The Cost of Delay: The Urgent Need for a National Health Insurance Scheme in Uganda
There’s this common adage among social groups: “An average Ugandan is one medical bill away from poverty” It’s not just a saying; it’s a stark reality we’ve all witnessed. The COVID-19 pandemic laid bare this vulnerability, forcing families to liquidate their meager assets for a chance at treatment, leaving many stranded and neglected in hospitals simply for lack of funds. How many times have we scrolled through social media, encountering desperate pleas for financial assistance to afford critical medical procedures? Where, in these moments of crisis, is the promised right to health?
Target 3.8 of Goal 3 of the Sustainable Development Goals (SDG) in Agenda 2030 clearly articulates that all countries should provide Universal Health Care (UHC), including financial risk protection by ensuring “access to quality health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” Yet, in Uganda, the burden of out-of-pocket health expenditure sits at a staggering 34.1%, the highest in East Africa and far exceeding the World Health Organisation’s recommended 15%. This exorbitant figure precipitates catastrophic health expenditures, pushing countless households into destitution.
The much-anticipated National Health Insurance Scheme (NHIS), a potential lifeline against this financial crisis, remains frustratingly out of reach. While Ugandans grapple with crippling medical bills, languishing on cold hospital floors, their leaders seem preoccupied with the political theater of vote-seeking, offering hollow promises instead of concrete solutions to this fundamental human need. NHIS has been a topic of discussion for far too long, an unanswered question mark hanging over the accessibility of quality and affordable healthcare for every citizen. The momentum behind this crucial scheme appears to have stalled, but with the relentless surge in the cost of living, access to health is fast becoming a privilege reserved for the few, leaving ordinary, impoverished Ugandans crying out for the government’s intervention.
Uganda and South Sudan are the only countries in the East African Community without a National Health Insurance Scheme. This absence places Uganda in a precarious position, with a healthcare system that struggles to meet the needs of its citizens. The original National Health Insurance Scheme (NHIS) Bill, introduced in 2019 and passed by Parliament in 2021, was later withdrawn by the government to address concerns raised by stakeholders, among these was the issue of affordability. This retreat, while intended to refine the scheme, has inadvertently prolonged the suffering of countless Ugandans.
However, Uganda can no longer afford further delays. The looming cut in donor funding, which is potentially leaving a UGX 604 billion financial gap in the health sector, presents a compelling urgency to revisit the NHIS bill. This new social contract between the government and its citizens will offer a viable pathway to bridge this gap by generating additional revenue through collective resource pooling for healthcare, provided it is implemented with integrity and efficiency.
For the NHIS to be a genuine success, it demands more than just legislative passage. It necessitates profound institutional reforms that support its framework, ensuring genuine affordability for all citizens. Furthermore, establishing ironclad systems of transparency and accountability is paramount to prevent mismanagement and build public trust. Critically, the pervasive issue of political interference, often a significant impediment to progress as we have witnessed, must be drastically minimized to safeguard both the bill’s enactment and its effective implementation.
The Ministry of Health’s plan to collaborate with Village Health Teams (VHTs) to assess individual contribution capacity is a welcome step towards achieving Universal Healthcare Coverage and delivering quality, affordable healthcare. However, this initiative must be accompanied by robust public awareness campaigns to address the current low understanding of health insurance and dispel misconceptions about immediate service improvements.
A well-functioning NHIS will undeniably ease access to affordable, quality health services nationwide, mitigating the devastating impact of out-of-pocket expenditures that currently threaten livelihoods and the fight against poverty.
Although the National Health Insurance Scheme is a critical component of UHC, it is not the silver bullet that will meet that aspiration in the country. The government must concurrently demonstrate a sustained commitment to investing directly in the health sector. This includes a significant increase in budgetary allocations for healthcare, a vital step towards improving the infrastructure of health facilities, ensuring the consistent availability of essential medicines, and recruiting and retaining health workers to reduce the existing burden.
The absence of a National Health Insurance Scheme in Uganda is not just a policy oversight; it is a pressing humanitarian issue demanding immediate and decisive action. By drawing valuable lessons from the successful implementation of such systems in other countries like Ghana, Kenya, Nigeria, Rwanda, and Tanzania, Uganda can , and must forge a path towards a healthier, more equitable, and ultimately more prosperous future for all its citizens. The time for decisive action is now.