Uganda: Community insurance bridging the healthcare gap (Global Press Journal)

| September 13, 2021

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In the past, when Tumuhairwe Ponsiano needed medical treatment for his diabetes or other ailments, he had to sell his cows or goats. Since it was an emergency, he often received less than the market value. Today, Mr. Ponsiano has a community health insurance plan that gives him and his family access to treatment at a local hospital for a fraction of the cost of private insurance. Many Ugandans have community insurance plans, which cover some health services, often with additional fees for hospital visits or a broader range of treatments. These community plans are more affordable than private insurance.

In 2007, Tumuhairwe Ponsiano didn’t have funds for regular or emergency medical bills, including treatment for his diabetes. Faced with the need for healthcare, he sold seven cows and six goats for prices far below market value to cover his medical bills.

Mr. Ponsiano lives in Ryaishe, a remote village nearly 330 kilometers west of Kampala, the nation’s capital. He says, “I desperately needed money to access quality treatment.”

One year later, Mr. Ponsiano joined a community insurance plan known as “Tweragurize,” which gave him and his family access to treatment at a local hospital for a fraction of what he would pay privately.

Members of community insurance plans like Tweragurize pay an annual fee for health coverage at a network of private hospitals, as well as a fee associated with individual hospital visits. Some plans only cover routine tests and minor illnesses, while others cover a broader range of treatments, including major surgery.

Mr. Ponsiano says he pays 96,000 Ugandan shillings ($25.60 US) yearly for a plan that covers him and his five family members.

Many like Mr. Ponsiano opt for community plans like these because private insurance, at up to $80 US per month, is unaffordable. The COVID-19 pandemic has heightened the need for affordable healthcare, but with private insurance, a COVID-19 test can cost up to $60 US.

These prices are beyond many rural residents.

Sarah Byakika is the commissioner for planning, financing and policy at the Ministry of Health. She explains, “More than 4% of the [Ugandan] population have been pushed below the poverty line due to healthcare payments. They will sell off their land or animals cheaply to get cash to be able to pay for treatment.”

Still, some Ugandans avoid public healthcare, even though it’s free, saying that government hospitals are inefficient and short-staffed.

Mr. Ponsiano says, “I never bothered to go to government health centers because I knew I wouldn’t get the quality of treatment I needed. Accessing doctors and nurses can be a very huge challenge.”

Nuwagaba Cerian pays for the Tweragurize plan as well. A few years ago, Mr. Cerian was forced to sell four goats to pay for his wife’s surgery at a private hospital. The goats went for a total of 240,000 shillings ($65 US). Normally Mr. Cerian would be able to sell them for three times as much.

Now, with the Tweragurize plan, Mr. Cerian pays 75,000 shillings ($20 US) a year for health insurance for five family members, including himself.

Moses Friday is a programs officer for the Tweragurize community health insurance plan. He  says that, since its creation in 2007, the insurance has served more than 10,000 people. Nonetheless, Mr. Friday says that some people leave the service because they pay their fees but don’t end up using the insurance. Others leave because they can’t afford the annual fee.

Currently, Uganda has no national health insurance plan. However, the proposed National Health Insurance Scheme bill would see almost all Ugandans employed in the formal sector paying into a national plan. If the law passes, it would help to reduce medical costs for the poorest Ugandans.

As it is, Mr. Ponsiano says that his community health insurance plan has freed up funds for other household needs. He also recalls when it rescued his wife eight years ago after a crippling headache left her unconscious. Mr. Ponsiano rushed her to a private hospital, where she got treatment, which the Tweragurize plan covered. She recovered soon after.

Mr. Ponsiano says, “Being a member of the Tweragurize community has been lifesaving for me and my family because we don’t have to worry about money when we fall sick and don’t have [healthcare].”This story is based on an article written by Nakisanze Segawa and published by Global Press Journal on September 13, 2020, titled “Uganda: Community Insurance Bridges Health Care Gap.” To read the full story, go to:

Photo: Nurse Oliver Bajurizi Muhangi attends to Nuwagaba Ceriano at a hospital run by the Ishaka Orthodox Church in Uganda. Credit: Nakisanze Segawa, GPJ Uganda, 2020.