Expedite National Health Insurance scheme Bill to achieve the SDGs 

In June 2019, the National Health Insurance Scheme (NHIS) Bill was approved by Cabinet and subsequently tabled before Parliament. The Bill was referred to the Parliament’s Health Committee for scrutiny. In its consultative process, the Health Committee chaired by Dr Michael Bukenya, received a number of views from various stakeholders. As a critical stakeholder representing the views of the insurance sector, the Insurance Regulatory Authority of Uganda (IRAU) advised that an immediate actuarial study should be carried out to determine the contributory rates for employees, employers and those in the informal sector under the NHIS. To date, the debate on the Bill has not yet been concluded.

Little did we all know that in the following year (2020), we were set for a health crisis, the Covid-19 pandemic, which has heavily disrupted the global health system. The outbreak has not only manifested as a public health emergency causing large-scale loss of lives and human suffering, but it has also disenfranchised the global economy.

Many communities which hitherto relied on government’s free healthcare programmes, are experiencing reduced access to primary healthcare. Reports indicate an increase in the number of preventable deaths during childbirth, health emergencies and other occurrence of deaths due to preventable disease like malaria.

The pandemic has indeed disrupted Uganda’s progress in achieving the Sustainable Development Goals (SDGs) and specifically Goal 3, which aims at ensuring healthy lives and promoting the well-being for all and at all ages, ending poverty and reducing inequalities. This pandemic has created a toll on the health sector significantly causing a drastic change in the lives of Ugandans who have to adapt to the new normal and practices in order to stay safe. 

The worrying situation this pandemic has caused will undoubtedly affect our Health Financing Strategy 2015/2016  to 2024/2025, which came at the time of the global commitment towards SDGs and Universal Health Coverage (UHC). The financing strategy is anticipated to serve as a critical element in the pathway to achieving health-related SDGs and attaining UHC, while emphasising access to good quality healthcare, according to needs, and at the same time limiting exposure to financial risk for those who seek care. 

Whereas government has set the right direction in developing the NHIS Bill, it is high time we expedited the process. Many countries have already established such schemes to raise resources for health and ensure access to healthcare through financial risk protection. 

In the East African region, one of the reasons why insurance penetration is considerably higher in other partner States compared to Uganda, is the root taken to diversify and strengthen healthcare financing. These States have health insurance schemes where contributions are made to bridge the financing gap in the health sector. Operationalising the NHIS will stimulate providers to avail good quality, accessible and affordable healthcare, as well as increase welfare gain in healthcare and ensuring that everyone has financial access to health care.
 
The major principle in a health insurance scheme is to promote social solidarity and pool resources for the rich to subsidise the poor, the single to subsidise already established families, the healthy communities to subsidise the unhealthy and the young working population to support the old to enable them access health care.
This pandemic should awaken the discourse on how our health systems should build the required resilience to withstand such shocks. 

By Ibrahim K Lubega

Mr Ibrahim Kaddunabbi Lubega is the 
chief executive officer Insurance Regulatory Authority of Uganda