Introduction: Community Based Health Insurance (CBHI) in Uganda is not a common phenomenon though it has proved to be viable in protecting vulnerable families from catastrophic health care expenditures in areas where it has been implemented. Given its importance, there are some organizations that have found it very vital to promote the community health insurance (CHI) schemes with an interest of solving the problems of limited financial access to quality health care services. However, promoting, growing, managing and sustaining CBHI schemes has remained a big challenge to most organizations supporting this initiative.

Save for Health Uganda having implemented CBHI schemes for 20 years in over 12 districts of Uganda brings a solution by providing short courses on all areas of the CBHI intervention. Come and enrich yourself with knowledge and skills to promote, manage and sustain a viable CBHI scheme.

Aim of the training:
To equip participants with knowledge, skills and tools needed in successfully establishing, promoting, managing and sustaining a Community Based Health Insurance Scheme (CBHIS)

Who can attend:
Scheme managers, Heads of organizations promoting or planning to establish CBHI schemes, Heads of health care facilities providing health care services to CBHI scheme members, authorities responsible for supervising and regulating CBHI schemes, students who wish to pursue a carrier in health care financing, researchers and others.

Organization and method of training:
The training shall be scheduled in two sessions and each session will take four (4) days of face-to-face interactions at a venue in Kampala.

Benefits of the training:
By the end of the training, participants will have gained more knowledge and understanding of principles, types, formation, functioning and management of a CBHI scheme.

 CONTENT OF THE TRAINING

MODULE 1: Understanding CBHI and its types.

  1. Introduction (important definitions and key principles)
  2. Locating CBHI in the wider health (financing) system and the roles of stakeholders
  3. The types of health insurance and their role in community and national development
  4. CBHI in Uganda, types and how it differs from other health insurances
  5. How health care is currently financed in Uganda, the pros and cons, highlights of the proposed National Health Insurance Scheme and the regulatory framework for CBHI.
  6. Making a decision to start promoting and managing a type of CBHI scheme (steps and pre-conditions) – actuarial / feasibility study

MODULE 2: Formation and management of CBHI schemes

  1. Community mobilization, organization and marketing CBHI schemes and products
  2. Scheme revenues and premiums collection
  3. Pooling CBHI scheme revenue
  4. Medical claims management and the different ways of paying for health services
  5. Understanding the common health insurance risks, profiling, monitoring and managing them
  6. Monitoring, evaluation and reporting performance and impact

 

Each participant will pay UGX 560,000 for Ugandans and USD 160 for international participants for each module inclusive of meals.

ENQUIRIES/APPLICATIONS:
For more information about the training, applying and submitting application forms, please contact Friday Moses on: +256775 557843 or +256706780316 and Email: This email address is being protected from spambots. You need JavaScript enabled to view it. or visit our website; www.shu.org.ug .

DOWNLOAD APPLICATION HERE

Save for Health Uganda (SHU) is extending operations to eastern Uganda and West Nile to enable families in the two areas access community health insurance (CHI) services.

For the next three years, SHU with support from Bread for the World will directly implement CHI in the districts of Iganga, Bugweri and Mayuge in Busoga region, eastern Uganda, as well as support the Forum for Development of Greater Nebbi (FDGN) to introduce CHI in Nebbi, Pakwach and Zombo district in West Nile.

Entry into Busoga region

In February 2021, the Executive Director, Mr. Makaire Fredrick, led a team of SHU staff to introduce the organization to authorities in Iganga, Bugweri and Mayuge and establish a working relationship. The team visited offices of Resident District commissioners (RDC), Chief Administrative Officers (CAOs) and District health officers. In Bugweri district, top officials including the Chief administrative officer and members of the health team were sensitized about (CHI) in one of the introductory meetings.

In addition, SHU established an office along Lubasi road, Nkono 1 Cell, in Iganga Municipality, off Kaliro road to serve as the coordination centre for all activities to be carried out in the three districts.

SHU’s work in the region will focus on promoting CHI schemes using past experiences from other areas where it has worked for more than 15 years. The main objective is to enable families in Busoga region access quality healthcare services through sustainable community health insurance arrangements.

Work at community level will start in one sub-county in each of the three districts: Nakigo in Iganga and Ibulanku in Bugweri. All CHI schemes that will be created in the area will form a network to pool risks and healthcare resources.

The three districts bring the total number of districts where SHU directly implements CHI to 11, the others being Luwero, Nakaseke, Nakasongola, Mityana, Kassanda, Bushenyi, Sheema and Mitooma. SHU now has five offices located in Bushenyi, Mityana, Luwero, Iganga and Kampala head office.

In 2020, CHI schemes promoted by SHU covered 27,037 individuals (12,067 male and 14,970 female) from 4,048 households in nine districts. These accessed healthcare services in 25 contracted healthcare providers.

The journey to West Nile

On 17th February, SHU signed a memorandum of understanding (MOU) with FDGN, a non-governmental organization located in Nebbi, aimed at promoting viable CHI schemes in the three districts of Nebbi, Pakwach and Zombo. Over the next three years, SHU will provide technical support to design appropriate CHI schemes while FDGN will promote the schemes at community level, in health facilities and among local authorities. The MOU follows a feasibility study conducted by SHU in the three districts over a year ago to establish opportunities for implementing CHI in the area.

