Uganda’s Health Care System Needs a Community-Driven Health Insurance Model.

By Amiri Wabusimba.

Uganda’s public health system has been caught in a cycle of crisis management for decades. The country has been plagued by recurring outbreaks of deadly diseases like Ebola, Mpox, and Marburg. Yet, despite the urgency and devastation these health emergencies cause, Uganda’s response continues to rely on short-term, reactive measures scrambling for emergency funds, seeking foreign aid, and implementing temporary containment strategies. The lessons from previous outbreaks seem to fade with each decline in infection rates, only to resurface when the next crisis inevitably strikes.

In fact, Uganda has faced more than 10 Ebola outbreaks in the past 50 years with the most recent one, in January 2025, resulted in one death. This cycle of crisis, response, and relapse underscores a fundamental flaw in Uganda’s approach to health. Despite significant external support from USAID, UNICEF, and the Global Fund, Uganda remains dangerously dependent on foreign aid, a dependency that leaves the nation vulnerable to shifting priorities on the global stage. The recent suspension of USAID funding should serve as a stark warning Uganda stands at a critical juncture. Either the country takes bold steps toward a self-sustaining health system, or it continues to rely on external aid, which often fluctuates based on political and economic shifts far beyond its control.

At the heart of Uganda’s public health crisis lies a glaring contradiction of government’s expenditure on administrative activities continue to rise, yet the health sector remains chronically underfunded. Public hospitals are routinely faced with shortages of medical supplies, while taxes collected from citizens are funneled into administrative luxuries rather than life-saving interventions. The irony is undeniable a healthy population is the backbone of economic productivity, yet those tasked with managing the nation’s resources seem to ignore this reality. For example, in the 2022-2023 national budget, Uganda allocated only 7.7% of its total spending to the health sector, far below the 15% target set by the African Union’s Abuja Declaration. Despite this, health spending often fails to reach critical areas like medical supplies, infrastructure, and personnel compensation. Consequently, Uganda’s citizens, who are directly impacted by health crises, continue to bear the brunt of poor health funding.

Beyond funding challenges, Uganda’s inability to provide essential services such as clean water exacerbates its public health woes. Urban and rural areas have faced critical water shortages during the dry season, with some communities going without water for over a month. In the context of battling infectious diseases like Ebola and Mpox, this water scarcity becomes a grave concern. Hand hygiene is a basic and effective measure in preventing the spread of these diseases, yet it becomes impossible to enforce when there is no water for handwashing.  According to a 2020 report by the World Health Organization, 38% of Ugandans lack access to basic water services, contributing to an environment ripe for the spread of diseases. Without consistent access to water, Uganda cannot effectively control the transmission of disease, making it impossible to protect citizens from future outbreaks.

The solution lies not in waiting for the next foreign grant but in building a self-sustaining, community-driven health system. One promising avenue is the establishment of a Community Health Insurance Scheme (CHIS), which could provide financial protection to Ugandans and strengthen health facilities from within. A well-structured CHIS, similar to Rwanda’s Mutuelles de Santé model, could enable individuals to contribute small, regular payments that create a collective pool of resources to guarantee access to medical care without the financial burden of out-of-pocket expenses. Rwanda’s success in implementing this model covering over 90% of its population proves that it is not only feasible but also effective. For such a system to work in Uganda, however, Transparency in health financing is non-negotiable. Ugandans will not invest in a national health insurance model if they believe that funds will be mismanaged. The government must demonstrate its commitment to health by passing the necessary legislation, ensuring public hospitals are equipped, paying health workers fairly, and maintaining a consistent supply of essential medicines.

While financial security is crucial, it alone will not prevent future outbreaks. Prevention remains the most cost-effective approach to public health, and Uganda must prioritize integrated health campaigns that combine disease awareness, vaccination, maternal health education, and sanitation initiatives. Rather than treating health issues in isolation, a comprehensive, community-centered approach should be adopted. Uganda’s health messaging, too, must evolve to better resonate with local populations. Health advisories in English often miss their mark with rural farmers who speak languages like Luganda or Runyankore. Engaging religious and cultural leaders as trusted messengers and utilizing mobile technology to send health updates can enhance public awareness. Community radio, an underutilized tool, can play a pivotal role in spreading health information, especially in rural areas.

Uganda’s health infrastructure must align with its ambitions of encouraging vaccination campaigns if rural clinics lack the basic infrastructure to store vaccines, or to promote handwashing if there is no access to water. Uganda must invest in local health infrastructure, including better-trained health workers and improved disease surveillance systems, to respond rapidly to outbreaks before they escalate into national crises. Innovations like mobile health technologies and telemedicine can bridge gaps, particularly in remote areas, providing vital health information and services where they are most needed.

