Community health insurance

Showing government how national health insurance scheme should run?

Kampala, Uganda | FLAVIA NASSAKA | Hillary Ssempa has nothing good to say about government healthcare facilities. For him, their promise of free, quality medical care is hollow. He no longer goes to government health facilities but recalls that whenever he was sick and visited them, he would count himself lucky to find medical workers. Even then, lab tests could not be done and he would often be referred to buy drugs from private pharmacies, sometimes costing as much as Shs 100, 000. Private healthcare, however, was never an option for him. It was too expensive for him as a low earning small holder farmer in Kihumbagazo village in the western Uganda district of Bushenyi.

The situation worsened when his aging mother started falling sick and her medical care bill mounted. He knew he had to look beyond the usual. He had to look for cheap and effective alternatives. Enrollment on available commercial private health insurance schemes required up to Shs 500, 000 per year for the cheapest bare bones package. Better packages cost millions of shillings.

That is when he was introduced to community health insurance schemes. These are voluntary self-help medical insurance schemes operated by community members for community members. Usually, members must join as a family, pay an agreed sum for a year’s coverage, and get a card that guarantees them service in selected contracted private medical facilities.

Ssempa says the first scheme he joined required Shs15, 000 per year payable in installments of Shs5, 000 every four months. But he soon got disillusioned.

“The scheme could only cater for simple illnesses like headaches and coughs,” he says.

He later joined Tweragurize Community Health Insurance Scheme. ‘Tweragurize’ literally means ‘Let’s treat ourselves’ and is promoted by Save for Health Uganda; an NGO.

As Fredrick Makaire, its executive director told The Independent, the idea of affordable self-help healthcare schemes was born out of the realization that “many people were dying at home” without care because public health care is moribund. Those who ventured to private hospitals often had to sell family assets to pay bills.

He says up to 35,000 people are currently enrolled under his organizationin eight districts in central and western Uganda. They include Nakaseke, Nakasongola, Mubende, Mityana, Sheema, Bushenyi, Mitooma and Masaka.

“We chose to focus on areas where there’s need and the population is interested. We also look at areas where people are able to contribute some bit of money because we only consider private facilities who offer a bit of quality,” he said.

Tweragurize Community Health Insurance Scheme has 29 families and is part of a bigger scheme in Bushenyi which has 350 members.

Under the plan, each member pays Shs15, 000 per year.So Ssempa,who has a family of five, pays Shs75, 000 every year. The scheme has contracts with six private health facilitiesthat promise to treat members without further cost. All the member has to do is show their card. The facilities are Bitooma Missionary Hospital, Ishaka Adventist Hospital, and Mushanga, Kitagata, Bugonji and Nyakashuro health facilities.