Regional Counterparts Move to Close Gap in Health Insurance as Uganda Trails Behind

Dr. Ian Clarke the CEO International Hospital Kampala and Chairman East Africa Healthcare Federation speaking at the closure of the regional health conference on Tuesday at Sheraton Hotel Kampala

Many countries in East Africa are moving to bridge the gap in providing equitable health care access as a way of achieving the newly rolled out global sustainable development goals (SDGs).

While this happens, try the debate on health insurance has increasingly become inevitable and some countries such as Rwanda, dosage Ghana and Nigeria have made remarkable strides in realizing this. The last WHO Assembly identified universal health coverage as a major driver in achieving SDGs.

Now standing at USD 60 per capita for equitable health access and USD 84 per capita for quality health care, viagra sale a significant proportion of people are being pushed into poverty as a result of direct payment for health services.

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During the 5th East African Health Federation (EAHF) conference which ended on Tuesday in Kampala, emphasis was placed on the need for the private sector to work closely with the public sector to scale up the access to health insurance. This requires subsidizing these often costly services especially for the people that can’t afford them.

In Kenya, government through National Health Insurance Fund (NHIF) enforced the law which mandates every Kenyan working within the formal sector to acquire health insurance. So far, 20% of the population is covered with the remaining portion being the informal sector and indigents which are the next target.

Dr. Njeri Mwaura of World Bank while speaking at the conference said 2million people have so far been covered in the informal sector. She said that government has received a USD 20M grant from World Bank to cover 200,000 other households in the initial phase but the coverage will be scaled up to even the indigents who are grappling with poverty.

However notwithstanding, challenges remain in areas of sensitization, quality improvement and inadequate reimbursement rates that are currently at 75%.

Rwanda’s health insurance policy is the best in the region so far with 91% of Rwanda’s population accessing services under the Community Based Health Insurance scheme. The scheme was establihed in 2004 and allows members to pay an annual premium of about USD 6 per family member with a 10% service fee paid for each visit to a health centre. However the program covers only public and not-for profit health facilities.

As opposed to Kenya, membership for Rwanda’s health insurance is voluntary and payment is based on one’s economic status.

Similarly, Tanzania adopted an insurance policy back in 2001 with all local governments establishing community schemes. 30% of these health services are provided by the private service providers while government provides 70%.

“The insurance pays USD 30 for up to 6 family members at a 50% subsidy by government. We work with volunteers who move house to house encouraging people to get insurance,” said Dr. Heri Marwa the Program Director Pharm Access Tanzania.

On Uganda’s part however, health insurance remains entirely in the private sector spectrum and limited to very few people (10%) majority of whom are formally employed and others financially enabled. The
National Health Insurance Bill 2007 which has been shelved for years will if passed make it mandatory for all civil servants and those in the formal sector to be insured.

25% of the population fall under this category. There’s so far no plan to cater for the majority (informal
sector, unemployed and the poor) and that falls outside the bracket.

Employees will be required to contribute 4% of their gross salary to which employers will top up another 4% to make an 8% contrubution to the scheme. However politics, abscence of infrastructure and human
resource gaps all remain major obstacles to realizing this.

Dr. Ian Clarke the Chairman Uganda Healthcare Federation an umbrella organization for the private health service providers points out the lack of cohesion between government, private sector and other
stakeholders such as donors.

“We need to go incrementally. Kenya has tried to bring the informal sector on board with good subsidies but I am not sure Tanzania’s approach will be of great benefit to the low income earners. It’s better to tread carefully than to jump into something that could result into scam and putting public resources to waste,” Dr. Clarke told Chimpreports in an interview.

He however expressed optimism in the newly appointed Minister of Health Dr. Ruth Achieng the former Director General of Health Services saying she would strengthen the public-private partnership.

Dr. Clarke like several other medical practitioners believes politics at the helm of the Ministry has hindered the delivery of health services and Dr. Achieng who’s a technocrat could change the way of doing business.


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