CSOs resurrect National Health Insurance Scheme debate as gov’t exempts employers from staff contribution

Uganda is the only country in East Africa that has not passed a national health insurance scheme and has some of the highest out-of-pocket costs for health in the region.

Uganda is the only country in East Africa that has not passed a national health insurance scheme and has some of the highest out-of-pocket costs for health in the region.

Employers will not be required to make contributions to the National Health Insurance Scheme for their employees. This follows a decision by the Health Ministry to scrap the provision from the National Health Insurance Scheme bill that was approved by Parliament in 2019.

According to the approved bill, employers were required to contribute one percent to top up the four percent contributed by employees from their gross salary. However, president, Yoweri Museveni declined to ascent to the bill citing the need for more consultations.

Dr. Sarah Byakika, the Commissioner of Planning, Financing and Policy in the Ministry of Health, says that during their consultations employers asked for an exemption, saying that the insurance premium would be a burden to them.

With the employers out of the picture, it is uncertain whether the employees will still need to make that 4 percent contribution as was suggested previously. Dr. Byakika, says that the Ministry of Health and the Insurance Regulatory Authority are in the process of carrying out studies that will determine how much each Ugandan will pay.

She says that at the end of the day, the contributions of Ugandans in the formal sector will be determined by how much one earns while those in the informal sector will contribute a set amount. As of now, she says they are looking at a set premium contribution of between Shillings 100,000 and 150,000 for persons in the informal sector per year.

“Everyone has to contribute. All individuals will pay something but now we are looking at how much this will be. For people in the formal sector, we shall have to rely on government bodies like URA, NIRA and NSSF to know how much they earn so that we can know how much to deduct. But for this to happen, the government needs to ensure that all of these bodies are functioning well,” she explained.

In addition to this, all Ugandans aged 18 years and above including the poor and persons with disabilities will be required to enrol on the scheme. According to Dr Byakika, excluding the poor and vulnerable as had been done in the previous bill would have left a funding gap since they constitute around 22 percent of the population.

According to Dr Byakika, they are still deciding on who will be making the contributions of persons in this category. They are currently considering the government and donors to meet this funding gap. Dr Grace Ssali Kiwanuka, the executive director of Uganda Health Federation which brings together private health providers, says that one of the major arguments that the employees raised during stakeholder engagements was the double taxation.

“The employers were saying that they are currently paying a lot of money to the government. 40 percent of the total payable wage package goes into mandatory taxes like NSSF and P.A.Y.E. The private sector was suggesting that the government pick their contributions from what they already contribute,” she said.

Another amendment to the bill is the way the benefits of the insurance package would be determined, which Byakika says will be spelt out in the regulations. She says this will make it possible for the government to provide care based on how much is available.

According to health ministry officials, they are working towards submitting the amended bill to the cabinet in June with the hope that parliament will pass it by the end of the year.

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