Advocacy for a National Health Insurance Scheme for Uganda

 

Is the proposed National Health Insurance Scheme (NHIS) for Uganda being rejected?

The recent Cabinet decision to introduce a National Health Insurance Scheme (NHIS) elaborated to the public by the Ministry of Health caused both frustration and excitement in the different segments of our population especially from the Kampala-based formal public and private sector. The other segments whose views have not been brought to light are the better-off self-employed, the poor self-employed, and the unemployed and poor. Going forward, it will be helpful to get feedback from them because they too, have concerns with the scheme in its current form. Judging from the media stories, the formal public and private sector in principle accept that this country needs a health insurance system, which should be acknowledged and applauded. From the media stories again, they have three main concerns: First is with the proposed monthly 5% of salary, the amount which some say is too high; second is with the choice of collection method, the monthly salary deduction which they perceive as a new income tax; and lastly is with the contribution share of 1% and 4% between the employer and the employee respectively seen as not fair by the employees. Even if no media stories (sorry if I am wrong) have run to show how the other population segments reacted to the proposed scheme, I believe that them too welcome the scheme in principle, however, the following will be some of the concerns the poor self-employed, and the unemployed and poor (the informal sector) will raise: The first will be a question of “what are you talking about?” because they have never seen the draft bill and even those few who could have seen it did not understand it because it is not translated into any local languages; second will be an issue of why they are seen as homogenous and therefore billed regressively a flat Ugx 100,000 per year per family? they know and they can tell who is wealthier than the others in their communities and they will definitely wish that those differences are taken into account while deciding the amount to pay into the scheme; thirdly will be the  issue of availability and quality of health care services especially in the rural/ remote areas; fourth will be how to deal with their belief that paying for health care when illness has not come is synonymous with inviting ill-health; and lastly is how actively they will participate in managing and governing the scheme because they have suffered with “fake” schemes in the past which have stolen from them money while others promised benefits but never delivered them to their satisfaction.

Feedback from all segments of our population is therefore necessary because we are talking about a National Health Insurance Scheme in which all citizens are obliged to join (especially the wealthy and the healthy), where all citizens can benefit from the insured services; and where solidarity encompassing all members of the Uganda society is critical because in this scheme there have to be subsidies from the rich to the poor, from the young to the old, from small to larger families, from workers to the unemployed, from the healthy to the sick and vulnerable. moreover, we all have to appreciate that the core objective of a National Health Insurance Scheme is to guarantee health care provision to all citizens, serve all citizens (including the poor and needy) according to their health care needs and not according to what they pay for insurance, and help families cope with catastrophic health costs which are one of the leading reasons why some families fall into poverty.

Let me end with two messages and some recommendations:

1)      Introducing a national health insurance scheme in Uganda will be a reform. It means we shall shift (immediately or in a phased manner) from the Government healthcare provision using the Government health facilities (currently free for all) financed through taxes, direct out-of-pocket payments and donor revenues to a health insurance healthcare provision to those with insurance identification cards using contracted health facilities both private and government, financed through pre-paid contributions/ premiums, and Government/ donor grants for especially subsidies.

2)      Illness is destiny and every one of us will someday come to terms with it. An individual catching a disease is unpredictable so is what type of disease it will be, what kind of treatment will be needed to treat that disease, and how much it will cost.  A health insurance system tries to address some especially the finance related uncertainties and enables a population to cope better with illness.

The Government through its Ministry of Health has taken an important step in the right direction even if it is coming after a very long wait. It is now urgent that the next steps be expedited to get the NHIS bill 2019 ready and tabled before parliament for consideration. At the same time, the population should be educated about the complicated concept of insurance and about the NHIS. This role of educating the public should not be solely for the Ministry of Health, but in partnership with other institutions like the Community Based Health Insurance Schemes, the Micro finance institutions most of which cover borrowers for medical expenses, and others. The continued branding of the health insurance premium/ contribution as a tax needs to be corrected to allow the public debate the scheme in a more realistic way. It is also important that the scheme is implemented “the Uganda way” because having waited for all this long, we should avoid taking the paths other countries already took and reformed because they didn’t work, we rather should implement our scheme in a unique way for example, premiums from salary workers could be deducted once every quarter for example as opposed to monthly deductions, the scheme implementation phasing could follow a more representative approach like regional phasing as opposed to the common social-economic classifications where you start by enrolling those with predictable income (formally employed) and not so much in need because some of them already have some private insurance cover, and end with those who do not have predictable income and are much more in need of the scheme.

Makaire Fredrick

Executive Director

Save for Health Uganda (SHU)

SHU is promoting Community Health Insurance Schemes in 9 Districts of Central and Western Uganda

makairef@yahoo.com

Makaire fredrick: Ugandas health system - A policy dilema.

Makaire fredrick: Ugandas health system - A policy dilema.: My country is proposing to introduce a National Health Insurance Scheme to which every resident shall be compelled to join over a 15 years p...

Ugandas health system - A policy dilema.

My country is proposing to introduce a National Health Insurance Scheme to which every resident shall be compelled to join over a 15 years period after it is inaugurated. While this is being planned, it is important to note that since 2001, the country has been implementing a "free" health care policy in public healthcare facilities; and whereas every body here in Uganda acknowledges the fact that the policy has not achieved its objectives, it remains popular especially to the rural folks who instead want the Government to make it work rather than scrap it off. The formal sector and urban folks on the contrary are divided with some favoring the tax funded health care policy for all and others preferring a more liberal health sector with both free and paid for services.

As we head into the polls next year (2016), it remain very clear that we are going to be promised free health care as opposed to the National Health Insurance Scheme where lots of resources have already been spent to develop a bill.

It will be interesting to see what happens after the elections are done.

Microinsurance Philippines: Mobile banking without a phone: Here comes the bank van

Microinsurance Philippines: Mobile banking without a phone: Here comes the bank van: “Ordinary people see ‘insurance’ as something that only rich people can afford,”

Looking for literature on ways to make community health insurance schemes work more successfully. Please share if you have some

Utilization of obstetrics services in rural areas of Uganda

I am working on a project aiming to increase financial access to quality obstetrics services for the women in reporoductive ages in one district in Uganda. On this project, the expected outputs should be increased utilization of ANC and medical services, increased institutional deliveries and increased utilization of PNC services. Immunization of the newborns is expected to increase as well.

Our approach is to get the community take the lead in making sure the women access the services. We have therefore designed and are promoting community health insurance schemes to which the communities pay premiums and the women in the paid up community automatically benefit from the scheme by accessing obstetrics services when they need them. The package is comprehensive. In addition to the obstetrics services, the women are provided with transort. In case of death the dead body is transported as well.

It has been two years now. What are we seeing?

1. A steady increase in utilization of services
2. Some resistance from culturalists. Cultural barriers making the utilization of TBAs still common
3. Data collection a challenge because some women deliver from communities as well as immunizations. Even cases of maternal death occuring from home are not easy to truck

Our biggest challenge is monitoring. How to collect data from the community? Institutional data is ok to collect but it accounts for only 60% of all the cases untill now.

Are there experiences to learn from?