Healthcare Financing Options in Urban Uganda: Household Health Financing Strategies, Challenges and Recommendations in Iganga Municipality

Background: The financing of health care is a key element to achieve Universal Health Coverage (UHC), although several households in Uganda are still at risk of financial burden due to the lack of adequate insurance coverage and low public funding. Therefore, this study analyzed the primary financing of health care options utilized by households living in urban areas in Iganga Municipality, the difficulties that have been encountered and household recommendations to improve the access to high-quality care. Methods: A cross-section household survey was conducted in Iganga Municipality between June 2024 and October 2025. All of the households in the municipality were randomly sampled and all data were collected electronically from the household head or the designated representative (greater than or equal to 18 years), including emancipated minors (15 to 18 years) who act as the household head. Descriptive and inferential statistical analyses were performed in STATA, including bivariate tests and multivariable logistic regression for predictors of reporting good perceived quality of care. Results: In total 403 households were included in the analysis. Approximately 58.2 percent of the households included in the sample were 18 to 35 years of age. Funding through public sources was the predominant (74.2 percent) primary financing method, followed by out-of-pocket (OOP) payments (23.8 percent) and private insurance and mixed financing methods were infrequent (1.0 percent each). For public funded households, quality was the most frequently reported challenge (47.5 percent), while for OOP funded households, affordability was the most frequently reported challenge (46.3 percent). Compared with public funding, OOP financing was an independent predictor of reporting good perceived quality of care (AOR equal to 2.52, 95 percent CI: 1.49 to 4.29) and higher household incomes (greater than UGX 1,000,000) also predicted good perceived quality (AOR equal to 2.61, 95 percent CI: 1.08 to 6.33). Conclusion: Households residing in urban areas primarily rely on public services with ongoing concerns regarding quality, while self-payment was related to perceived quality but was also associated with increased affordability challenges. Recommendations from households emphasized cost reductions or subsidies to reduce costs, increasing the strength of the health workforce, improving the facilities, and ensuring consistent availability of medicines and medical supplies.