Community health insurance

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“We are starting with the group where it’s easy for money to be collected.” Atwiine says, “Along the way, we will pick lessons and lay strategies on how to collect from the informally employed.”

The plan is that government should be able to provide the poor with free but quality services when the National Health Insurance Scheme starts; in other words, more of the same as now.

For Grace Kiwanuka; the Uganda HealthCare Federation Executive Director,the idea of free care might make the proposed government scheme fail like the free medical care government policy.

“We have to accept that health in Uganda cannot be free. Let everyone make a contribution however small. We simply donot have enough of the tax base with over 50% of the population under 18 and not contributing to the economy,” she says. She says the government should take lessons from the self- initiated community schemes that seem to be succeeding.

Makaire agrees. He says government should know that people will not find problems contributing to the schemes once they are assured that they will actually be getting the services.

“People will not complain because they are already paying under the table. The way we are financing healthcare now is more catastrophic. We just need to make these informal payments formal,” he says.

For him what should worry policy makers is how they get people to appreciate health insurance and he recommends civic education. He says even in the voluntary schemes, people keep dropping in and out because they have not understood how the concept of pooling resources works and seem to want tangible returns on their investment.

Makaire says involvement of community schemes should start with those that alreadyexist.

“How will they learn how to collect money from peasants if they don’t work with schemes that are already collecting money from peasants?” he says.