Let’s rethink compulsory health insurance scheme

Thursday June 27 2019

To pay. Patients admitted to Kiruddu Hospital

To pay. Patients admitted to Kiruddu Hospital in Kampala. Cabinet has approved the National Health Insurance Scheme that will require all Ugandans above 18 years to contribute to the scheme before accessing health services across the country. PHOTO BY RACHEL MABALA 

By Editor

On Tuesday, the Commissioner for Policy, Finance and Planning at the Ministry of Health, Dr Sarah Byakika, announced that the Cabinet had finally approved the National Health Insurance Scheme (NHIS) Bill 2019, a must pay for all scheme, that is expected to come into force once the necessary law is approved by Parliament.

The announcement is very welcome. It was if anything long overdue. The woes that have been afflicting our healthcare system have been well chronicled.Statistics from the Ministry of Health indicate that only 40,375 out of the approved 58,000 posts in health facilities in rural Uganda where most of the population lives have never been filled. The deficit is made worse by the fact that the doctor to patient ratio stands at 1:24,000, far higher than the World Health Organisation’s (WHO’s) recommended ratio of 1:1000.

The World Bank lists Uganda as one of the world’s 49 low income economies, which cannot meet the minimum threshold of 23 medical doctors, nurses and midwives per 10,000 people. With such ratios, it would not be possible for patients not to feel neglected by the few overwhelmed health workers.

Last December, the non-government organisation (NGO), Twaweza, released findings of a study, ‘Sauti ya wanainchi’ (voices of the people), which revealed that 60 per cent of Ugandans who visited public health facilities in Uganda between August and September last year did not access medicines or get appropriate care from health workers.

The survey also revealed other challenges, including overcrowding, with patients sleeping on floors of some of the public health facilities. The report was to say the least an indictment of Uganda’s public health system.

At the same time, the Uganda Medical Association (UMA), revealed that more than 65 per cent of hospitals lack drugs and supplies for emergency care because government delivers only 35 per cent of what it should be delivering to health facilities. This, was discovered to be a major cause of the preventable and unnecessary deaths occurring in public health facilities.


In light of all that, the effort to introduce the National Health Insurance Scheme ought to be embraced, but we should go about implementation of the scheme with caution. Introduction of the scheme is not the silver bullet that will solve the problems in the health sector. It will be only a beginning point that might cure problems related to underfunding, poor remuneration and motivation of health workers.

At the same time, the declaration by Dr Byakika that those subscribers to private insurance schemes must drop them and subscribe to the government scheme is problematic. Let Ugandans have an option to subscribe to whichever scheme they desire or the one that offers them the best service.