Uganda has long debated the introduction of a National Health Insurance Scheme (NHIS) as part of efforts to strengthen health financing and achieve universal health coverage (UHC). This new technical brief, produced by the Health Economics and Policy (HEP) Research Group at Makerere University School of Public Health (MakSPH), provides evidence and critical reflections to guide this policy conversation.
The brief examines the objectives of NHIS, including mobilising resources, reducing out-of-pocket expenditures, improving equity in access, and operationalising public-private partnerships. While Uganda already operates a free care system funded through general taxation, gaps such as inadequate financing, inefficiencies, and limited access continue to undermine progress toward UHC. An NHIS could, in theory, mobilise additional resources and enhance risk pooling. However, experiences from countries like Ghana, Rwanda, and Kenya reveal challenges of sustainability, inequity, and high administrative costs.
A central insight of the brief is that Uganda should carefully weigh alternatives to NHIS, including strengthening existing public health financing and supply systems, expanding results-based financing, and deepening strategic purchasing reforms. If an NHIS is introduced, the authors recommend a component-based sequencing approach that prioritises system capacity, service delivery, and governance before rolling out contributory arrangements. This phased pathway would allow Uganda to build resilience, manage political risks, and enhance trust in service quality before premium contributions are introduced.
The report concludes that NHIS is not a panacea. For Uganda, success will depend on aligning reforms with fiscal realities, expanding innovative financing, pooling donor support, strengthening public-private partnerships, and managing the political economy of health reforms. Above all, stakeholder engagement and sustained political commitment will be critical to delivering a robust and sustainable pathway to universal health coverage.
Please find the detailed 2024 technical report attached below:
About The Author
