National health insurance should start; perfection will come as we move on

Richard Ssempala

Recently Uganda received news that Cabinet had approved the Health Insurance Scheme. Health insurance is one of the ways in which health services are financed in such a way that an individual does not need to always have money on him/her to access services at a health facility.

The World Health Organisation (WHO) recommends health insurance as one of the ways in which out-of-pocket payments can be reduced and as an avenue to achieving Universal Health Coverage (UHC).  In fact, the cardinal definition of UHC strongly emphasises the need to protect people from incurring financial hardships as a result of health expenses. Thus people are protected against financial risks that might come with illness.

Currently, the National Health Accounts data compiled by the Ministry of Health shows that in FY 2015/16, the private sector contributed the largest share of the health sector budget, estimated at 42.6%, followed by development partners at 41.7%. This is not very different from FY 2014/15, in which the private sector contributed 41.4% and development partners 43.4%.

This data shows that the government contributes the least when compared to the development partners and the private sector. A more in-depth look at the contribution of the private sector (42.6%) shows that the bulk of funds (37%) are paid out-of-pocket by households, indicating that households devote a bigger proportional of their incomes to accessing health care services.

With health insurance, people can access medical services at various health facilities that are accredited, according to the National Health Insurance Scheme (NHIS).

Universal access ensures equity in health care provision, which is a right according to the WHO constitution of 1948, which declares health as a fundamental human right, and on the Health for All Agenda set by the Alma-Ata Declaration of 1978.

In Uganda, different processes have been going on, from the drafting of the draft bill in 2002, to the issuance of a certificate of financial implication in 2017 and the recent approval of the bill by Cabinet on 24 June 2019.

Many countries have embraced health insurance as a way of financing health care, for instance, Rwanda, Kenya and Ghana, to mention but a few.

It is reported that in such countries, out-of-pocket expenditures on health have reduced significantly.

For instance, it was reported that in Rwanda, the community-based health insurance programme, Mutuelle de Santé, which covers more than 90% of the population, had reduced out-of-pocket spending on health from 28% to 12% of total health expenditure, and increased service use to 1•8 contacts per year. This suggests that with insurance, the utilisation of health services increases.

Given the move to introduce health insurance in Uganda and the need to ensure its functionality, the Government of Uganda should take heed of a number of issues, as many will be shared in the subsequent SPEED Project Health Insurance Scheme Series.

The government should start with system arrangements to ensure that clients get value for their money. In the first phases, emphasis should be on making available health utilities in the facilities and instituting a mechanism for tracking members to avoid irregularities. In addition, since it is estimated that the collected amount would not be enough to cater for the entire population, it is feasible for the government to start with high-end services whose costs are generally high, for instance, cancer treatment, heart transplants etc.

Also, while implementing the scheme, the government should not abandon prioritising disease control and prevention measures, given their role in reducing the number of people who would demand health services. In this way, health resources will be saved.

As mentioned earlier, a number of countries first embraced health insurance some years ago, but still keep on modifying their schemes as they move on. Uganda, too, can start on the scheme, and modifications can be made as we move on. This, though, does not rule out the need to learn from countries with experience in this form of financing health care.

Richard Ssempala, Knowledge Management Officer,

SPEED Project, Makerere University School of  Public Health

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