Community Health Insurance in Uganda: Status, Obstacles and Prospects

Abstract

The aim of this thesis is to contribute to the understanding of CHI, both in general and in Uganda specifically. The general objective is to investigate the obstacles and prospects for CHI schemes in Uganda. The specific objectives are: (1) to study demand and supply side factors to explain the low levels of enrolment in existing CHI schemes; (2) to investigate the perceptions of CHI held by those enrolled and those not enrolled in the schemes; (3) to determine knowledge, understanding and perceptions of the relevance of CHI among policy-makers and health service managers; and (4) to formulate evidencebased policy recommendations for the Ugandan health sector_We set the stage for this research by using secondary data sources to embark on a review of the context of CHI schemes in sub-Saharan Africa. Results indicate that the coverage rates of the target population remain low. Other findings suggest that there are five dimensions that seem to be relevant within the framework of the development of CHI: political, economic, social, technical and managerial contexts. We acknowledged the need for more contextualised analyses of both successful and less successful schemes to enhance our collective understanding of why CHI works in certain circumstances and why it fails in others. Therefore, we set out to investigate in detail the emerging features of CHI schemes in East Africa. Schemes from three East African countries (Uganda, Kenya and Tanzania) were examined using a grid to analytically tabulate their features. The key descriptive findings are as follows: (1) the schemes' coverage within their catchment areas was small; (2) the schemes had been in existence for only a short time; (3) they were established with donor support; and (4) they provided both inpatient and outpatient benefits. The findings of this study underscore the role of the government in the promotion of CHI. This is especially true for advocacy, as the government must pay the premiums for the poorest citizens and develop an enabling policy and legal framework. We also concluded that there is a need for primary data to understand the mix of factors involved in CHI schemes.