In Uganda, we have a saying, “you are one sickness away from a fundraising campaign.” This is precisely true for two key reasons, the abhorrent state of the health care systems and the ever-increasing cost of good medication in Uganda.

Our motto as a country is couched in hope and service to God and Country and elaborately reads “For God and My country”. However, the promise of hope has been extinguished continuously by poor governance characterised by corruption, nepotism and poor service delivery.

In Uganda today, it is increasingly common for people to conduct fundraisers for various illness and medical conditions and one has to wonder, do all these fundraising initiatives finally hit their targets or the subjects of the fundraising initiatives are left to the inevitable deterioration in health and in worst case scenarios death. This eye-opening realisation coincided with a conversation I had recently with my friend on the importance of medical insurance and the absence of a national health insurance scheme in Uganda. According to the National Population and Housing Census final report, 2024, 1.1% Ugandans have medical insurance covers. This statistic depicts both the landscape of medical insurance as well as the attitude towards it by both citizens and the Government.

Medical insurance would play a critical role in enhancing the better wellbeing of many Ugandans and although the International legal instruments that espouse the right to health and the courts in Uganda have interpreted the obligation of states as one of progressive realisation taking into consideration the available resources of Uganda, it is my argument that medical insurance should not be at the tail end of this progressive realisation. By all standards, Uganda isn’t a welfare state and I am not necessary rooting for it to become one, not a least now because of many other impeding factors, however Uganda has the potential to progressively realise medical insurance for a greater part of its population that is most prone to mortality and gradually for the whole country. This insurance doesn’t necessarily have to be a complete cover against all medical risks and occurrences but perhaps those that are most expensive to treat and pose the greatest risk to Ugandans. In this situation, the elephant in the room is where such a huge sum of money would come from to fund this very ambitious initiative. The solution is to be found in the country enormous mineral and oil wealth. These sums of money if channelled correctly into a well-established and managed sovereign fund would be a ground breaking solution to finance a national health insurance scheme.

Presently, there existed a National Health Insurance Bill that was passed by Parliament in 2019, but since it was a government-initiated bill, it was withdrawn in 2021 citing gaps that had to be addressed after stake holder consultations. According to the Ministry of Health, under the revised national health insurance scheme all Uganda adults will be required to contribute 15,000 Uganda shillings on an annual basis and under the proposed new scheme, its mandatory for all Ugandans to join regardless of occupation or economic standing.  However, since no new bill has been proposed it’s possible the mandatory contribution might even be higher in light of changing economic times. This could potentially put this insurance scheme out of the reach of many Ugandans who as are grappling to stay above the poverty line. Fortunately, Uganda is experiencing a tide of change in its oil and gas sector that could see the country earn between US$1 to US$2.5 billion annually once the East African Crude Oil project pipeline is operationalised.

Uganda can channel this immense wealth to contribute meaningfully towards the national health insurance scheme and greatly subsidise for Ugandans especially the poor that might not be able to make their mandatory contribution. This raises the question of whether the pipeline could benefit Ugandans more apart from increased infrastructure development, jobs as well as services supplied by Ugandans to the project. In this direction, Uganda can draw from the examples of other states that have channelled their mineral and oil wealth into significant welfare initiatives for their citizens such as Abu Dhabi Investment Authority (ADIA) and Norway’s Government Pension Fund Global (GPFG) being among the best examples. These funds have managed the wealth generated from the mineral and oil production of those countries and have invested heavily in renewable energy projects both domestically and internationally. Norway’s welfare state is indeed built on the base of its functioning sovereign fund that has channelled its financial resources into investment in infrastructure projects, social safety nets and universal health care which comprises of not just national health insurance but improved medical facilities and investment in medical research and knowledge through training and employing more medical personnel.

Uganda, as a state on the path to progressively realise the right to health can adopt a model tailored towards using its new found oil and gas wealth to play a substantial role in increasing its capacity to role out a national health insurance scheme for all Ugandans albeit with different covers depending on contributions made and subsidising for those whose income cannot allow them reach the required contributions. This properly resonates with the state obligation to utilise the maximum available resources of the state to fully realise the right to health as provided for under Article 2 of the International Covenant on Economic Social and Cultural rights and the General Comment No. 14 on the Right to Health as well as the African Commission Principles and Guidelines on the Implementation of Economic Social and Cultural rights.

In conclusion, the obligation to use the maximum available resources means that government must do all that it can to mobilise resources within the country in order to have funds available to progressively realise their economic social and cultural rights and this includes financial resources’ allocation as represented in the budget. This broad categorisation squarely puts the incoming financial resources from the East African Crude Oil pipeline under the available resources which if well managed under a sovereign fund model mirroring that of Norway and Abu Dhabi, a national health insurance scheme at a subsidised contribution may become a reality. However, it’s also important to note that national health insurance will not absolve the Ugandan government of its many faults in Uganda’s deplorable health care system because insurance doesn’t guarantee more health centres or hospitals and neither does it guarantee medicine in these health centres or trained medical personnel and generally more has to be done by the government to support and complement this national health insurance scheme.

Nuwe Ahereza Marvin, Lawyer
Ambassador, International Society for Human Rights