Why Uganda’s national health insurance scheme remains stalled?

9 May 2025, 4:45 pm

By BYAMUKAMA ALOZIOUS

More than five years since it was first tabled, Uganda’s proposed National Health Insurance Scheme (NHIS) remains stalled, leaving millions of citizens exposed to catastrophic health expenses and deepening inequality in healthcare access.

The NHIS Bill was first brought to the floor of the Parliament in August 2019 by Hon. Dr. Michael Bukenya as a private member’s bill while serving as Chairperson of the Parliamentary Health Committee. Parliament passed it on March 31 2021 during the 10th Parliament, but President Yoweri Museveni declined to assent and returned it to the Ministry of Health for amendments. Since then, the bill has not resurfaced in Parliament.

Under the proposed scheme, salaried employees in the formal sector would contribute 4% of their income, with employers contributing 1%. Informal sector workers would pay an annual fee of UGX 100,000. These contributions would create a national health fund aimed at promoting universal health coverage and reducing out-of-pocket spending.

Uganda’s Ministry of Health 2018 Midterm Review Report shows that households spend 41% of their income on healthcare, far above the 15% recommended by the World Health Organization (WHO). This places Uganda among the highest in out-of-pocket expenditure in East and Southern Africa.

During the National Dialogue on Health Financing held from May 6 to 8, 2025, at Commonwealth Resort Munyonyo, stakeholders underscored the urgency of domestic health financing as donor support continues to shrink. Hon. Dr. Joseph Ruyonga, Chairperson of the Parliamentary Health Committee, stated that “health financing in Uganda is demanding on donor funding and currently stuck due to donor withdrawal,” urging that the NHIS be prioritized as a sustainable solution.

Currently, private health insurance covers only 1% to 2% of Uganda’s population. The rest rely heavily on underfunded public health services or resort to expensive private care. “People sell land, cattle, or go into debt just to access life-saving treatment for cancer, diabetes, or heart diseases,” said Melisa Nyakwera, head of commercial banking at Stanbic Bank

The NHIS Bill seeks to correct this by pooling resources based on solidarity, where the healthy subsidize the sick and the wealthy support the poor. Services to be covered include outpatient and inpatient care, mental health, maternal and child health, dental and eye care, radiological investigations, and more.

Health rights activists like Abdulkarim Muhumuza, head of partnerships at Afya na Haki, argue that the Ministry of Health has delayed too long. “It’s been years since the bill was returned. The Minister should have presented revised amendments by now so that Parliament can debate and pass it for Presidential assent,” he said.

During the same dialogue, discussions centered around the theme “sustainable health financing strategy for universal health coverage and resilient health systems in Uganda “, reflecting on how domestic investment in health systems, like NHIS, could improve access and equity. Experts pointed out that national insurance schemes, as adopted in countries like Kenya and Rwanda, have become critical vehicles for achieving Sustainable Development Goal 3.8 universal health coverage.

Dr. Daniel Kyabayinze, Director of Public Health at the Ministry of Health, acknowledged the financing challenge, stating that “those below 18 or above 60 are often not contributing taxes, which affects the pool.” He suggested that local community organizations could mobilize resources to support each other while a national scheme is awaited.

Ugandans remain waiting when the Ministry of Health will communicate a clear timeline for returning the revised bill to Parliament. In the meantime, millions continue to face the risk of financial ruin due to illness a situation the NHIS was designed to prevent.