Improving access to care the economically disadvantaged is critical to the broader agenda of economic and social empowerment of communities.
By Chrispus Mayora
A few years ago, Government of Uganda set up a students' loan scheme for tertiary education.
The objective of the scheme is to help the disadvantaged students in society to access tertiary education - especially those who would not get an opportunity to attain tertiary education. Indeed a number of students have benefited from this scheme since its inception.
While the challenge of vulnerability was identified in accessing tertiary education, this challenge is even more pronounced in health especially in accessing costly chronic care, by the socioeconomically constrained populations.
Yet, improving access to care the economically disadvantaged is critical to the broader agenda of economic and social empowerment of communities. How the health sector learn from the education sector's loan scheme to address this challenge is certainly worth discussing.
The current global as well as national agenda for health is the strife to achieve Universal Health Coverage (UHC) - defined as "access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost". UHC entails increase coverage or access to essential and good quality services to wider populations, yet protecting families or individuals from financial hardships that may result from health care seeking.
How households finance health care without being left in financial stress is a challenging issue which is at the core of the current health care financing debate.
One of the big challenges in Uganda currently is the emergency of chronic and non-communicable conditions such as cancers - partly attributed to changes in life styles but also improvements in diagnostic technology. These conditions are hard to manage, and require complicated and sometimes costly medical procedures. Some of these procedures are available in Uganda and some are not, but even for existing procedures, it is costly to households and families to manage such conditions.
The media has often times ran stories of many Ugandans who seek care in other countries particularly India, the UK, USA, and South Africa, for cancer treatment, heart surgeries, organ transplants, etc.
There are huge amounts of resources that have often been reported for expenditures and treatment abroad for just government officials. To these, add individuals who cannot access government resources and have often run public campaigns for support for treatment abroad - for those that are lucky to access the media or you have strong social networks that you can leverage, otherwise majority never get to see the gates of a hospital.
The recent breakdown of the cancer machine at the cancer institute and the ensuing national crisis ably illustrated what it can be if government does not intervene in provision of or subsidization of such services. The cost of successful treatment of one cancer case can be equivalent to treating probably five hundred or even more malaria cases at an outpatient clinic of a hospital.
The cost to family of treating and managing a cancer patient is so enormous that sometimes family property is sold or children have to drop out of schools - it is so impoverishing. At times, families decide never to "waste" resources on seeking care because of a loss of hope. The cost from productivity losses to the economy due to ill-health are even greater
Considering the huge cost involved in treating and managing chronic diseases/conditions, mechanisms for preventive care services including public health education on lifestyle change need to be advanced. This could for example include designing and implementing an incentive package for people who enroll into physical/exercise programs.
In South Africa for example, people who jog and do exercises and are enrolled on medical insurance are tracked and earn bonus points that are reflected on their insurance scheme. Such incentives motivate people to exercise even more, or eat healthy foods, and significantly cuts down on cost of treatment.
Beyond this however, and for those who need treatment, we propose an innovative financing approach that could enable individuals to access this quite costly care through a loan facility.
In the absence of health insurance, families could access a loan from government payable after recovery and return to productive work.
This is premised on the understanding that the object of treatment or any medical procedure is to return one to full health and productive status. Poor treatment outcomes such as death or treatment failure result from delays in early diagnosis and treatment seeking - linked to financial challenges, and this needs to be addressed.
The implementation modalities can be discussed at policy level and the loan scheme for tertiary education could offer us important lessons in this regard.
The writer is a health economist with SPEED - Makerere University School of Public Health