Constituent policy

National insurance policy should also take rural population into account – experts

It is unclear whether President Museveni will sign the National Insurance Bill into law, but researchers have dug in and called for more action, writes Derrick Kiyonga
As Ugandans waited for President Museveni to pass the National Health Insurance Bill passed by parliament in 2021, researchers from Makerere University School of Public Health (MakSPH) weighed in on the debate by offering proposals on how an insurance policy can be implemented in a cost effective manner.
In an article titled Redefining the National Essential Health Services Package (UNEHCP) for Uganda, researchers led by Dr. Elizabeth Ekirapa note that Uganda has a high burden of preventable diseases. According to the World Health Program (WHO), the burden of disease in Uganda is dominated by communicable diseases, which account for more than 50% of morbidity and mortality.

While malaria, HIV/AIDS, tuberculosis, respiratory, diarrheal, epidemic and vaccine-preventable diseases are the leading causes of illness and death, WHO observes that there is also a growing burden of non-human diseases. diseases (NCDs), including mental illnesses. health disorders. Maternal and perinatal conditions also contribute to high mortality. In his presentation at a workshop organized by MakSPH, the Department of Health and the University of York under the theme Role of partnerships and collaborations in supporting health policy and decision-making in low (LIC): the case of Thanzi La Onse in Uganda, Malawi and the UK, Dr Ekirapa explained that Uganda’s health insurance program should contain a package of cost-effective interventions aimed at meeting country needs – disease burden, equity, mortality, disease prevention and health promotion.
“RAP [ Health Benefits Package] should be aligned with available resources and should be reviewed and updated regularly to get the most out of the HBP. The development of the HBP should include broad stakeholder consultation to ensure buy-in and inclusiveness,” Dr Ekirapa said.
The researchers also punched holes in Uganda’s National Minimum Health Care Program (UNMHCP) which was introduced in the 1999 health policy and which featured a litany of cost-effective interventions against the most prevalent diseases or conditions in the country.

Applied to the entire health sector of the country, the UNHMCP aims to be accessible to all social strata. It covers community services; primary care at hospital level; It covers the most critical public health interventions, such as health promotion, disease prevention, and community health initiatives, including epidemic and disaster preparedness, maternal and child health, and disease prevention and prevention. the management of communicable and non-communicable diseases, but public health experts are now criticizing it on the grounds that it is not explicit and is very broad.
“The package includes both preventive and curative services, communicable and non-communicable diseases, but does not fully address some of the risk factors for NCDs (lifestyle, occupational hazards, traffic accidents, environmental health and population) “, she pointed out, adding that by design, the UNHMCP is implemented by both the public and private sectors, but the private sector receives very little government support.
“UNMHCP is not universally available to the general population, largely due to insufficient financial, human and material resources for delivery,” Dr Ekirapa said.

Going forward, the researchers advise to heed the lessons of history and therefore the new national package of essential health services should tackle the burden of disease in Uganda, prioritizing preventive services and health promotion and make services accessible to all. making facilities functional and ensuring that care is affordable, for example through health insurance; Provide holistic care throughout the life cycle approach – meeting the needs of priority groups – newborns, elderly, adolescents and taking a multisectoral approach to delivery with the involvement of schools and workplaces.
For his part, Professor Freddie Ssengooba addressed the reason why Mr Museveni has so far not signed the insurance bill.
Ssengooba, whose specialty is health economics and health systems management, attributed the delay to a lack of unity among all stakeholders.
“Once all the consultations are done and parliament passes the bill, you hear about splinter groups,” Professor Ssegooba said.
“Then you hear that the president sent the bill back to parliament for further revisions.”

With 74.45% of Ugandans living in rural areas, Prof Ssengooba said it was very important to consider this demographic when designing health insurance if it was to gain support from politicians. “The president has a veto over bills sent to him by parliament, so if you disregard the rural population, he will send the bill back to parliament because many of his constituents are in the villages. “, Ssengooba said.
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Ugandans recognized the importance of insurance, according to Prof Ssengooba, when the second wave of the Covid-19 pandemic took its toll, with many families suffocating from the high bills they had to pay on a daily basis.

“During the height of Covid-19, people realized they needed insurance as they had to pay between 3 and 5 million shillings a day for patients to access the intensive care unit (ICU) “, did he declare. “If they need insurance, they won’t have the money out of pocket.”
Records show that Uganda is the only country in East Africa that has not adopted a national health insurance scheme and has among the highest health expenditures in the region.
“We are under pressure to fit in. We are under peer pressure but we have to look at our reality before saying that Uganda is the only country in East Africa without a national insurance scheme,” said Professor Ssengooba while noting that York University had funded the research.

“Most of the budget of the Ministry of Finance is funded by donors. Can donors help with this insurance plan? An estimated 38 percent of Uganda’s health expenditure is paid for by individuals through out-of-pocket charges, followed by development partners (41 percent), government (16 percent) and others ( 5 percent). Uganda’s current health insurance options are employer or community based schemes and these are estimated to cover less than 2% of the population. Health insurers contribute only about 1% to health expenditure in Uganda.
“Even when we look at insurance, it’s very important that people understand that nothing is free. You can get a service for free at the point of delivery, but someone would have paid for it through taxes, insurance or donations, i.e. taxpayers in another country,” said Dr. Timothy Musila from the Ministry of Health.