Mandatory national health insurance – lessons for Uganda
In 2021, the National Health Insurance (NHI) Bill was introduced in the Uganda Parliament. Following numerous debates, that Bill was set aside and the Ministry of Health went back to the drawing board. Five years later (2026), an amended Bill has not yet been tabled, yet Ugandans continue to yearn for affordable, equitable and quality healthcare. The NHI model was based on three pillars (a) the rich subsidize the poor (b) the healthy subsidize the sick, and (c) the young subsidize the elderly. Rwanda established its mandatory health insurance scheme in 2015 while Kenya and Tanzania took bold decisions in 2023 to establish their own schemes. Summarized situation in the three (3) countries:
| Rwanda | Kenya | Tanzania |
| Established: 2015 | Established: 2023 | Established: 2023 |
| Community-Based Health Insurance (CBHI) | Social Health Insurance (SHI) | Universal Health Insurance (UHI) |
| RWF4,000-20,000 per person per annum, depending on income level RWF3,000 for low-income | 2.75% of formal-sector employee monthly salary; min. KES300 2.75% of assessed annual household income | 3% of formal-sector employee monthly salary; additional 3% by their Employer TZS150,000 annual premium for households of up to 6 members |
| Government provides full subsidy for indigent households, partial for the low-income | Government provides full subsidy for indigent households, partial for the low-income | Government provides full subsidy for indigent households, partial for the low-income |
| Regulator: National Health Insurance Council | Regulator: Social Health Authority | Regulator: Tanzania Insurance Regulatory Authority |
| Implementer: Rwanda Social Security Board | Implementer: Social Health Insurance Fund | Implementer: National Health Insurance Fund |
2% of monthly salary by formal-sector employees plus another 2% by their employer would be a good start. Households and informal-sector could start with UGX15,000 per month. NSSF Uganda collected UGX2.4trillion in the year 2025/26 in mandatory social security contributions, which are 15% (Employee 5%, Employer 10%) of monthly salary of formal-sector employees. The proposed 4% (Employee 2%, Employer 2%) would yield an estimated UGX640billion per annum. The Uganda Bureau of Statistics (UBOS) figure of 3.5million households would yield an estimate of UGX630billion per annum, using the recommended UGX15,000 per month. However, this projected total of UGX1.27trillion is insufficient to cater for the current out-of-pocket medical expenditure which is estimated at UGX3trillion per annum. In 2027, Uganda Parliament should pass the amended National Health Insurance Bill and appropriate a budget to establish the National Health Insurance Scheme Fund.
By CPA Dr. Albert Richards Otete
Partner, J. Samuel Richards & Associates
