National insurance scheme should focus on NCDs, experts say

Following an uptick of Non – communicable diseases (NCDs) in Uganda, public health experts have called for the National Insurance Scheme to finance the prevention of such ailments.  

President Museveni is yet to assent to the national health insurance bill that was passed by Parliament but researchers at Makerere’s University’s School of Public Health (MakSPH) in conjunction with Harvard School of Public Health have suggested that NCDs should be in financing plans of the government.  

“Non- communicable diseases aren’t being financed well because we have been paying attention to maternal health, infectious diseases, and child health. And we see that NCDs have been making steep rise while the country has been making progress in reducing infectious diseases,” said   Prof Fredrick Ssengooba, a lecturer in the Department of Health Policy, Planning, and Management at the School of Public Health during a workshop in Kampala.  

Official figures released by the Ministry of Finance indicate that there is a rising burden of NCDs in Uganda, accounting for more than one-third of deaths by the year 2016. 
An estimated 27 percent of the population are living with hypertension, while only eight percent of people with hypertension are aware they have the disease.

 While the government has a free care policy at the point of using health services in public facilities, the healthcare experts at the workshop pointed out that many households are pushed into poverty each year due to high levels of out-of-pocket (OOP) expenditure on healthcare.  

Specifically, the experts said that households spend 75 percent of their incomes on medicine, especially when services are not available in public facilities. This is exacerbated by the lack of a national health insurance scheme which they said would have to protect the Ugandan population from the financial risks associated with using healthcare.  
 
“Less than five percent of the population has private or community-based health insurance. We know from other settings that health insurance can generate demand for healthcare, especially preventive healthcare such as anti-hypertensive medicines and cholesterol-lowering drugs,”   said Aliyi Walimbwa, an official from the Ministry of Health.

The experts who attended the workshop were of the view that implementing and scaling up a national health insurance scheme in Uganda may generate demand for primary care and preventive interventions and further impact long-term health and welfare of Ugandans living with or at-risk of developing NCDs if insurance is well designed and targeted. 

“The questions we are dealing with is how can we use insurance, if it’s coming, to try and help improve the control of NCDS and what should be the packages and the design issues with insurance that can help people to screen for example cancer for the prostate or hypertension or blood sugar issues,” Prof Ssengooba said. 
“If we don’t do that it means people are going to come with diseases that the expensive to treat,”    he said.