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All Ugandans irrespective of age or employment status will have to fork out Shs 15,000 per year should the cabinet approve the proposed National Health Insurance Scheme bill, Health minister, Dr Ruth Aceng has revealed.

There have been various failed attempts by the Health ministry to establish the National Health Insurance Scheme since 2004. The latest attempt was last year when parliament passed the bill only to be withdrawn shortly after. Now, Aceng says in the new proposals, they are making it mandatory for everyone to join the scheme after establishing that Ugandans don’t appreciate what they don’t pay for.

"We have done a good job consulting many people and drafting this bill. In this bill, the National Health Insurance Scheme it is mandatory for all of us to join. Mandatory! When I say it is mandatory it means you don't have a choice whether you're working or not working. Whether you're in the village or whether you're a boda boda [rider], it is mandatory! Because people don't appreciate services that they don't pay for and I can give you very good examples. When you go and find patients in Nakasero hospital, they behave, they don't break the toilet door or pull off the doors. They use the toilets very well and they pay for their services. But go to Mulago, they want to pull off the door, they want to break the windows, the beds are mishandled. People don't appreciate what they don't pay for," said Aceng.

She adds that the more dependants one has, the more money they will be required to contribute to the pool.

"I'm going now to tell you the sad news. The sad news is that the more the dependants and the more the children, the more you pay because you have to pay for your dependants, nobody is going to pay for your dependants. So if you're a hajji here and you have 3 wives with 25 children you pay your Sis 15,000 per child - all of them. And me who has 4 children, I will pay for the four. But if your child is 18 and above let them pay. Those are adults, we must instill in our children a spirit of hard work. You can give them some work to do and they pay for themselves and that way we shall be able to mobilise resources. We need money and when you have money you can get better services," added Aceng. 

However, experts differ on the idea of having everyone contribute to the scheme. In an earlier interview, for instance, Dr Githinji Gitahi, the AMREF Health Africa chief executive officer suggested that the government does mapping to determine, which people can afford to contribute irrespective of whether they work in the informal or formal sector.  

He suggests the use of village health teams (VHTs) to determine those who can afford the annual contribution and this he says has to be a continuous process because poverty levels keep changing. On her part, Grace Kiwanuka the executive director of the Uganda Healthcare Federation (UHF), says that the government’s proposal to have everyone pay irrespective of their financial capacity is a welcome move as it will protect the integrity of the fund.

“Where people don’t contribute experience globally is all beneficiaries need to contribute to appreciate the scheme and not to abuse it. To ensure the risk pool is managed, they consume responsibly because their money is in there as well," she said.

According to her, people are already paying for their healthcare anyway, and that health cannot be free or funded fully by the government as there is no big enough tax base. However, in the new proposals, the formally employed who are already covered by private health insurance will continue with their insurance plans already subscribed to, though they will still be mandatorily required to contribute to the NHIS. - URN/The Observer

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