Abstract
BackgroundThis paper investigates knowledge of Community Health Insurance (CHI) and the perception of its relevance by key policy makers and health service managers in Uganda. Community Health Insurance schemes currently operate in the private-not-for-profit sector, in settings where church-based facilities function. They operate in a wider policy environment where user fees in the public sector have been abolished.MethodsSemi-structured interviews were conducted during the second half of 2007 with District Health Officers (DHOs) and senior staff of the Ministry of Health (MOH). The qualitative data collected were analyzed using the framework method, facilitated by EZ-Text software.ResultsThere is poor knowledge and understanding of CHI activities by staff of the MOH headquarters and DHOs. However, a comparison of responses reveals a relatively high level of awareness of CHI principles among DHOs compared to that of MOH staff. All the DHOs in the districts with schemes had a good understanding of CHI principles compared to DHOs in districts without schemes. Out-of-pocket expenditure remains an important feature of health care financing in Uganda despite blanket abolition of user fees in government facilities.ConclusionCHI is perceived as a relevant policy option and potential source of funds for health care. It is also considered a means of raising the quality of health care in both public and private health units. To assess whether it is also feasible to introduce CHI in the public sector, there is an urgent need to investigate the willingness and readiness of stakeholders, in particular high level political authorities, to follow this new path. The current ambiguity and contradictions in the health financing policy of the Uganda MOH need to be addressed and clarified.
Highlights
This paper investigates knowledge of Community Health Insurance (CHI) and the perception of its relevance by key policy makers and health service managers in Uganda
The index (DHO1) indicates that one quote with the specific issue of concern was collected from a District Health Officer and (DHO 2) denotes two quotations from District Health Officers (DHOs)
The central level staff may have been expected to know more about CHI principles and other strategic plan issues compared to periphery staff, but we found the opposite: 90% of the DHO in districts without schemes compared to 24% of the Ministry of Health (MOH) were aware of CHI
Summary
This paper investigates knowledge of Community Health Insurance (CHI) and the perception of its relevance by key policy makers and health service managers in Uganda. Community Health Insurance schemes currently operate in the private-not-for-profit sector, in settings where church-based facilities function. They operate in a wider policy environment where user fees in the public sector have been abolished. Community Health Insurance (CHI) schemes are voluntary arrangements, organized at the community level, that target people employed in the informal sector. They aim to improve people’s financial access to health care. They run on a non-profit basis and apply the basic principle of risk sharing with community participation in design and management. Insurance schemes offer an this group benefit preferentially and, ensure that their views were heard in decision-making [5]
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