Withdrawing National Health Insurance Bill is not solution

Amid the worldwide panic about the Corona pandemic, Uganda’s Ministry of Health following a directive from the President, is withdrawing the National Health Insurance Bill.

If we have learnt any lessons from the last couple of weeks and how the pandemic has played out in other countries, we need to get serious about fixing Uganda’s health sector.

The coronavirus pandemic has reminded us of what we should have always known: Failure to access healthcare because of inability to pay does not only violate human rights, but is bad for the economy.

Universal health coverage is a pressing national security issue. We, rich or poor, are going to need to access healthcare regardless of ability to pay. Our mutual survival depends on it. To do that, we need three things: Access to healthcare for all regardless of ability to pay; a strong resilient public healthcare system at home that caters for everyone; and strong preventative mechanisms.
Accessing healthcare regardless of ability to pay is a central premise of universal health coverage. This is something the world agreed should be a priority and included among the Sustainable Development Goals.

Uganda is in the process of developing a universal health coverage road map. However, a well designed National Health Insurance Scheme (NHIS) that covers everyone is a critical step on the path to achieving universal health coverage.

It can mobilise resources from those willing to pay while allowing government to subsidise the most vulnerable, who would not have the means to do so.

It is no secret that preventative care is grossly underfunded. Yet globally, our ability to respond to pandemics like coronavirus or Ebola reveal failure to address this is playing with life.

Imagine widespread testing was available but at a cost. How many Ugandans would simply forfeit and remain undetected due to lack of resources? NHIS, if well designed, could improve access to preventative care.

Ultimately, it cannot be business as usual for the health sector. National Health Insurance on its own, will not be the silver bullet to achieve universal health coverage. That requires investing in and financing a resilient public health system.

The Initiative for Social and Economic Rights (ISER) research, ‘Are We Failing to Progressively Realise the Right to Health? An Analysis of Health Sector Budget Trends,’ found current financing levels to the health sector grossly insufficient, particularly for the span of National Development Plan II.

The need for government to adequately finance public health sector, which is the first point of call for the poorest, therefore, remains prime. Setting up financing modalities like national health insurance that complement the public sector is crucial.

When ISER appeared before Parliamentary Health Committee during consultations on the NHIS, we pointed out that the Bill had a number of gaps, including the omission of government contribution to the scheme, without which the scheme would fail.

Consultations we held over the years found the majority were in favour of reducing out of pocket costs for health. They were in favour of a national health insurance scheme that is well designed, that covers those that often fall through the cracks; the poor, persons with disabilities, older persons and ensures they can access healthcare. They were concerned about affordability of premiums, something the Bill is silent on.

We agree the Bill should be fixed. The solution, however, is not for the ministry to withdraw the Bill with no indication of when it will be resubmitted, if at all. This will only result in further delays.

The country has been waiting for this scheme for more than 10 years. The ministry has spent 20 years designing it and government lengthened the process by initially delaying to provide a certificate of financial implication. The cost of this delay is not merely statistical.

In this time, we have seen out of pocket costs for health sky rocket. People have sold land, cows, goats and even mattresses just to be able to access healthcare. It is the sum of children and mothers lost, deaths that provision of health facilities, ambulances, medical equipment or other basic resources should have made avoidable.

The Parliamentary Committee on Health has held consultations on the Bill the Health ministry submitted. Civil society, national human rights institutions, Ministry of Health, and the private sector have appeared. The Committee is now conducting regional consultations.

It should be facilitated to consult with those that were not able to come to Parliament and then do the hard work of fixing the scheme.

While there is no consensus on premiums and how to identify the most vulnerable, this is precisely what the consultation process should bring forth. Withdrawing the Bill right now is not strategic.

The Parliamentary Committee on Health should ensure the bill that is passed covers the poorest and most vulnerable like children, persons with disabilities and older persons from the onset.
Government needs to commit to contribute to the scheme and to strengthen the accountability for the funds and services within the scheme including regulating the private sector.

Premiums need to be affordable. The devil is in the details, and we will continue watching closely.

Ms Kembabazi is the programme manager, Right to Health at Initiative for Social and Economic Rights (ISER).