By Dr.Ariho Kategaya
My attention has been drawn to the intention of government to withdraw the National Health Insurance Bill (NHIB) as it was intimated by the State Minister for Health in charge of General Duties, Hon Robinah Nabbanja, when she asked Parliament to stop scrutinizing the bill as a possibility of withdrawing the bill is looked into.
This comes at a time when the parliamentary Health Committee has confirmed that it is in final stages of preparing a report on the bill for tabling before the house for debate.
I’m 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 would have had the best Health Insurance Law instead of withdrawing it at such time when we need it most; when the global health pandemic COVID-19 has struck.
It is very unfortunate that such thoughts by government to withdraw the Health Insurance bill are coming up in the wake of COVID-19, which 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 has negative implications to the economy as has been the notion since COVID-19 struck.
The reason so far enumerated for the withdraw is that the cost implication that the bill has on an average Ugandan citizen is not feasible, with the certificate of financial implication having been issued by the Ministry of Finance, planning and Economic Development two years ago, showing the capacity and willingness of government to fulfill its part in rolling out the scheme and the big out-of-pocket expenditures by Ugandans as demonstrated in the subsequent paragraphs of this write up.
The cost implication on an average Ugandan does not stand out as the most credible and best interest reason for the withdraw of this bill that Ugandans have been waiting for, for a long period of time, more so during such crisis when all citizens are craving for Universal Health Coverage.
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 improving 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 health care 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.
The National Household Survey of 2016/17 data showed that 14.2% percent 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 hence driving them into absolute poverty.
In the wake of COVID-19 that has caused unprecedented economic meltdown in the country, 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 FY 2016/2017 the annual per capita expenditure on health in Uganda is USD 53. This is still far below the WHO recommended minimum of USD 84 per capita expenditure on Health.
The total annual health expenditure is Ushs 7.5 trillion, of this 15% is from government funding, 42% from donors, 41% from individuals (out of pocket) when they fall sick and only 2% from pre-payment mechanisms like Health Insurance, community payment mechanisms.
It is thus convincing that we need a law addressing such costs 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 ultimately contributing to healthy human capital that will facilitate social and economic development.
The National Health insurance scheme would have benefited the indigent on the solidarity principle where the rich subsidize the treatment of the poor and the healthy subsidize the treatment of the sick, young and elderly.
I thus so submit that as the economy continues to spiral downwards, unemployment soars and there is increased mortality rates from other silent illness in the wake of COVID-19, hence withdrawing the Health Insurance Bill by government would be the worst gift the government would give to Ugandans in the wake of this unprecedented global COVID-19 pandemic and is thus a step in the wrong direction.
Aruho Amon Kategaya
Dentist/Advocate High Court of Uganda
PHD Candidate Medical Law- University of Kwazulu Natal Durban (UKZN)
Medical –Legal & Reproductive Health Advocate
Enforcement of patients and Health Workers’ Rights Uganda