efficient. Yet, evidence from multiple contexts shows that these arrangements frequently prioritise financial returns over patient welfare, operate with limited transparency, and deliver services based on the ability to pay rather than public health need.
Worse still, Uganda is neither mobilising enough revenue to deliver quality public health services nor creating income generating opportunities for her citizens to afford the prohibitive healthcare costs in the private health facilities. Even in IFC-funded facilities, and private-not-for-profit health facilities, abuse patient rights, including of emergency and detaining poor patients is well documented. These incidents highlight the human cost of reducing healthcare to a commodity.
4. Human Impact and Global Pattern
The human cost of commercialised healthcare is not limited to Uganda. It has also been documented across countries where IFC-funded and PPP hospital models have been implemented. In Kenya, IFC-supported Avenue Hospital has been documented for excessive charges and their pay-upfront policy, undermining the stated goals of accessible healthcare. Similarly, in India, a high-profile probe into an IFC-funded hospital chain revealed alleged links to illegal organ harvesting (the ‘cash-for-kidneys’ scandal) and systemic ethical failures that prioritised profit over patient safety. Such outcomes contradict the stated development goals of institutions like the World Bank, which emphasise poverty reduction but often support models that systematically exclude the poor.
5. What Should Change: Rethinking Health finance and governance
Addressing this requires a decisive shift away from private-sector-first models toward policies that place public welfare and equity at their core. This means to government of Uganda:
- Adequately invest in the public healthcare system and address the commercial determinants of health by; leveraging Uganda’s natural resources; ensure the wealthy pay their fair share of tax and negotiate fair tax and debt instruments. This approach will increase domestic resource mobilisation and mininise illicit financial flows.
- Strengthen state oversight and regulation of private actors involved in health as recommended by the African Commission in its General Comment No. 7. To the International Financing Institutes
- Strengthen health diplomacy, negotiate capacity, accountability, and solidarity.
- Stop attaching austerity conditions against loans to developing economies and adopt a fairer debt architecture.
- The World Bank Board should direct the Compliance Advisor Ombudsman (CAO) to investigate IFC-funded hospitals implicated in denying emergency healthcare and detaining poor patients as per the CAO policy.
Commercialisation of healthcare in Uganda mirrors a series of political choices and external pressures that have prioritised market logic over public need, with devastating consequences for equity, access, and human dignity. The combined effects of shrinking aid, rising debt, and an overreliance on PPPs, particularly those structured around private profit rather than public welfare, have deepened existing inequalities and placed essential healthcare further out of reach for millions. Reversing the status quo requires political courage to reclaim health as a public good, strengthen primary care, and demand accountability from both governments and global financial institutions. Ensuring that every Ugandan can access quality healthcare is both a policy choice and moral imperative, because health justice is, at its core, economic justice.
