Uganda ready for National Health Insurance Scheme

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Ali Walimbwa, an officer at the health ministry says the final draft of the National Health Insurance Scheme (NHIS) was submitted to cabinet last year, waiting to get to the agenda to be tabled for discussion.

The NHIS is an initiative where members of the population contribute a defined amount of money based on their ability so as to access the benefit package from accredited public and private health facilities using a health card.

The draft bill stipulates that all Ugandans aged 18 and above will have to enrol and pay a premium to the proposed scheme. Parents or guardians will have to pay for those below 18 and are dependants.

A midwife checks a pregnant woman for blood pressure. (Photo by Agnes Kyotalengerire)

“A flat fee based on individual’s income will be determined and not based on the percentage of salary” Dr Sarah Byakika, the Commissioner, Planning Financing and Policy, says.

Employees in the informal sector who earn more than those in the formal sector will contribute sh15,000 per month until a system is established either through the Uganda Revenue Authority (URA) or the National Identification and Registration Authority (NIRA) where income bands can be determined for everyone, Byakika says

According to Walimbwa, the proposal still stands and since discussions are still ongoing, there is an opportunity to improve it with stakeholders’ input. Uganda remains the only country in the greater East Africa that has not passed a NHIS despite having the highest out-of-pocket costs for health in the region. An estimated 27.7% of Uganda’s health expenditures are paid by individuals through out-of-pocket costs.

Third-Party insurance, community partnership

According to Richard Kabagambe, the Commissioner Budget and Health Financing the Third-Party insurance is another venture to boost finance for health. For example, on average, over 100 bodabodas are involved in accidents daily and are rushed to hospitals for treatment.

The cost of care for bodaboda accident victims is too high, commodities and medicines run out in less than a month instead of lasting for three months. Estimates done by Parliament recently discovered that the country needs about sh300m every year to treat and manage trauma. Yet, the Third-Party insurance money is not directly channelled to the health sector, Kabagambe notes.

Mothers waiting to immunise their babies. (Photo by Agnes Kyotalengerire)

The World Health Organisation (WHO) Representative to Uganda, Dr Yonus Tegegn says the other way to leverage local resources is by prioritising investments in primary health care.

This can be achieved through community health systems to reduce the disease burden through targeted health promotion and education, and disease prevention intervention because that is where the health sector strategic plan is focused.

Also, Flavia Kyomukama who is the executive director Action Group for Health Human Rights and HIV Action (AGHA) says investment in primary health care through community structures is a big save for this country because it is the last mile.