Abstract
BackgroundDespite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt.MethodsA case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU) schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients.ResultsOur research points to a series of not mutually exclusive explanations for this under-achievement at both the demand and the supply side of health care delivery. On the demand side, the following elements have been identified: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, we have identified the following explanations: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI.ConclusionThe policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.
Highlights
Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low
Community Health Insurance (CHI) is a general term for voluntary health insurance schemes organized at community level, that are alternatively known as mutual health organizations or microinsurance schemes
A case study research design was chosen in order to permit an in-depth focus on relationships and processes that may help explain the low levels of enrolment in CHI schemes
Summary
Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Community Health Insurance (CHI) is a general term for voluntary health insurance schemes organized at community level, that are alternatively known as mutual health organizations (or mutuelles de santé in French) or microinsurance schemes. They all share the following characteristics: being run on a not for profit basis, targeting informal sector and applying the basic principles of risk-. Despite promotion of CHI schemes in Uganda since the mid 90's, membership has remained persistently low, with only 30,000 or so people enrolled in the schemes, comprising approximately 2% of the catchment population. Little is known on the reasons for low enrolment in Uganda, an evaluation was carried out on two selected CHI schemes; Ishaka and Save for Health Uganda (SHU) with the objective of gaining better understanding of this low enrolment
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