Health Financing Reforms in Uganda: Dispelling the Fears and Misconceptions Related to Introduction of a National Health Insurance Scheme; Comment on “Health Coverage and Financial Protection in Uganda: A Political Economy Perspective”

Document Type : Commentary


1 School of Medicine, Uganda Christian University, Mukono, Uganda

2 School of Public Health, Gudie University Project, Kampala, Uganda

3 Institution of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

4 Faculty of Social Sciences, Ndejje University, Kampala, Uganda

5 College of Health Sciences, Makerere University, Kampala, Uganda


Uganda introduced health financing reforms that entailed abolition of user fees, and in due process planned to introduce a National Health Insurance Scheme (NHIS). This paper accentuates a contextual and political-economic analysis that dispels the fears and misconceptions related to introduction of the insurance scheme. The Grindle and Thomas model is used to depict how various factors affect decision making by policy elites concerning a particular policy at a particular time. Drawing lessons from the sub-Sahara region and in particular, Ghana and Rwanda’s experience, it is clear that the political will of the executive led by the president in many countries is a key determinant in bringing about health reforms. In this paper, we provide insights based on contextual and political-economic analysis to countries in similar setting that are interested in setting up NHISs.


  1. Burnham GM, Pariyo G, Galiwango E, Wabwire-Mangen F. Discontinuation of cost sharing in Uganda. Bull World Health Organ. 2004;82(3):187-195.
  2. Robert E, Ridde V. Global health actors no longer in favor of user fees: a documentary study. Global Health. 2013;9:29. doi:1186/1744-8603-9-29
  3. Nabyonga Orem J, Mugisha F, Kirunga C, Macq J, Criel B. Abolition of user fees: the Uganda paradox. Health Policy Plan. 2011;26 Suppl 2:ii41-51. doi:1093/heapol/czr065
  4. Kwesiga B, Aliti T, Nabukhonzo P, et al. What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments. BMC Health Serv Res. 2020;20(1):741. doi:1186/s12913-020-05500-2
  5. Rothman S. Political elites: recruitment and careers. In: Smelser NJ, Baltes PB, eds. International Encyclopedia of the Social & Behavioral Sciences. Oxford: Pergamon; 2001:11656-11661. doi:1016/B0-08-043076-7/01199-2
  6. Basaza RK, Namyalo PK, Mayora C, Shepard DS. The Journey to Universal Health Insurance Coverage: What Are the Lessons for Uganda and the Other LMIC? New York: Nova Science Publishers; 2020.
  7. Thomas JW, Grindle MS. Political leadership and policy characteristics in population policy reform. Popul Dev Rev. 1994;20:51-70. doi:2307/2807939
  8. Parliament of Uganda. National Health Insurance Scheme Bill. Kampala, Parliament of Uganda; 2020. Accessed April 20, 2022.
  9. East African Community (EAC). Situational Analysis and Feasibility Study of Options for Harmonization of Social Health Protection Systems Towards Universal Health Coverage in the East African Community Partner States. Arusha: EAC; 2014. Accessed April 20, 2022.
  10. National Planning Authority (NPA). Third National Development Plan (NDPIII) 2020-25. Kampala: NPA; 2020. Accessed April 20, 2022.
  11. Ministry of Health (MOH). Feasibility Analysis of Community-based Health Insurance Scheme Structures and their Integration in the National Health Insurance Scheme. Kampala: MOH; 2021. Accessed April 20, 2022.
  12. Kalyango E, Kananura RM, Kiracho EE. Household preferences and willingness to pay for health insurance in Kampala city: a discrete choice experiment. Cost Eff Resour Alloc. 2021;19(1):21. doi:1186/s12962-021-00274-8
  13. Basaza R, Kyasiimire EP, Namyalo PK, Kawooya A, Nnamulondo P, Alier KP. Willingness to pay for Community Health Insurance among taxi drivers in Kampala city, Uganda: a contingent evaluation. Risk Manag Healthc Policy. 2019;12:133-143. doi:2147/rmhp.s184872
  14. Uganda Bureau of Standards (UBOS). The Uganda National Household Survey 2019/2020. Kampala, Uganda: UBOS; 2021. Accessed April 20, 2022.
  15. Country comparison Uganda vs Rwanda. 2021. Accessed April 20, 2022.
  16. Nannini M, Biggeri M, Putoto G. Health coverage and financial protection in Uganda: a political economy perspective. Int J Health Policy Manag. doi:10.34172/ijhpm.2021.116