Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage

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SPEED project among its core objectives is to engage and influence policymakers with contextually adapted evidence for health policy and systems changes to advance UHC. Recently a SPEED member and senior lecturer Makerere University School of Public Health Dr Sebastian Olikira Baine and colleagues wrote a paper on Uganda based community health insurance scheme based in western Uganda and published by BMC Health services. The paper is entitled, Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage.

Using descriptive cross-sectional technique, the study found out that most households (96%) were organized in Engozi societies (e-Societies), met monthly, and made financial contributions. Cultural solidarity in e-Societies provided a platform for the Kisiizi hospital health insurance scheme establishment, operation and made it compulsory for members. E-Societies disciplinary measures and fear of high out-of-pocket payment for health care enforced enrolment, retention and increased membership.

Membership in the scheme increased from 330 in 1996 to 38,400 families in 2017. The scheme offered no exemption, credit and referral facilities. E-Societies sometimes paid premiums for members from savings and offered those loans. Through this scheme, the hospital was in a position to provide quality and easily accessible health services to insured members.

The authors concluded that Kisiizi hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme. Good quality health services at Kisiizi hospital demonstrated value for money and offered incentives for enrolment and retention, and coverage expansion.

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