How a community-based insurance scheme is helping fill health care gaps in rural Uganda

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A local community in Namutuba district runs a social health program that already shields them from huge health costs (PHOTO/Courtesy)

NAMUTUMBA- A community insurance scheme allows families to access treatment at the Bukonte III health center, a local private non-profit facility, for less than a fraction of what non-members pay. in the same establishment.

Group members under their umbrella association, Bukonte Health Insurance Scheme in Nakawunzi Village, Naikonja Sub-County in Namutuba District, are applying a bottom-up community approach to increase access to health services.

Dominic Sabuka, the vice president of the group, told a group of reporters that members of the community insurance scheme pay an annual fee of between 8,000 and 28,000 Ugshs for health coverage at Bukonte Health Center III. These contributions, he said, are saved to reduce out-of-pocket expenses associated with seeking health care services.

Subuku said the roughly five-month-old program provides financial protection against any unforeseen costs of illness for community members. “The plan covers a wide range of healthcare services, including maternity, routine testing and minor ailments.” he explained, citing that in just four months, the group has registered over 800 members, the majority of whom are women.

ActionAid International Uganda (AAIU) with funding from the European Union (EU) assisted in the establishment of the Bukonte health insurance scheme and facilitated its leaders on a benchmarking trip to the scheme. Kisiizi health insurance which has existed since 1996 where they have adapted good practices.

“What we saw there (in Kisiizi), gave us the confidence to start. We adopted their model and introduced it to existing groups in Bukonte,” Subuka said.

He explained that the social health plan committee is responsible for sensitizing the community, registering new beneficiaries, collecting premiums and handing them over to the health center. Committee representatives meet monthly with health facility authorities to review the progress of the insurance scheme.

The committee reviews financial records monthly to ensure that all payments and disbursements are accounted for.

Ethel Naigobye, a mother of six who has been in the program for three months, now says the community insurance scheme has freed up resources for other household needs.

“Since we (my family) joined the Bukonte health insurance scheme, we don’t have to worry about money anymore, especially when we get sick and don’t have any,” Naigobye said. Ethel.

She attacked government health centers in Namutumba as ineffective. Earlier, Sabuka had also told reporters that members of the Bukonte health insurance scheme avoid public health centers due to long queues and absence of staff.

Naigobye, however, asked Action Aid and the EU to continue supporting them for another year as they uncover the undercurrents and other gray areas of social insurance schemes.

The representative of the European Union Delegation to Uganda, Elizabeth Ongom, briefed the group members on the dynamics of social insurance schemes, telling them that “social insurance cannot solve all problems”.

“I am not here to discourage you but you must know very well that social insurance cannot solve all the problems but can cover some of them,” Ms Ongom insisted. She cautioned women against using the program as a shield to produce unmanageable numbers of children.

Ms Ongom however said the EU will focus on other development areas such as roads and agriculture due to resource constraints.

Ms. Shibah Namulindwa, Program Coordinator for ActionAid International Uganda in Eastern Uganda, urged the group to continue working together, but also to establish other working relationships with other development partners until to be able to fully maintain their social health plan.

Cost of healthcare in Uganda

The cost of health care threatens to widen inequality in Uganda, as many patients must choose between paying their medical bills or protecting their livelihoods.

According to the National Health Insurance Bill proposed in 2020, only 1-2% of Ugandans use private insurance, but private care accounts for more than 40% of total patient health expenditure.

Private care can be expensive. In a country with a gross domestic product of $777 per capita, a routine gynecological exam can cost $15.

Uganda is the only country in East Africa that has not adopted a national health insurance scheme and has among the highest health expenditures in the region. An estimated 38% of Uganda’s health expenditure is paid for by individuals through out-of-pocket charges, followed by development partners (41%), government (16%) and others (5%) .

Current health insurance options in Uganda are employer or community based schemes and these are estimated to cover less than 2% of the population.

Health insurers contribute only about 1% to health expenditure in Uganda.

Government efforts

However, the Ugandan government has continued to provide subsidies to private non-profit health providers to reduce user fees, while health care has been provided free of charge in public health facilities since 2001.

The country has also upgraded more than 200 Health Center II to Health Center III with the aim of ensuring that each sub-county has a health facility at the level of Health Center III.

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