Uganda cannot afford to continue functioning on borrowed time, waiting for the next international bailout to solve its health problems. The country’s public health system must evolve from a reactive model to a proactive, self-sustaining one. This requires increasing health funding, ensuring reliable water systems, prioritizing prevention, and developing a transparent, accountable healthcare system. The time has come for Ugandans to take control of their own health future not as recipients of foreign aid, but as architects of sustainable solutions. The health of a nation is directly tied to its economic productivity, and it is in Uganda’s best interest to invest in its people and their well-being.

Amiri Wabusimba is a diplomatic Scholar, Journalist, political analyst and Human Right activist. Tel: +56775103895 email: Wabusimbaa@gmail.com.

Lawyers representing Advocate Eron Kiiza, currently serving a nine‐month sentence for contempt following his conviction by the General Court Martial in Makindye this January, have moved the civil division of the High Court to secure his unconditional release.

In a court appearance on Tuesday morning before Judge Douglas Singiza of the civil division, Kiiza’s defense team, led by Peter Walubiri and George Musisi, argued that the military court lacked the authority to try a civilian.

“The fundamental point is that Kiiza was subjected to contempt proceedings in a court that the Supreme Court has ruled lacks the necessary competence and jurisdiction due to its composition and method of appointment,” Walubiri asserted.

The legal team further argued that a landmark Supreme Court decision, which declared the trial of civilians by military courts unconstitutional, mandates that all related proceedings cease immediately.

“The Supreme Court held that any charges or trials involving civilians before a court martial should be terminated and transferred to ordinary courts with proper jurisdiction. Where such convictions and sentences are challenged, the judgment has a retrospective effect, effectively nullifying the military court’s actions,” Walubiri explained.

Judge Singiza questioned what was meant by transferring these cases to “civilian courts.” In response, Walubiri clarified, “If these were criminal trials, they would naturally go to the criminal division. However, administrative divisions are merely conveniences. In regions like Masaka, for instance, judges handle a variety of matters: land, criminal, civil, and even labor issues. Here, we are focused on safeguarding an individual’s liberty, and that right should not be constrained by such administrative boundaries.”

While previous efforts were made to file the case in the criminal division, the defense maintained that the civil division is the appropriate forum for addressing Kiiza’s fundamental right to freedom.

Countering these arguments, Attorney General’s representative Johnson Natuhwera argued that Kiiza’s conviction was lawful. “Eron Kiiza was charged with contempt in the General Court Martial, a court which the Supreme Court has acknowledged as a court of law, although limited to specific cases and offenses. He was tried and sentenced under section 169 (i)g and 212 (9) of the UPDF Act,” Natuhwera stated.

He added that these provisions provide for a maximum sentence of five years, emphasizing that the court martial was notably lenient in Kiiza’s case. Natuhwera maintained that Kiiza’s conviction and sentence remain valid until they are successfully challenged, noting that the proper venue for such an appeal would be the criminal division.

Judge Douglas Singiza has scheduled his ruling for Monday, March 3, 2025, at 2:30 p.m

Elias Nalukoola, the National Unity Platform (NUP) candidate for the Kawempe North parliamentary by-election, has been arrested by security operatives shortly after his nomination. Nalukoola is reportedly being held at Kawempe Police Station on charges yet to be disclosed.

His arrest comes on the first day of nominations for candidates seeking to replace the late Kawempe North MP, Muhammad Ssegirinya. Earlier in the day, Nalukoola had told journalists that one of his agents had been abducted and that his official nomination documents had been stolen. Despite this setback, he managed to submit his papers and secure his candidacy.

The by-election has already sparked political controversy, with candidates from Uganda’s two biggest parties—NUP and the ruling National Resistance Movement (NRM)—defying their respective party positions to contest as independents.

NUP’s Luwemba Lusswa Muhammed and NRM’s Hanifa Karadi Murerwa have gone against their party directives and were nominated as independent candidates, despite warnings that they could face disciplinary action, including suspension.

Luwemba, a former personal assistant to the late Ssegirinya, argued that he deserved the NUP flag but was rejected by the party leadership. NUP instead chose Nalukoola as its official flagbearer after an internal debate among contenders. Luwemba, however, insists he is still a member of NUP and is only running independently because he believes he was unfairly sidelined.

On the NRM side, Karadi has challenged the endorsement of Faridah Nambi, daughter of NRM’s National Vice Chairman, Hajj Moses Kigongo, as the party’s official candidate. Karadi claims the party’s nomination process was fraudulent and unfairly favored Nambi due to her family connections. She declared her independent candidacy in protest.

Nambi, however, has dismissed the allegations, saying the party followed the correct procedures and that internal mechanisms exist to address any grievances.

The arrest of Nalukoola has heightened tensions in an already heated by-election race, raising concerns over fairness and political interference. NUP leaders and supporters have condemned the arrest, demanding his immediate release.

The Kawempe North by-election is set to take place on March 13, 2025, with the race shaping up to be a test of party loyalty, internal democracy, and political influence in the capital’s opposition stronghold.