Why every Ugandan should be insured

By Patrick Kagurusi
Recently, I met a gentleman in his late 30s working in a major sector in this country and hailing from very rural Uganda. Having told him that I worked for a health development organisation, he immediately recalled his primary school days, where, while in primary three, he was leader of his health club and learned about HIV/AIDS and other health subjects as a result of the action of the organisation I work for.

He added that the experience had made him serious about his health, including insuring his health and that of his family.Thinking about this, I noted that if every person of his generation and those after him had such an opportunity to know about and be covered with health information and services, they would grow up confident, healthy and productive with the ability to pay 35% of their earnings as taxes - contributing to national development, just as this gentleman does.

I wondered why this gentleman opened up to me about his health in such a positive way. He informed me that it took many people and institutions such as health workers who taught him; his teachers and school that allowed this interaction to happen; parents who took him to that school; a favourable policy that allowed school health to happen and, of course, someone was paying for it.

I visualised how every Ugandan can be covered in regard to health so that they can focus on production. This led me to universal health coverage.According to the World Health Organisation, universal health coverage (UHC) refers to a state of a population where every member has undeterred access to quality essential health-care services, access to safe, effective, quality and affordable essential medicines and vaccines and is protected from catastrophic financial risks when they or their community members fall sick.

Such a community should also have free access to accurate and useable health information and taking action as individuals or families to maintain good health.
Arriving at such a state takes deliberate action to organise and maintain a health system that provides such healthcare coverage, by having and implementing the enabling legislation, dedicated financing, a motivated, skilled and equitably distributed health workforce, health communications networks, health technologies, information systems, quality assurance mechanisms and reliable service delivery at health facilities.

These cannot be achieved unless there is a leadership and governance that works towards achieving it.Globally, there has been action towards UHC. The United Nations member states, of which Uganda is a member, have agreed under the Sustainable Development Goals (SDGs) to try to achieve Universal Health Coverage by 2030. Indeed, there are examples of countries that have nearly arrived at UHC. Most European countries, Canada, Australia and Russia have at least 90% of their populations covered with basic healthcare.

In Africa, Algeria, Botswana, Burkina Faso, Egypt, Ghana, Mauritius, Morocco, Rwanda, South Africa and Seychelles are leading on the continent.Common to all the countries is that the public sector runs nearly 85% of free primary healthcare services but, in addition, they have made the leap towards national health insurance schemes through a public lead mechanism of financial pooling for health care where citizens pay premiums into these schemes.

Uganda has explored these waters before and has the potential to arrive at universal health coverage. However, a few things still remain. First, the national health insurance Bill still lies on the shelves of Parliament gathering dust. The health infrastructure exists, but the state of most of it needs improvement.

The health workforce remains small, overworked and unmotivated - the recent events notwithstanding. Access to safe genuine medicines, although improving, remains at less than the desired standard.

The health financing by the public sector remains a challenges as, over the years, the GDP contribution deviates negatively from the 15% agreed to under the Abuja declaration. The impact of the latter is catastrophic as many people sell all they have and pay heavily to access healthcare leaving families in poverty.

The challenge to the leadership of Uganda is to take a bold step towards universal health coverage in Uganda and implement it. Parliamentarians: pull out and pass the national health insurance Bill. To avoid the authority syndrome that could bedevil the scheme, a citizen led structure should be established to run such a scheme and provide accountability for it.

We can then have a healthy and productive society, ready to be led to the middle income state.
The writer is the Amref Health Africa Head of Programmes