Govt eyes innovative financing to boost National Health Insurance Scheme
According to the Civil Society Budget Advocacy Group (CSBAG), Uganda continues to rely heavily on out-of-pocket healthcare payments, with households financing between 27% and 41.4% of healthcare costs.
A nurse attending to a patient. (File photo)
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Health sector stakeholders have warned that the country’s long-awaited National Health Insurance Scheme (NHIS) will only succeed if the government moves beyond individual contributions and adopts innovative financing models.
These models, they said, are capable of sustaining healthcare costs amid shrinking donor funding and rising public debt.
The call emerged during the Integrated Advocacy Coalition Hub meeting held in Kampala on Thursday, at AIDS Healthcare Foundation (AHF) Uganda offices, where government officials, civil society organisations, development partners and health advocates discussed sustainable financing for Uganda’s proposed national health insurance programme.
While public debate has largely focused on the proposed sh15,000 contributions, participants argued that the real challenge is building a financing system that can support the country’s growing healthcare needs over the long term.
Opening the meeting, Henry Magala, the Country Director of AIDS Healthcare Foundation (AHF) Uganda, warned that decades of progress in expanding healthcare services are under threat due to declining donor support, mounting public debt and competing national priorities.
“The hard-won health gains over decades are being threatened by rising public debt, reduced donor funding, constrained budgets and competing spending priorities,” Magala said.
According to the Civil Society Budget Advocacy Group (CSBAG), Uganda continues to rely heavily on out-of-pocket healthcare payments, with households financing between 27% and 41.4% of healthcare costs.
Namatovu Sharifa, the Programme Associate at CSBAG, warned that this exposes families to catastrophic medical expenses, forcing many into debt, poverty or delayed treatment.
Health Ministry responds
Responding to growing concerns over the affordability of the proposed insurance scheme, Dr. Walimbwa Aliyi from the Ministry of Health said the government is already exploring innovative financing mechanisms that extend beyond household contributions.
“The scheme is expensive, but there is what we call innovative financing,” Dr. Walimbwa said. He revealed that discussions are underway with development partners and United Nations agencies to identify alternative funding sources, including climate financing and Global Fund support.
“In some countries, Global Fund resources finance health insurance. In Rwanda, different government resources are transferred into one insurance pool. Once the scheme is established, innovation in financing becomes much easier,” he explained.
“Countries like Kenya, Tanzania and Ghana have created separate funds to finance cancer and heart diseases. Such an approach would supplement the main insurance scheme instead of overtaxing contributors,” he said.
The Ministry of Health’s Senior Advocacy Officer, John Robert Ekapu, said concerns surrounding the proposed sh15,000 contribution remain premature because the National Health Insurance Bill is still before Cabinet and could undergo further changes before reaching Parliament.
“The proposed amount was an estimate. Since the Bill is still undergoing scrutiny, some provisions, including the contribution levels, could still change,” Ekapu said.
He explained that the government is considering a holistic financing model bringing together taxes, employer contributions, private sector participation, individual payments and government subsidies for vulnerable populations into one national insurance pool.
Health experts also stressed that prevention should become a central financing strategy rather than an afterthought.
Participants argued that increased investment in early disease detection, screening and health promotion would significantly reduce the future cost of treating expensive chronic illnesses such as cancer, kidney disease and diabetes.
“The cheapest healthcare is prevention,” Dr. Kawooya Sulaiman noted, urging the government to prioritise community screening programmes to reduce future insurance claims.