In Summary
  • Hospital data shows that malaria is among the most common comorbidities reported at facilities and accounts for a sizeable number of hospital deaths in Uganda. Let’s use a malaria burden study in Lira District (2014), which found that on average, a household spent $5.30 and $16.70 on outpatient and inpatient treatment respectively for a single episode of malaria in a child

Last June, government endorsed the establishment of the National Health Insurance (NHI). This is in line with government’s commitment to achieving Universal Health Coverage (UHC) for all Ugandans. UHC means that all people are able to receive quality health services without suffering financial challenges. With insurance, one can access healthcare whenever they need it from accredited providers without worrying about whether or not they have money to pay for the service. Globally, many countries have a social insurance system. While this has taken long to be realised in Uganda, we must applaud government for this vital step.

According to the NHI policy, people in formal employment will pay 4 per cent of their net monthly salary (or annually) to the scheme, and another 1 per cent will be paid by the employer. The scheme is expected to start with the formal sector and progressively cover everyone. Government has also committed to providing funds to cover vulnerable people such as orphans, people with disability, street children, among others. However, sections of the population have expressed mixed reactions about the policy.

The workers’ unions have protested the scheme saying workers already pay many taxes that leave them with a meagre disposable income. They say the 4 per cent insurance charge is another form of tax that adds to a myriad of taxes that workers suffer. While these sentiments are reasonable, they are borne out of limited information about how the scheme will operate and what benefits it will generate. The Ministry of Health must embark on a sensitisation campaign for everyone to appreciate what is in the proposed insurance scheme for them.

A critical analysis of the scheme shows that it may be the workers who stand to benefit more than anyone else, more so those in the public sector. A primary teacher, for instance, on average earns a net pay of Shs467,000 per month, which translates into Shs5,604,000 annually. The proposed 4 per cent deduction for insurance means that a primary teacher would contribute Shs224,160 to the fund, and is entitled to register four beneficiaries to the scheme, implying a total of five people are tagged on to the Shs224,160 a year.

This gives an average estimate of Shs44,800 per individual per year. Without insurance, how much would a family of five spend on healthcare in a year? Studies show that low income earners in low socioeconomic brackets have more risks of illness and based on this, it is reasonable to assume that families of primary teachers or security forces are more vulnerable to illnesses than other classes within the formal sector workers, spend a lot more on health services, and thus need financial protection.

Hospital data shows that malaria is among the most common comorbidities reported at facilities and accounts for a sizeable number of hospital deaths in Uganda. Let’s use a malaria burden study in Lira District (2014), which found that on average, a household spent $5.30 and $16.70 on outpatient and inpatient treatment respectively for a single episode of malaria in a child.

Back to our family of 5, and the reported episodes annually for malaria, we can estimate 2.5 episodes, a family of five people, would suffer an equivalent of 12 episodes a year. Assume 50 per cent of episodes are treated as outpatient, and another 50 per cent as inpatient, then the cost of outpatient care would be 6 episodes times $5.3, an equivalent of $32. The inpatient costs would be six episodes times $16.70, an equivalent of $100. The total cost for this family on malaria in a year would be $132, an equivalent of Shs488,400 at the prevailing exchange rate. This is just on malaria, so what about other illnesses?

Chrispus Mayora