National Health Insurance Raises Hopes and Questions

Government plans to start a national health insurance scheme have drawn mixed reactions, with some sector experts upbeat, while others warn against a beautiful castle with no foundation.

Officials say that the NHIS will help people across the country to access quality health care, whether they live in towns or villages.

The chairman of the taskforce for designing the NHIS, Dr Francis Runumi, told The Observer last week that following consultations with different stakeholders, the ministry and the parliamentary committee on Health had come up with a draft bill on its introduction.

“We are only waiting for the certificate of financial implications from the ministry of Finance then we will prepare a cabinet paper and have it tabled in parliament,” said Dr Runumi, the commissioner for health services in charge of planning in the ministry of Health.

Envisaged as a body corporate independent of the Health ministry, the NHIS has been in the pipeline for more than a decade. If operationalised before end of 2015, as envisioned, the scheme will initially cover about two million employed Ugandans, including 300,000 government workers.


According to the 2007 National Health Insurance Bill, civil servants and other formally-employed Ugandans would have to pay insurance premiums to ensure coverage for all citizens. An eight per cent contribution is being proposed to raise finances for the scheme. Of this, four per cent will be met by employers and another four per cent by employees.

According to Mariam Nalunkuuma, the communications officer of the Insurance Regulatory Authority of Uganda, the NHIS will initially generate $100m in its first year of operation.

“This money will go into a resource pool and will be used to sustain the scheme so that every Ugandan may access health care. The problem is changing the mindset of people who are equating the contribution to a tax. It is not a tax because you will follow it up with free services for you and your beneficiaries,” Nalunkuuma explained.

Recurrent problems:

However, Ritah Kyategeka, a health analyst, warns that the health scheme is not worthwhile at a time when the public healthcare system is collapsing.

“Government, in one way or the other, is already providing insurance by providing free services at health centres. However, these have problems of their own as they are often without drugs and medical personnel. So, will this change with the scheme?” Kyategeka says. “My proposal is that government should first rectify the already existing ills before imposing additional tax on us.”

According to the Economic Policy Research Centre (EPRC), households spend about nine per cent of their expenditure on healthcare, despite the scrapping of user fees in lower-level government health units and general wings of public hospitals in 2001. Dr Kenneth Omona, the chairperson of the parliamentary committee on Health, said the time was ripe to have the scheme in place to save families this expenditure.

“The scheme is not about defrauding Ugandans of their money. We are aiming at bolstering health services in terms of modern diagnostic equipment, better health services and better trained health workers. The scheme will enable this through encouraging competition among health care providers. But we are moving quite slowly,” he said.

Once operationalised, according to Omona, the scheme, will oversee the roll-out of basic primary health care, diagnosis and treatment of common illnesses such as malaria. This would mean, for instance, that NHIS card holders would get certain services at private but accredited facilities, which now only accept cash-paying or insured patients.

Those facilities would then claim payment from NHIS. It would also mean that patients would not have to go to failing public facilities when there are efficient private ones. Uganda is the last East African country to adopt a NHIS. At 0.8 per cent, Uganda has the lowest insurance penetration in the region, compared to Kenya’s three per cent, and Tanzania and Rwanda’s one and two per cent respectively.

Source : The Observer

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