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Civil society organisations (CSOs) and legislators under the Uganda Parliamentary Forum on Social Protection (UPFSC) have called for speedy implementation of the National Health Insurance Scheme (NHIS). They believe this will combat challenges of health care access.

They have listed justifications for expediting Uganda's NHIS and urged the Government to fast-track its implementation.

Dr Bhoka George Didi, a Member of Parliament representing Obongi County says for millions of Ugandans, accessing quality healthcare often feels like a distant dream. This, according to him, is because out-of-pocket expenses force many to forego treatment, leading to preventable illness and financial hardship. `

Bhoka Didi George, Obongi County Obongi (NRM).

However, a beacon of hope glimmers on the horizon with the Uganda National Health Insurance Scheme according to Bhoka.

Its swift implementation, he says, holds the potential to revolutionise healthcare access and usher in an era of increased equity, affordability and improved health outcomes.

He was speaking during a Uganda Parliamentary Forum on Social Protection (UPFSC) event that was held at Parliament on February 1, 2024.

The forum aimed at discussing interventions to ensure inclusive social protection, especially for the elderly and vulnerable people of Uganda.

Other legislators also reiterated Bhoka’s message, emphasizing the need for a healthier, more equitable Uganda, which they said the scheme’s implementation could bring their vision to reality.

Achan Judith Peace (Woman MP for Nwoya) said the urgency for action is undeniable and suggested that the Government should quickly roll out a NHIS to enhance access to essential basic health services, especially for low-income individuals, households and the elderly.

“There is need to document and progressively revive traditional social support systems to complement formal social protection services for the poor and vulnerable and explore possibility for inclusion in accessing social protection services,” she said.

CSOs speaks out

Peter Eceru, a programme co-ordinator and advocacy officer at CEHURD, which involved in social justice in health, said extending health insurance nationally is rational since the current out of pocket expenditure demonstrates that Ugandans are already paying hugely for access to health services.

“In Uganda, about 39% of health expenditure is from out of pocket, thus calling for a social health protection scheme. However, it is important to note that health insurance does not replace government budgetary allocation for healthcare. Rather, it compliments health expenses that contribute to the functionalisation of health facilities,” he said.

Uganda’s per capita spending has remained way below the international threshold target of $86 (about shillings 326,800) per person. The World Health Organisation (WHO) recognises that without health insurance, chances of the country attaining universal health coverage are low.

Funding for the elderly needed

Peggy Joy Wako (Woman MP for elderly persons) rooted for more funding to cater for the needs of the elderly and vulnerable people and underscored the importance of health insurance, especially for the elderly who are often affected by health complications.

Legislators emphasized that social insurance is a contributory arrangement to mitigate livelihood risks and shocks such as work-related disability and ill-health among others.

Despite economic growth, it is evident that a significant proportion of people in Uganda still have a low quality of life, exacerbated by growing inequality.

Old-aged persons constitute 4.3% of the population which is estimated at 45.6 million as of 2023 (49.3% male and 51.7% female).

This number is expected to increase four fold by 2050. Therefore, this calls for strategic interventions like the insurance scheme to ensure social protection for the vulnerable population.

Like the MPs pointed out, the thought of having a national health insurance scheme for Uganda is a step in the right direction.

This is because health insurance has a demonstrated ability to avert financial risks that arise from high out-of-pocket expenditures thus contributing to the reduction of impoverishment.

Where successful insurance schemes exist, the population is guaranteed social health protection, preventing the need for money when accessing essential health care.

Furthermore, existing private commercial health insurance schemes cover only less than one percent of the Ugandan population, suggesting limited affordability by many Ugandans.

National health budget

Uganda’s health budget has also been on an upward trajectory, doubling from shillings 1.456 trillion in 2016/17 to shillings 3.094 trillion in the 2023/24 approved budget.

The highest rate of increase was experienced in the 2020/21 and the 2021/22 financial years, which also coincided with the COVID-19 pandemic phase.

If sustained, the recent increase in the health budget provides the opportunity for the country to build on past investment gains to accelerate progress towards attainment of the Sustainable Development Goal (SDG) 3 that aims to ensure healthy lives and promote well-being for all at all ages.

Contribution to the scheme

According to health minister Dr Jane Ruth Aceng, families will be contributing at least shillings 15,000 monthly to the health insurance pool for each member of their household should Cabinet approve the proposed National Health Insurance Scheme Bill.

However, the indigents (people living below the poverty line) will contribute shillings 15,000 per year. Others, according to the health ministry, will contribute based on their income after being financially assessed.

Basically, what the Government is not paying for in the health service sector, individuals will pay for it through insurance.

NHIS background

The NHIS was supposed to start in 2017, however, the plan is still on ice. The process of developing a NHIS Bill was initiated in 2002 following a feasibility assessment for development of social health insurance in Uganda by Makerere University Public Health Institute (MakSPH) and Harvard University School of Public Health.

Several versions of the Bill have been developed; The draft in 2012 focused on statutory health insurance targeting civil servants.

The draft in 2014 targeted formal public and private employees as well as indigents. The current draft in aims to establish NHIS for all residents in Uganda.

The Ministry of Health in collaboration with other key stakeholders in the insurance sector is still undertaking further consultations and analysis on the scheme.

The mover of the Bill, Sarah Opendi (Tororo District Woman MP), believes that with the small contribution from the citizens, the country shall be able to meet all the health expenditures that the Government is supposed to meet.

Other proponents of the scheme envision a system where the healthy subsidies the unhealthy, the young subsidizing the elderly, and the high-income earners subsidizing the poor.