Governments in Africa are constrained in their capacity to finance health, as evidenced by the low levels of public health spending in most African countries. Financing health care is not only an indication of the government’s commitment to the population’s well being but it also addresses issues of equity especially for the vulnerable and the poor who cannot afford private health care. In Uganda, where 67% of the population is either poor or highly vulnerable to poverty, Universal health coverage would be a worthwhile investment by the government.
More than money is required for a successful health insurance scheme in Uganda. Challenges such as absenteeism of health workers, low domestic resource mobilization still exist for the public health sector in Uganda. Ethiopia is one country that has implemented community based health insurance. However, , enrollment to the scheme was hampered by lack of awareness about the scheme, negative perception, moral hazard, fraud, corruption and inefficiency in the health care delivery. Continuous dialogue with stakeholders including; policy makers, community members and service providers was one way the Community Based Health Insurance (CBHI) Scheme a WOTRO funded project that has just closed used to overcome these challenges. These are key lessons for Uganda. Strengthening the health system through improving leadership and governance structures would be a starting point for LMICs like Uganda who are moving towards introducing health financing for the population. One way this could be achieved is through putting in place systems and structures to strengthen the health facility management committees at all levels of the health service delivery in Uganda.
A Photo courtesy of the New Vision Newspaper published March 19th 2013
Ghana is a good case study for African countries like Uganda to borrow lessons from as they plan the introduction of health insurance since it has implemented the NHIS for more than a decade. The COHEiSION Ghana project, which is one of the WOTRO, funded projects supported by KTNET Africa offers key lessons for operational and financial sustainability. The project has implemented client interventions focusing on raising awareness on the clients’ role in improving health care. At the level of health care providers, the project’s interventions focused on client-oriented services, medical services and administration while at the level of the National Health Insurance Agency, interventions focused on public relation and marketing. Successful interventions have been shared with policy makers of the Ghana NHIS, the Ghanaian Ministry of Health, and Ghana Health Services so as to improve client-oriented services.
Unlike the pioneer countries that faced a number of challenges during the implementation of their insurance schemes, Uganda has a chance to learn from what has already been done elsewhere and borrow the best practices. I believe with all the lessons available Uganda can easily roll put a successful health insurance scheme for its population.
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