Critical Analysis of Regulatory Mechanisms for Governance of Community Health Insurance Schemes in Uganda

Abstract

Regulating operational modalities of community health insurance schemes is important for protection of consumers and providers of healthcare services against exploitation. This study on governance of community health insurance schemes interrogated the current policies and legislation and the extent to which they addressed governance and sustainability issues of community health insurance schemes.

The investigation adopted a case study research design underpinned by the interpretivist philosophical orientation. The study site was Kampala Capital City, Nakasongola, Nakaseke, Kanungu and Luwero districts targeting policy and decision makers as well as program implementers. These were purposively selected for their unique exposure to community health insurance schemes. 16 key informants were interviewed. The variables of interest were enrolment and sustainability of community health insurance schemes. Key informant interviews and document review guides were used to generate the required data, subjected to thematic and content analysis.

This study established that the current policies and legislation do not adequately address governance and sustainability of community health insurance schemes despite the cultural diversity in communities. The governance structure of the schemes requires serious attention to the diverse social networks in the different communities in Uganda. The drive by Government of Uganda towards universal health coverage will continue to meet constraints especially with respect to integrating community health insurance governance and sustainability in the management of healthcare service delivery.

Provisions for social networks underpinned by diversity and homogeneity of communities be reflected in the law. The study exposes social cultural disparities inherent in the study population and recommends adoption of the Bull’s Eye Community Health Insurance Governance Model which facilitates integration of communities in management of community health insurance.