Health insurance: putting the cart before the horse

The minister of Health, Dr Jane Ruth Aceng, is about to bring a law to parliament that will compel all Ugandans to subscribe to the national health insurance.

The language of the minister is what is intriguing. It is couched in mandatory terms. She says everyone ‘must’ pay for the insurance. In the absence of reliable and comprehensive public health services, there is a need for a national health scheme.

However, the minister seems to have learnt nothing from past efforts to have Ugandans subscribe to health insurance. First, the ministry needs to be humble enough to explain to Ugandans what they intend to accomplish with this insurance scheme.

They need to know the benefits, bottlenecks and limitations of this insurance scheme. And if there is any skepticism about government projects, it is for a reason. It is important for the government to approach the public with clear messages about its intended policies and laws.

There is no harm in educating the public about the specifics of the bill where they apply, such as the categories of payments and penalties for non-compliance.

Public awareness campaigns should begin as soon as the policy and bill are conceived and passed by the cabinet. The minister needs to contact and collect views from the different stakeholders.

And those views should be incorporated into the law, because the law is meant for the good governance of society. The ministry of Health needs to build public understanding of the law and consequences for non-compliance. The public needs to know the safeguards available to subscribers. And that is not all. The awareness campaign should continue even after the bill is passed.

This is important to ensure the public is familiar with the new policies and their requirements. This is crucial because it can facilitate self-compliance with the law.

The other objective of public education is to prevent public backlash by maintaining an understanding of the public health goals of the law. Therefore, Dr Aceng needs to start a public awareness campaign even before she tables the bill before parliament.

The law should not be misunderstood as a punitive tool but as an instrument to improve health services in the country. It is also evident that where people have had ample education about certain policies and laws, compliance has been attained without resistance.