The Ministry of Health through the national task force is currently conducting county-wide sensitisation tours, considering stakeholder inputs while simultaneously reviewing the proposed National Health Insurance (NHI) Bill to be presented to Parliament. The national health insurance scheme aims at complementing the existing health care financing gaps, and assuring universal coverage and access to quality, equitable and affordable health care. The scheme intends to begin with formal public sector, contributing four per cent of the employees’ gross salary which will be matched by the employer and subsequently roll out to the formal private, and lastly the informal sector.
It is notable that the majority population who suffer catastrophic health expenditure are the informal sector that the proposed scheme is likely to cover in a decade or so. Community health financing schemes whose primary focus is to provide risk pooling to cover part or all health care costs for the mainly informal sector, have existed in some parts of Uganda for over 10 years, and have significantly contributed to improving rural household health status, and economic portfolios.
The household enrollment capacities of these community health insurance schemes have however been decreasing or remained static partly because of the “free health care policy” in public health facilities, and structural and organisational challenges within schemes. The “free health care policy” has not effectively delivered on its intended goals, partly because of challenges which have resulted in frequent drugs and sundries-stock outs, work-force absenteeism and poor work ethics.
The net effect of this has been deplorably low drug dispensing rates—dispensed versus prescribed drugs, of about 30 per cent or less, compared to 90-98 per cent in Private Not-For-Profit (PNFP) health care facilities, and sky-rocketing out-of-pocket payments for health services (In Uganda it is 55-61 per cent of the total health care expenditure).
It is partly in light of the above that community health schemes (CHIs) have voluntarily continued to exist in partnership with mainly PNFP facilities to afford quality health care and manageable out-of-pocket health expenditure. The forthcoming national health insurance plan should draw on the experience and expertise of existing community health care plans in order to appropriately afford access to quality and equitable health care to the informal sector mainly in rural areas.
The proposed bill should seek to provide a legal framework to the existence of community health insurance schemes, and consolidate their relationship with the NHI while at the same time government strengthens the existing community schemes—which are currently operating mainly on the recruitment of households in organised groups.
Just like SACCOS are being boosted for purposes of rural economic empowerment, the government could explore and encourage the possibility of organised rural groups joining community health insurance schemes. Where they exist in Uganda, community health insurance schemes have equitably improved the health status of households and their subsequent economic mileage. The government should consolidate these gains and expand this concept countrywide.
Dr Kasyaba is a member, Uganda community-based health financing association