Universal health insurance does not replace health centres

The debate will not end until we have the scheme in place: Universal health insurance for all Ugandans. And the latest defender of no insurance is Mr Godfrey Kiwanda, NRM Central Executive Committee member for central region and former State minister for Tourism.

He is a travelled man. He has visited several countries near and far, where universal health insurance functions. And in these countries, heath centres and facilities do exist and they function. Universal health insurance has not replaced them. And they are within easy reach. And they are equipped and staffed to handle health services as expected at that level.  

Insurance in general is a potential domestic revenue source, but as a country, we remain at the lowest rung when it comes to insurance coverage. Even the essential one like comprehensive motor vehicle insurance, residential and commercial premises insurance is still very low. 

When shall we have mandatory comprehensive insurance for motor vehicles, owner-occupied residential premises, rented residential premises (bungalows and apartment blocks), commercial premises (shop chains, arcades, malls, markets), leisure and hospitality facilities; institutional building (schools, hospitals, universities)? 

 Our vulnerability in this area is evident whenever misfortune strikes and any of these premises catches fire. We must have a shock absorber against this.  Moreover, the unit cost of premiums will reduce once the numbers are many: the secret lies in the power of numbers.

Back to health insurance. Yes, not every Ugandan can afford it. No, every Ugandan can afford it. The formula is simple. The few Ugandans employed in the formal sector will pay through a shared contribution from the employees and the employer.

The current stalemate, arising from employers protesting the increase in goods prices due to high costs occasioned by insurance contributions is misleading. The cost will be borne by the final consumer who pays the prices, and as the post-Covid situation has shown us, we the consumers have no control over price hikes and we do absorb them. With a dedicated Health Insurance Fund (HIF) established along the lines of NSSF, as the government agency in charge of universal health insurance, we shall have a financial pool solid enough to finance essential drugs and equipment, staff remuneration and motivation across the health value chain from the village to the national referral. It is possible. HIF will neither eliminate nor compete against private health insurers.

Employers will contribute a mandatory percentage of their private insurance bill to the HIF, since it’s a national scheme. In the informal sector, Health Centre IIs become the points of registration for households in each parish to get HIF cards: manpower teams and equipment used for voter registration will ably execute this.  Households pay direct to HIF, carry evidence of payment to register and get HIF cards. Shs10,000 annually for each individual aged 16 and above. This can be paid in two equal instalments, so that a family of 10 eligible people, will pay Shs50,000 every six months to access quality health services obtainable at whatever level where they seek the service.  Extreme cases of families unable to pay this amount will be covered by the mandatory percentage levy from private sector insurance bills.

The scheme will work in both government and private hospitals, with a government cap on drug prices in private hospitals: a brand of paracetamol in an upmarket private facility should cost the same price as in a government health centre II under the HIF scheme. Yes.

It is possible and urgent to have universal health insurance. It will attract quality investment in our health sector including pharmaceutical manufacturing.

Matsiko Kahunga, 

[email protected]