National health insurance should start

Monday August 5 2019


By Richard Ssempala

Recently, Cabinet approved the national health insurance scheme. Health insurance is one of the ways in which health services are financed in such a way that an individual does not need to always have money in order to access services at a health facility.

The World Health Organisation (WHO) recommends health insurance as one of the ways in which out-of-pocket payments can be reduced and as an avenue to achieving Universal Health Coverage (UHC). The cardinal definition of UHC emphasises the need to protect people from incurring financial hardships as a result of health expenses. Thus people are protected against financial risks that might come with illness.

Currently, the National Health Accounts Data compiled by the Ministry of Health shows that in FY 2015/16, the private sector contributed the largest share of the health sector budget, estimated at 42.6 per cent, followed by development partners at 41.7 per cent. This is not very different from FY 2014/15, in which the private sector contributed 41.4 per cent and development partners 43.4 per cent.
This data shows that the government contributes the least when compared to the development partners and the private sector.

A more in-depth look at the contribution of the private sector (42.6 per cent) shows that the bulk of funds (37 per cent) are paid out-of-pocket by households, indicating that households devote a bigger proportional of their incomes to accessing healthcare services.

With health insurance, people can access medical services at various accredited health facilities.
Universal access ensures equity in healthcare provision, which is a right, according to the WHO constitution of 1948, which declares health as a fundamental human right, and on the Health for All Agenda set by the Alma-Ata Declaration of 1978. In Uganda, different processes have been going on, from the drafting of the Bill in 2002, to the issuance of a certificate of financial implication in 2017, and the recent approval of the Bill by Cabinet on June 24.

Many countries have embraced health insurance as a way of financing healthcare, for instance, Rwanda, Kenya and Ghana. It is reported that in these countries, out-of-pocket expenditures on health have reduced significantly. It has been reported that in Rwanda, the community-based health insurance programme, Mutuelle de Santé, which covers more than 90 per cent of the population, had reduced out-of-pocket spending on health from 28 per cent to 12 per cent of total health expenditure. This suggests that with insurance, the utilisation of health services increases.


Given the move to introduce health insurance in Uganda and the need to ensure its functionality, the government of Uganda should take heed of a number of issues, as many will be shared in the subsequent SPEED Project Health Insurance Scheme Series.

The government should start with system arrangements to ensure that clients get value for money.
Emphasis should be put on making available health utilities in the facilities and instituting a mechanism for tracking members to avoid irregularities. Besides, since it is estimated that the collected amount would not be enough to cater for the entire population, it is feasible for the government to start with high-end services, whose costs are generally high.

Also, while implementing the scheme, the government should not abandon prioritising disease control and prevention measures, given their role in reducing the number of people who would demand health services.

Richard Ssempala,