My attention has been drawn to the intention of government to withdraw the National Health Insurance Bill.
Robinah Nabbanja, the state minister for Health in charge of General Duties, is said to have asked parliament to stop scrutinizing the bill as a possibility of withdrawing it. This was coming at a time when the parliamentary health committee has confirmed that it is in the final stages of preparing a report on the bill for tabling before the House for debate.
I am lucky to have been among the few patients’ rights centered activists that had an interface with the parliamentary health committee to make my submissions regarding the medical-legal implication of the impugned bill.
The bill could be lacking in some sense but this could be improved over time and by the time it passes as an Act of parliament, we will have the best health insurance law rather than withdrawing it at such a time when it is needed most.
It is unfortunate that such thoughts by government to withdraw the health insurance bill are coming up in the wake of Covid-19 that has led to unprecedented financial meltdown and economic catastrophe.
This pandemic has demonstrated to us clearly that this bill should have been passed into law many years ago because failure to access health care service does not only violate human rights but also has negative implications to the economy.
The reason so far enumerated for the withdrawal is that the cost implication that the bill has on an average Ugandan citizen is not feasible.
The National Health Insurance Bill provides for a contributory mechanism whereby the scheme would pool resources, where the rich subsidize the treatment of the poor and the healthy subsidize the treatment of the sick, young and elderly.
The scheme would have assisted in the improvement of universal health coverage and accessibility to health care services, regulate health insurance across the country and avert financial risks that arise from high out-of-pocket expenditure on sickness, disability and others.
The National Health Insurance Bill envisaged realization of universal healthcare in Uganda hence giving life to objective XIV, XX of the national objective and directive principles of state policy, Article 8A of the Constitution of Uganda that mandates the state to take all practical measures to ensure the provision of basic medical services to the population and goal 3 of the Sustainable Development Goals that aims at ensuring healthy lives and promotion of wellbeing for all at all stages.
Looking at the National Household Survey of 2016/17, data showed that 14.2 per cent per cent of Ugandan households incur catastrophic health expenditure due to direct household out-of-pocket payments, which compromises the household welfare and affects their ability to consume other basic needs such as food, education and shelter.
In the wake of Covid-19, unless the National Health Insurance Bill is passed into law, Ugandans may not be in position to afford out-of-pocket payments for health services and other basic needs.
According to the National Health account report for FY 2016/2017, the annual per capita expenditure on health in Uganda is $53. This is still far below the WHO recommended minimum of $84 per capita expenditure on health. The total annual health expenditure is Shs 7.5 trillion.
Of this, 15 per cent is from government funding, 42 per cent from donors, 41 per cent from individuals (out-of-pocket) when they fall sick and only two per cent from pre-payment mechanisms like health insurance and community payment mechanisms.
It is thus convincing that we needed a law addressing cost as one of the barriers to accessing quality health care in Uganda and a means by which government fulfills its obligation to provide citizens with the highest attainable standard of health.
The national health insurance scheme would have benefited from the solidarity principle where the rich subsidize the treatment of the poor and the healthy subsidize the treatment of the sick, young and elderly.
As the pandemic batters the economy and our way of lives, withdrawing the National Health Insurance Bill would be the worst gift the government would give to Ugandans at this time. The author is a dentist and an advocate of the High court.