Lubowa hospital: Why we need the national health insurance scheme

By Denis Jjuuko

The proposed Lubowa hospital has been dominating the headlines for sometime now. A section of the public feels that government is throwing away money by collaborating with an investor the majority of people have never heard of. One of the arguments that is advanced is that money should be instead channeled to the National Referral Hospital at Mulago, which is currently undergoing an upgrade.

I think it is not a generally bad idea to guarantee an investor for a project that is needed but there are so many other ways it could be done without perhaps government guaranteeing anything including offering prime real estate. However, something needs to give for this to work.

A statement authored by Keith Muhakanizi, the Secretary to the Treasury, claimed that as many as 5,000 patients are sent to India on the government bill each year. It costs approximately USD20,000 for treatment in India which brings the figure to USD100m. The same statement claimed another 3,200 patients who are self sponsored bringing the total amount of money spent in India to USD164m a year. By the way, those figures quoted were reportedly for India alone. There are many Ugandans who seek treatment in neighbouring Kenya and other countries such as South Africa and United Kingdom.

Yet on Monday this week, Daily Monitor carried two headlines on health related issues. The first one was about the Permanent Secretary begging pharmaceutical companies to donate drugs to treat non-communicable diseases such as cancer and diabetes while the other talked of a woman who lost a premature baby because after accumulating a bill of Shs32m, the hospital where the baby had been admitted couldn’t provide medical care anymore without the mother clearing the bill. The baby was prematurely discharged and eventually died.

Yet it shouldn’t be like that at all if the country started a health insurance scheme for the majority of its people. Assuming there are 20 million people who can afford to each pay Shs30,000 a year, that would come to Shs600 billion or approximately USD162m. This means that most Ugandans would now have access to treatment; entrepreneurs would set up private hospitals to access this money.

The real reason as many as 5,000 people are sent abroad by government has nothing to do with their condition rather the daily subsistence allowances they get while there. The lowest allowance for a public officials is USD530 per a night for a sub county/town council/municipal councilor while the highest is USD920 for the Vice President. Let us take an average of USD700. So if a public official spends 10 days abroad, they would earn USD7,000 and their spouse would earn USD5,250. So one family in 10 days doing tests for diagnostic purposes would earn much more money than they would in a couple of months of work here in Uganda. That is why public officials now prefer to do tests abroad than in medical labs here or sending samples abroad for diagnosis. It is lucrative to travel abroad for a few days for medical and other reasons.

Because many Ugandans are sponsored to go abroad for treatment, entrepreneurs have only set up basic hospitals here, which can treat malaria and bacterial infections. It doesn’t make much business sense to invest in a high-end hospital where the majority of clients will be coming for immunizations, giving birth, and such other basic stuff.

An insurance sector that works and tough processes and requirements for public officials to go abroad for medical reasons would lead to significant investments in hospitals by the private sector. Money would also be available afterall those with means who would still pay health insurance would prefer to go to private facilities as opposed to public hospitals. If the government continues paying top dollars for its officials abroad for basic treatment, the private sector will not invest or will require promissory notes and guarantees to set up base here. This is because they wouldn’t get better returns on investment if they invested a lot as the country continues to send its fat-cats abroad.

The writer is a Communication and Visibility Consultant. djjuuko@gmail.com

Members of Rotary Club of Kampala Naalya at a medical camp in Agago District