Somewhere there between Kenya and Rwanda lies a land with no health cover

Wednesday June 6 2018

Uganda has no health cover

Somewhere between Kenya and Rwanda lies a country with no universal health coverage for its people. ILLUSTRATION | JOHN NYAGAH | NMG 

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As I mentor a number of journalists from three continents under the auspices of the International Centre for Journalists, we occasionally get to meet physically for a week or two for some practical fieldwork.

That is how we found ourselves in Geneva at the time when the 71st World Health Assembly was taking place.

The assembly was attended by two national presidents, of the Swiss Confederation and of the Republic of Rwanda. WHO Director General Dr Tedros Adhanom Ghebreyesus showered praise on President Paul Kagame for having shown that even at low income levels, universal health coverage can be achieved, as coverage in Rwanda is now at 90 per cent.

Briefly explaining how Rwanda did it, President Kagame said that community-based health insurance now meets two-thirds of the country’s medical bills while government foots the rest.

He cited other African countries on the way to attaining universal health coverage such as Kenya, Ghana and Morocco, saying that universal access to healthcare frees people to plan their future with confidence.

President Kagame pointed out that the practice of paying for medical care out of pocket is a source of impoverishment. (Indeed, how do you stick to your investment plans if you have to raid your savings or even incur debt whenever you or a loved one falls sick?)


WHO’s Dr Tedros also praised Kenya for its commitment to achieving universal coverage before 2022. He described President Uhuru Kenyatta’s consultations with him about attaining his commitment to provide all Kenyans with health cover before the end of his second and last term of office.  

In all, Kenya’s Health Ministry has been allocated Ksh90 billion ($900 million) in the new financial year, up from Ksh54 billion ($540 million) for FY 2017-18. Significantly, Uhuru is also determined to deliver half a million affordable houses in the same period, and has thus allocated Ksh32 billion ($320 million) to the Housing Department, up from Ksh15.7 billion ($157 million). Of course quality housing enhances good health as it reduces respiratory problems among other things.

Coming out of that World Health Assembly, my heart was swelling with pride at being an East African. I reflected on President Kagame’s words about out-of-pocket payments for medical care and its role in entrenching poverty.

I recalled that Dr Tedros proudly reporting that women had taken up 64 per cent of WHO’s senior positions, but quickly adding that Rwanda had already achieved that percentage of women in its parliament. I also recalled individual cases of Kenyans who had their medical bills sorted out to a big extent by their National Hospital Insurance Fund.

But above all, I kept reflecting on the realisation that a country does not have to wait to become very rich before aiming at universal health coverage for its people.

The realisation then hit me that some countries that spend millions of dollars sending a few of their VIPs abroad on medical tourism could actually use a small fraction of that money to pay insurance cover for those VIPs and then spend the balance on improving health care access for their people.

Then I told myself that if anybody in Geneva asked me where I come from, I would say, truthfully, from somewhere between Kenya and Rwanda.

Joachim Buwembo is a Kampala-based journalist. Email:[email protected]