Sustainability of community health insurance among low-income people; case study: selected save for health Uganda community health insurance schemes in Luweero district

Abstract

Community health insurance (CHI) is a not-for-profit type of health insurance used by poor people to protect themselves against the high costs of medical care and treatment for illness. In CHI schemes, members regularly pay small premiums into a collective fund which is then used to pay for health services that they require as opposed to the out of pocket payments. The schemes are designed for people that live and work in rural areas or the informal sector that are unable to get adequate public, private, or employer-sponsored health insurance. Since 2001 Save for Health Uganda (SHU) has been implementing CHI among the rural people in several districts in Uganda including Luweero with the goal to ensure universal coverage for services especially for the vulnerable, and to reduce on the out of pocket payments for health services in order to provide financial protection and avert catastrophic expenditure on health care. Over the years, the scheme has expanded to more districts in Uganda. However, there is need to assess the sustainability of these schemes among poor people with low income. The goal of this study was therefore to assess the sustainability of the selected SHU CHI scheme among people of low income in Luweero District. The study was carried out in May/June 2014 and focussed in six parishes in Luweero district. It is expected that the findings in this study will contribute to the stock of knowledge already existing about community health insurance and especially about its sustainability among the rural poor. The research employed a qualitative study and assessed the population groups covered by the schemes in the communities, the percentage of the target population covered by the schemes, the level of coverage in terms of exclusions of services, the level of revenue collection in the schemes and the level of support obtained from government and or other sources. A convenience sampling technique was used to select respondents basing on their being beneficiaries and staff of SHU key informants were interviewed using interview guides and focus group discussions were also conducted to collect data using guiding questions to solicit wider understanding from different opinions of the participants. The main finding of the study included the scheme covering various population groups although the proportion of the target population covered was only 11%. The benefit package was comprehensive including high cost care like admissions and surgeries. Most of the CHI scheme belonged to the mixed scheme of insurance and credit and paid co-payments of Ug.Shs 10,000 every time they accessed services. The schemes receive no support from government or external donors. The mixed type of scheme provides a revolving fund which helps to cover the health cost of the members although sometimes some schemes would run out of funds before time To ensure sustainability of the CHI schemes, SHU should find out strategies to make the schemes more attractive to the population groups and increase the membership in order to provide economy of scale in the revenue contributions by scheme members. SHU should advocate with government and donors to provide all types of support while helping the communities to understand the values of the scheme and own it. Communities’ involvement in all the processes and decision making of the scheme is of paramount importance. The benefit package should cover comprehensively the different services required by the scheme members as this will reduce inequality and prevent out of pocket payments especially for high cost health conditions. This will attract more people to enroll guaranteeing the sustainability of the CHI.