Expedite National Health Insurance Scheme Bill

Many Ugandans are facing hardship (deprivation) in accessing healthcare because of the out-of-pocket costs that they cannot afford. The National Health Insurance Scheme is an essential tool for addressing this problem, but this requires the National Health Insurance Scheme (NHIS) Bill to first be passed by Parliament and then assented to by the President.

The push to have this NHIS operational in the country has not yielded fruit, decades after the plan was birthed. The Bill was passed by Parliament in March 2021, but President Museveni declined to assent to it due to disagreements on its implementation framework.

Private companies were reportedly not comfortable with some of the provisions in the Bill which required the employer to contribute 50 percent of the employee’s total contribution. There have also been complaints and disagreements on why the focus should be on employed people to pay for those in the informal sector who may be hard to bring on board.

NHIS is aimed at attaining the goal of universal health coverage, a global drive to ensure all people obtain the health services they need without suffering financial hardship by having to incur out-of-pocket expenses to pay for said services.

Currently, according to available statistics from the government and other research reports, 38 percent of healthcare expenditures are paid by individuals, 41 percent by development partners, and the government (16 percent).

The Health ministry has severally announced that the plans to sort out these disagreements on the Bill were being expedited and the Bill would be re-tabled before Parliament, but this has not yet happened, two years after the President refused to sign it.

As the government is reprocessing the Bill, to, among other things, get on board  the informal sector where majority of Ugandans work, some experts have proposed that the poor should be excluded from contributing the average amount of Shs15,000 per person for the scheme. 

But the minister for Primary Health Care, Ms Margaret Muhanga, said last week that everyone should contribute towards this scheme. Whereas it is still hard to predict what the general public thinks about her proposal, it is important to bring as many people as possible contributing to the scheme to reduce dependency and avoid placing burden on the few who are in formal sector. 

The other big concern, especially following the issues at the National Social Security Fund, is how the money contributed towards this scheme would be kept safe and used for the right purpose. While expediting the processing of this Bill, the Ministry of Health should be very intentional about convincing people about this scheme, laying out clear strategies for operations and ensuring transparency at all levels.