How the NHIS bill was passed

On 31st March 2021, Parliament passed the National Health Insurance Scheme (NHIS) Bill 2019 into law, waiting for assent by the President.

In a spectacular show of great fortitude, Members of Parliament overwhelmingly rejected a move by the Minister of Health to withdraw the bill from Parliament.

Hon. Robinah Nabbanja, the Minister of State for Health (General Duties) had requested to withdraw the bill from Parliament citing disagreement of stakeholders in the private sector with some provisions of the bill.

Several MPs who objected to the Minister’s request questioned government’s commitment to improve people’s access to healthcare arguing that Ugandans need health insurance urgently because they spend a lot of money on medical bills.

The bill was passed in the absence of Hon. Nabbanja who walked out of Parliament during the debate. The Minister of State for Planning Hon. David Bahati represented cabinet in the discussions and proposed passing of the bill by Parliament after the debate.

MPs including the former Minister of State for Health Hon. Sarah Opendi argued that the Ministry of Health consulted widely for over 10 years during formulation of the bill.

A report presented by Dr. Michael Bukenya, the chairperson of the Health Committee of Parliament, indicated that while scrutinizing the bill, the committee received views from 30 stakeholders, held six regional consultative meetings and conducted three benchmarking visits in Kenya.

Next steps

Article 92 of the Constitution of Uganda provides that a bill passed by Parliament has to be presented to the President for assent as soon as possible and the President has to take action within 30 days. The actions include assenting to the bill, returning it to Parliament for reconsideration or refusing to assent to it. The President is deemed to have assented to a bill once the specified period elapses without taking any action. The bill also becomes a law if the President returns it twice and Parliament passes it for the third time.

Key provisions passed by Parliament

  • Any person who has attained the age of l8 years and who is a citizen and resident in Uganda will contribute to the NHIS.
  • The Government will be liable to make contributions on behalf of indigents. Indigent persons will be required to register under regulations to be issued by the Minister of Health.
  • A person’s contribution to the Scheme will depend on his/her total income.
  • An employer will contribute 50% of the employee’s total contribution to the Scheme.
  • Benefits under the Scheme will be accessible from any accredited health service provider in Uganda.
  • It will be mandatory for all health facilities, both government and private, to be accredited to provide services under the scheme.

New clauses introduced by Parliament

Parliament incorporated new clauses into the bill. The new clauses introduced provisions on the following:

Community health insurance schemes: the proposal is that the NHIS law shall not affect the existence and operations of the community-based health insurance (CBHI) schemes but the minister may issue guidelines for their proper functioning. The justification given is to acknowledge the existence and give visibility to CBHI schemes.

Government’s Obligations in National Health Insurance: government will have an obligation to ensure access to health care services for all including children, women and people with disabilities in addition to developing, implementing, promoting awareness, and providing adequate funding for NHIS. This was intended to provide for continuity of state obligations in the health sector during implementation of the NHIS.

Government to contribute for indigents: government will pay health insurance premiums for indigent persons. Parliament defined an indigent person as a person who is deemed by the Board of the NHIS to be unable to pay a contribution and is registered as such.

Contribution by employer: both the employer and employee will each pay 50% of the employee’s contribution to the NHIS. The bill was originally silent on the rate of contributions by the employers and employees.

Registration of indigents: the Minister is required to issue regulations to determine and register persons who qualify as indigents within six months of coming into force of the NHIS Act.

Portability of benefits: Contributors to the scheme will access benefits from any accredited health service provider in Uganda subject to regulations by the Minister while the Board of the Scheme will prescribe the procedure for accessing healthcare benefits outside Uganda.

Functions of the Board of the NHIS:

Parliament proposed the following functions of the board:

  • ensure the effective implementation of the policies of the Scheme;
  • manage the Scheme in accordance with this Act;
  • cause to be carried out audits of the funds of the Scheme;
  • determine the mission and strategy of the Scheme;
  • appoint, support and evaluate the Chief Executive Officer of the Scheme;
  • ensure the proper management and protection of assets of the Scheme; and
  • carry out any other function as may be necessary to meet the objects of the Scheme.”

Changes to some clauses in the bill

NHIS as a complementary health financing mechanism: Parliament revised the first object of the bill to provide for developing the NHIS as a complementary mechanism of healthcare financing. The original clause implied that health insurance would be the only mechanism of financing healthcare in Uganda.

Accreditation of health facilities: it will be mandatory for all health facilities, both government and private, to be accredited to provide services under the scheme. This will guarantee quality of services. The bill had proposed accreditation of only private health facilities which would make government facilities automatically qualify to provide services.  

Composition of the Board of Directors: While the bill had proposed appointment of board members except representatives of ministries, basing on professional qualifications, Parliament changed the clause to allow different stakeholders to nominate representatives. Institutions to be represented are:

  • Ministries responsible for Finance, Gender, Labour and Social Development and Health.
  • Trade unions
  • National Social Security Fund
  • Private health insurance providers
  • Federation of Uganda Employers
  • Insurance Regulatory Authority