Uganda Medical Insurance
One of the biggest obstacles facing Uganda is the lack of proper funding. In 2002, Uganda spent 7.4 percent of its Gross Domestic Product (GDP) on the public healthcare sector. However, how much of this funding actually makes it into the health sector is uncertain. In addition, the World Bank has estimated that in 2008 $300 million USD of foreign aid and state funding was lost to corruption. Although Uganda does have many schools and health clinics, most of which are concentrated in urban areas, there is no funding to pay for teachers, medicine, supplies, physicians, nurses, and other administrative staff. Most hospitals and clinics are over-crowded with patients trying to get basic medical care and supplies. In a country where malaria is one of the leading causes of death, anti-malarial medicine can scarcely be found. On the other hand, senior administrative members of the Ministry of Health can be found with 4 X 4 vehicles and other luxuries, while some hospitals struggle with only a handful of ambulances. To exacerbate the situation, while healthcare is supposed to be free, many medical personnel are known to demand under-the-table payments. The government has made pledges to curb corruption and to improve the organization and distribution of foreign aid and government funds. However, this remains to be seen.
In 2009, the government attempted to reform the country’s health care system by introducing a public health insurance scheme, which would initially cover around 2 million employed Ugandans. Employees would have to pay the equivalent of 4 percent of their salary, with employers matching this amount. However, this legislation failed to pass through the Ugandan parliament. Employers, unions, and workers felt pressured by already existing taxes, and did not believe that their money would improve the quality and efficiency of health services. Furthermore, citizens were afraid that the funding, like much of foreign donations, would fall into the hands of corrupt officials. Instead, citizens believed that the government should concentrate on stimulating economic growth.
Uganda’s healthcare system is organized into 5 tiers, centered on a referral basis. At the bottom are village health teams (VHT) and medicine distributors. Volunteers run these health teams, but the majority of the time, they are non-existent or cannot provide treatment because they lack basic supplies and drugs. Most of the time, the VHT can only offer advice and referrals to a higher up clinic.
The second level is made up of clinics called Health Center IIs. Every sub-district is supposed to have at least one of these clinics, which are operated by a nurse, midwives, or other health workers. Health Center IIs are supposed to be able to treat malaria and offer pre-natal care.
The third level is made up of larger facilities called Health Center IIIs, which should be in every sub-county. Generally speaking, there are roughly 18 staff atthese health centers. There should be a laboratory for diagnosis purposes, an outpatient clinic, and a maternity ward. Some sub-counties may not have Health Center IIIs because they will have an even higher-level facility.
At the fourth level are Health Center IVs, which are small hospitals. These provide the same services offered in Health Center IIIs, but they are able to serve more patients and wards.
Finally, at the highest level are the hospitals, which should have all the services that are offered at the other levels. In addition, they should also have larger facilities and specialists. Each district is supposed to have one of these. However, the number of physicians, nurses, and other administrative staff at these hospitals is still highly variable. Within the hospital tier, there are also sub-divisions. District referral hospitals are not as well equipped as the national referral hospital, which is where the best medical facilities and services can be found. However, even here, the standards are well below western ones.
Many doctors are paid very low salaries and work on the side at private clinics. The private health sector has helped supplement the lackluster government system. However, these are also mainly in urban areas and costs may exceed what most Ugandans can afford. In addition to private practices, there are private not for profit (PNFP) health clinics. However, these clinics usually only offer basic medical services and are likely to be temporary. These PNFP health centers still charge a user fee, which means that many of the poorest percentages of the population still cannot access services here. Many who cannot afford treatment may take on a loan or debt in order to pay for services, which often leave them in a greater state of poverty than before. There are also Community Health Insurance (CHI) schemes that are owned and managed by the hospitals that were established during the late 90’s. The number of people who are covered by the Community Health Insurance (CHI) is very small as hospitals cannot afford the costs, especially after the Department for International Development (DFID) withdrew much of its financial support in 2002.
Overall, the quality of care and infrastructure, and the quantity of medicine and supplies are well below that of the standards of Western Europe and North America. The overwhelming majority of Ugandans do not have access to healthcare. Travelers and expatriates traveling to Uganda will be able to use these facilities. However, be forewarned that beyond basic medical services, most hospitals cannot provide much more. In the event of a serious illness or injury, travelers will have to be evacuated to a different country. These expenses are known to be as much as $100,000 USD; thus, it is imperative to purchase a policy that will cover medical evacuation and transportation costs.
Travelers should get vaccinated against yellow fever, hepatitis A, hepatitis B, typhoid, rabies, tetanus-diphtheria, mumps, measles, rubella, and meningococcus. In addition, malaria is prevalent, so visitors need to carry anti-malarial medicine, sleep in bed nets, and use insect repellant. Always bring adequate supplies of personal prescription medicine and a doctor’s note for these prescriptions. It is also recommended that travelers bring diarrhea medicine, as diarrhea is a common ailment of travelers in this part of the world.
Pacific Prime can assist you with any travel, or health insurance needs should you decide to travel to Uganda. We offer professional advice at no cost to you. No matter what your budget is or what your requirements are, our professional consultants can help find a policy that fits you or your group. Our policies can cover a wide range of services including dental, maternity, specialist consultation, transportation, inpatient services, and many more. Please contact us today for a free consultation.