We need National Health Insurance Scheme like yesterday, population expert

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The senior presidential advisor on population and Family matters, Dr Jotham Musinguzi, said there is an urgent need to advocate for a National Health Insurance Scheme to ensure accessible and sustainable healthcare for all Ugandans.

“We cannot continue to treat Government with soft hands, and we do not have a National Health Insurance Scheme. No country has ever had a good health system without a national health insurance of some nature. And so we need this not tomorrow but yesterday,” Dr Musinguzi said.

He further noted that in today’s global landscape, especially in the Trump era, such a scheme is becoming increasingly important to strengthen our health system and provide equitable healthcare solutions.

Dr Musinguzi made the remarks recently during the launch of the Ahaki Afya na Haki Institute in Gayaza Nakwero on Thursday (March 27, 2025).

Ahaki institute is an African Institute of higher learning offering specialized programs in health and social justice. The institute provides an integrated Afrocentric and interdisciplinary approach to teaching, learning and research.  

The scheme in offing

The commissioner planning, financing and policy, Dr Sarah Byakika, said the National Health Insurance Scheme (NHIS) draft bill was submitted to cabinet last year, waiting for approval.

The National Health Insurance Scheme is where members of the population contribute a defined amount of money based on their ability to access the benefit package from accredited public and private health facilities using a card.

The draft bill stipulates that all Ugandans aged 18 and above will have to enroll and pay a premium to the proposed National Health Insurance Scheme. For those below 18 who are dependents, their parents or guardians will have to pay for them.

A lady receiving a tetanus injection. (Credit: Agnes Kyotalengerire)

Premium for employees in the formal sector will be based on income bands.

“A flat fee based on an individual’s income will be determined and not based on percentage of salary”, Dr Byakika said.

Those in the informal sector and 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 URA or NIRA, where income bands can be determined for everyone, whether in the formal or informal sector.

Uganda is the only country in East Africa that has not passed a National Health Insurance Scheme despite having the highest out-of-pocket costs for health in the region. An estimated 41 per cent of Uganda’s health expenditures are paid by individuals through out-of-pocket costs.

Background

Discussions about national health insurance in Uganda started in the late 1980’s and evolved slowly over the years.

On August 22, 2019, the Minister of Health tabled the National Health Insurance Scheme Bill before parliament for the first time reading.

The National Health Insurance Scheme (NHIS) Bill was passed by the Parliament of Uganda on March 31, 2021.

Sadly, in October 2021, the bill was bounced back to the health ministry for amendment because it was not addressing the legal issues. In May 2022, the Attorney General was tasked to look at the bill to harmonize it with Insurance Regulatory Authority.