Medical care in Uganda

Ugandans are to be cushioned against the high cost of healthcare offered by private health-care providers following the passing of the National Health Insurance Scheme Bill, 2019.

Seen as a giant leap in strengthening the health system, the Bill that caters for only residents or citizens of Uganda, awaits presidential assent to have the effect of law.

MPs passed the Bill on Wednesday, 31 March 2021, in a sitting chaired by Speaker Rebecca Kadaga, despite calls by the Ministry of Health to withdraw the Bill from the House.

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According to Hon. Robinah Nabbanja, the State Minister for Primary Healthcare, some key stakeholders in the private sector were not in agreement with provisions of clause 5 of the Bill pertaining to contributions and benefits to the National Health Insurance Scheme.

Clause 5 of the Bill that caters for the functions of the National Health Insurance Scheme has been amended to register members and beneficiaries of the Scheme, design and implement the health benefits package delivery mechanism as well as formulate and issue guidelines on contributions, quality assurance and health service provider arrangements.

“The Ministry [Health] in collaboration with other key stakeholders is undertaking further consultations and analysis of a premium based on the interim actuarial study conducted National Insurance Regulatory Authority in collaboration with the Ministry of Health 2019,” said Nabbanja.

However, Hon. Sarah Opendi who previously served as the Primary Healthcare, told fellow legislators that the Ministry had carried out wide consultations on the Bill before tabling it to Parliament in 2019.

“We know that government does not have adequate resources to put into healthcare so with the small contribution from the citizens, we shall be able to meet all these health expenditures that government is supposed to meet,” Opendi said.

Members of Parliament supported the Bill saying it would go a long way in enabling all Ugandans be able to afford good health services, citing the phasing out health centre IIs which will likely further distance persons in rural areas from health facilities.

“We should do a little more in health than what we are doing right now and this Bill will go a long way in ensuring that. We should not deny our voters from getting onto the national health insurance,” said Hon. Betty Aol Ocan, the Leader of the Opposition in Parliament.

“This is a good financial management system because it fights the corruption in our health system and improves its functionality,” added Hon. Stephen Mukitale (Ind. Buliisa County).

Among the proposed amendments to the National Health Insurance Scheme Bill, 2019 is in clause 2, which will make it mandatory for all health facilities to be accredited before enrollment as service providers to the scheme and ensure guaranteed quality services and accountability.

The clause will also provide for the payment of contributions to the Scheme by contributors like self-employed Ugandans or those employed by the public or private sector, and exclude contributors aged below 18 years.

Clause 8 of the Bill is another key aspect that has been amended to provide for nine directors on the Board of the Scheme, down from the originally proposed 11, with the chairperson appointed by the Minister for Health.

The Board will constitute members from the Ministries of Finance, Health, Gender, Labour and Social Development, as well as representatives from trade unions [NOTU and COFTU], National Social Security Fund, private health service providers, the Federation of Uganda Employers and the Insurance Regulatory Authority.

A new clause has been added in part five of the Bill before clause 21, which stipulates government’s obligations in national health insurance including provision of adequate funding for the Scheme and ensuring that all Ugandans have access to health services, among others.

Clause 21 of the Bill has been amended to make government liable to make contributions on behalf of indigent persons; indigents being persons deemed by the Board to be unable to pay a contribution and are registered as such.

A new clause in the Bill has been inserted after clause 27(4), to provide for the establishment of the National Health Insurance Fund where funds of the Scheme will be kept, including contributions from government and members of the Scheme, income on investment, fees, fines and penalties as well as interest on dues.

Another new clause has been inserted into the Bill after clause 57, to ensure that nothing in the Act, when assented to, shall affect the existence and operations of community based health insurance schemes, save that the Minister for Health may issue guidelines for their proper function.