Monday, December 15, 2014


The acronym SMH is widely used on social media. It stands for Shaking My Head.

Last week I SMH when I read that government is pushing ahead with the National Health Insurance

Under the scheme the government is undertaking to organise health insurance that will increase the accessibility to health coverage countrywide. Workers will be required to pay 4 percent of their gross salary into a pool with their employers forking out an additional 4 percent.

My knee jerk reaction was shock at the shamelessness of these government officials trying to fleece us yet again. I couldn’t comprehend how you can ask me to pay insurance for services which do not exist.

Health insurance schemes in Kenya, Tanzania and even further afield in South Africa and Ghana have
managed some measure of success, actually improved the quality of health services in those countries for their people. But this is Uganda!

Dr Francis Runumi, the health ministry’s commissioner for planning, was gracious enough to absorb my scepticism (to put it mildly) and shed more light on the concept.

That health services are undercapitalised and staff unmotivated while health is a human right underpins a move towards the introduction of a health insurance scheme.

The law, a draft of which is already working its way through the system, proposes the creation of an independent agency to oversee the scheme and will contract public as well as private health providers.

"The designers of the scheme expect that a properly run national scheme will lower the cost of health care, improve government services and will help not only set but enforce benchmarks for health service providers, as the penalty for falling short of set criteria will be black listing...

In reaction to it being too expensive for Ugandans Runumi said this is not borne out by the facts. In 2009 he said the ministry’s budget was Sh472b but in that year Ugandans spent sh3 trillion on health care. Essentially government had fallen short of national requirements by at least four-fifths.

Health officials suggested that up to $100m (sh260b) in premiums will be collected from the formal sector and another $10m from the informal sector, but Runumi said projections are that within five years they expect to be collecting at least $400m (one trillion shillings).

Opposition to the scheme has come from business owners, who anticipate a rise in their operating costs and existing service providers, who can expect to lose some business initially.

But that is not unusual. When Tanzania launched its own scheme in 2001 the opposition was intense and protracted. But as the scheme begun to operate some of its most voracious critics have become is greatest champions.

And finally he scheme will not be run by the health ministry but by an autonomous body like the NSSF with its own management and reporting structures.

The principle of national health insurance is a good one on many levels.

At the most basic level that it has the potential to improve access to health services for more Ugandans. Secondly in order to comply as providers to what will be the biggest pool of funds in the health sector, providers will have to improve their offerings ensuring more widely spread improved

Which still leaves the niggling question of whether we can trust a government agency with our money? If government has failed to provide decent health care with all the money we pay in taxes how can they be expected to do any better? Why don’t they improve health services before they can come to us asking for or hard earned cash?

Runumi is adamant that the health sector cannot be improved with government funding alone.

Secondly, he argues that you cant wait for circumstances to improve while people are suffering.

“If we are going to do the chicken-and-egg debate  we will never get off the ground. You pay then complain later – if there is something to complain about,” he said.

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