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Badilisha Lugha KISWAHILI

Why health insurance for all deserves attention

23rd September 2012

A meeting of East African Community (EAC) member countries to deliberate on universal health insurance in the region took place a week or so in the Rwandan capital of Kigali but, unfortunately, did not get adequate media attention in Tanzania. The event was simply overshadowed by social conflicts related happenings, in an environment where sensational journalism reigns supreme.

At stake at the Kigali conference was the sharing of experience on the level of health protection in Kenya, Uganda, Tanzania, Burundi and Rwanda, as well as to exchange ideas on how to formulate systems which can best ensure health insurance for all in these countries.

The key motivate is to harmonise systems in this sector in line with similar efforts being made in other sectors like trade, investments, tourism, immigration and security.

There are several reasons to explain why initiatives to address the question of universal health insurance are important and long overdue. First, is the cost of health services worldwide, as reflected in the ever rising costs of relevant equipment and medicines.

This aspect is making even services in public health facilities expensive, forcing governments to resort to cost sharing arrangements, whereby beneficiaries have also to foot part of the costs.

Since public health facilities are inadequate in most third world countries, including those in the EAC region, citizens have no option but to depend on services provided by the private sector.

As we are very much aware, prices of services and medicines made available through this channel are on the rise every passing day, partly due to foreign exchange related complications as well as lack of efficient regulatory mechanism of the sector.

The implication here is that most citizens nowadays find it difficult to foot medical bills, a situation aggravated by the overall inflation, which drastically devalues their already low incomes.

This leads to all sorts of other complications. Some of the citizens who are too poor to afford hospital treatment simply wait to meet their fate when severe illness strikes. Others simply resort to traditional medicine, which is now a thriving industry penetrated by quacks who make fast bucks.

In the old good days, extended family ties ensured that the responsibility of taking care of the economically disadvantaged member of the large family was in the hands of his/ her kith and kin.

Changing conditions, including rapid urbanization, has exposed us to a new scenario where communal bonds have been torn apart, thus effectively blocking this social insurance avenue. Things are worse for the unemployed in urban centres, where the army of this cadre is growing at an alarming rate.

Now so far it is mainly those engaged in formal employment who have access to health insurance, through the national health insurance scheme and several social security funds. Most of the workers in the informal sector are left out, except for a few who are taking personal initiative to exploit windows being now opened by social security institutions, originally designed to cater for the interests of their formal sector counterparts.

Observers note that much as effort is being made to bring informal sector workers on board, health insurance services continue to be predominantly enjoyed by those living in urban areas. Obviously, this trend is one of the factors which widen the standard of living gap between rural and urban residents. One may as well add that it is another catalyst to the increasing rural-urban migration.

As noted earlier, this scenario makes it a must for policy makers to pursue seriously the recommendations made by participants at the Kigali meeting on health care for all in the region. One of them is to invest more resources in the health sector. Senior officials and other players noted with regret that governments have failed to observe the Abuja Declaration commitment of allocating at least 15% of their annual national budgets to the health sector.

Observes further opine that failure to walk the talk on the above commitment is one of the reasons why health services, which are essential for viable health insurance for all projects, are poor and, in some cases, keep on deteriorating .

We may as well conclude with the advice given to governments in the region by the EAC Secretary General, Dr. Richard Sezibera, in his message to the Kigali meeting. He said, among other things, that each country can take immediate steps towards universal health coverage, irrespective of its level of development, by making right policy decisions.

Henry Muhanika is a Media Consultant (

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