Kampala, Uganda | URN | A retired Commissioner in the Health Ministry, Dr. Francis Runumi says President Yoweri Kaguta Museveni must ensure commencement of the National health insurance scheme.
Dr. Runumi, then Commissioner for planning says the delay of the national health insurance has left many Ugandans impoverished by out of pocket payments for health services.
“Introduction of health insurance is a political decision. And it must be made by the president. So whatever arrangements are being made, the President must be part of it. Where does he fall? In Ghana it is Kuffuor who introduced it. Even in Thailand, the same thing we found in Vietnam, Nigeria it was the same. Rwanda it is Kagame behind the whole thing. So until our president puts his foot down, all we are doing is preparation and more documents on the shelf,” said Dr. Runumi.
Runumi who has been at the center of health financing policies right from 1987 with the commencement of World Bank’s Agenda for reform noted with concern that health insurance has not taken off.
He says the ministry of health had by 2015 collected evidence for introduction of health insurance but the efforts were frustrated by politicians.
“We are not lacking resources in this country. We are disorganized. We need serious policy reforms. When you want to do something that is study-based, the politician overrules. We have had so many studies bringing clear evidence about what should be done, data has come out. But a lot is ignored and the political aspect reigns,” he said.
Dr. Runumi was one of the contributors to the public debate on the proposed National Health Insurance scheme.
The debate at Makerere University Business School recently was hosted by National Democratic Institute in collaboration with Uganda Radio Network. It was attended by students, academicians, workers and health ministry officials.
Despite support from sections of the public, progress with the National Health Insurances has been slow for political economic reasons.
Those in support say it will lessen the inequitable burden of healthcare spending. Cabinet in June approved the National Health Insurance Scheme (NHIS) Bill 2019. The Bill will soon be debated by Parliament after public hearings.
What Government is suggesting
Government is suggesting a mandatory contributory scheme to be contributed to by persons of 18 years and above who is ordinarily resident in Uganda.
The scheme under the propose law suggests that a person with salaried employment will have 4 per cent of his/her salary deducted.
Employers will be required to contribute one percent of the employee’s salary to health insurance. Persons in self-employment will have to contribute one hundred thousand shillings annually to insure their lives.
Pensioners according the Bill shall contribute 1 per cent of their monthly pension payment to the health Insurance scheme.
Resistance from workers and employers
Sections from the worker’s and employer’s organisations have so far raised objections to the Bill.
Usher Wilson Owere, the Chairman General of National Organisation of Trade Unions, one of the panelists at the debate said he did not disagree that Uganda needed a health insurance scheme.
“A health scheme that is coming today first of all it not well researched. It is going to over burden workers mainly. And yet it is going to benefit everybody. And when you look at the workers, they are already overburdened,” said Owere.
Owere argued that workers are already footing their pension in form of NSSF on top of paying other taxes like Pay As You Earn (PAYE), Local Service Tax and other taxes that he said take up a big part of the salary they are supposed to earn.
But Dr. Runumi however argues that it would be stupid for Ugandans to oppose health insurance given that on top of the taxes, they continue to foot a substantial part of their incomes on out of pocket payments for health services. All these young people who say for me I don’t fall sick. I don’t want to pay my money. The Bodaboda are waiting for you. They will crush you. And you will not have any money when you are hanging your legs in Mulago.So as long as you live, the most precious thing is your life,” said Runumi.
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“You insure your car, you insure your property but if you don’t insure your life, but if you don’t insure your life you are you stupid I would call that. All the 42 million Ugandans need insurance don’t segregate” he added.
Runumi says while user fees were abolished in 2001 in all public hospitals and health centers, there are few health workers, little or no medicines available on the shelf and there is low motivation of health workers.
“So when you say you have gone to pick free services, you pick free services that are free of care. That doesn’t work. We can’t run away from the reality we need to work on that and reform it. If I’m going to pay my money and it’s national health insurance. Meaning there is assurance of service, I need to walk in an find what I want,” said Runumi.
He explained that the reality now is that most Ugandans including ministers and members of parliament seek for services out of the public health care facilities where they perceives care to exist.
Financing of health services in Uganda
Currently, Uganda’s health financing system is designed to meet the National Minimum Healthcare Package. Studies show that government was spending about 51 dollars on each Ugandan for health by 2016. The fifty-one US dollars was said to be far below the 84 dollars recommended by WHO.
In addition, the current health expenditure as a percentage of GDP is as low as 1.4 per cent, against the WHO target of 5 per cent. Some studies have found that households contribute close to 42 per cent of health care cost majorly out-of-pocket which is far above the recommended maximum of 20 per cent household expenditure by World Health Organisation (WHO).