health accounts for the vast majority of major disease etiologies in developing
countries, like Uganda, with the poor bearing the highest burden. Although Uganda
has a well-structured health care system, linking the community to the higher-level
health services, the government has not given environmental health, an important
aspect of preventive healthcare, the priority it deserves. Consequently, low-income
settlements have become breeding grounds for disease, making the search for solutions
to improve environmental health in such communities an utmost urgency. Community-based
health insurance is much debated as a way of tackling the challenge of providing
access to health care for the poor in developing countries, like Uganda, without
worsening their economic situation. This is especially important at this time when
the country is faced with high preventable disease burden, shrinking budgetary support
to the public health services, and an unacceptably low quality of these services.
This article provides an analytical framework for the health care systems in Uganda
to integrate environmental health into community-based health insurance. The study
was a qualitative systematic review of various books, peer reviewed journal articles,
websites and relevant literature related to concepts. The author concludes that
community-based health insurance could be a high impact, cost-effective and sustainable
solution for improving environmental health, an important aspect of preventive healthcare,
in low-income communities in Uganda.
. ADAA. (2020, February 21). Low-Income Communities. Retrieved from Anxiety and Depression Association of America (ADAA): https://adaa.org/low-income-communities
Ahuja, R. (2004). Health insurance for the poor in India, Working Paper, No.
123. New Delhi: Indian Council for Research on International Economic Relations
. APHA. (2020, February 2). Environmental Health. Retrieved from American Public Health Association (APHA): https://www.apha.org/topics-and-issues/environmental-health
Arhin-Tenkorang, D. (2001). Health insurance for the informal sector in Africa
: design features, risk protection, and resource mobilization (English). HNP discussion
paper series. Washington, DC: World Bank.
Bartram, J., & Cairncross, S. (2010). Hygiene, sanitation, and water:
forgotten foundations of health. PLoS Medicine, 7, 11, Article ID e1000367.
Bwire, G., Malimbo, M., Maskery, B., Kim, Y., Mogasale, V., & Levin, A.
(2013). The burden of cholera in Uganda. PLOS Neglected Tropical Diseases, 7, 12,
Article ID e2545.
Carasco, J., Munene, J., Kasente, D., & Odada, M. (1996). Factors influencing
effectiveness in primary schools: a baseline study. Kampala: Makerere University/Uganda
National Examinations Board, Uganda IEQ Project - Phase 1 Research.
CARB. (2020, February 23). Priority Population Investments. Retrieved from
Carlifornia Air Resources Board (CARB):
CDC & APHA. (2020, February 3). Investing in an EffectiveEnvironmental
Health System. Retrieved from neha.org:
Clasen, T., Schmidt, W., Rabie, T., Roberts, I., & Cairncross, S. (2007).
Interventions to improve water quality for preventing diarrhoea: systematic review
and meta-analysis. British Medical Journal, 334, 7597: 782–785.
CSBAG. (2017). Cost of Providing Sustainable WASH Services in Schools and
Healthcare facilities in Kibuku and Pallisa Districts. Kampala, Uganda.: Civil
Society Budget Advocacy Group (CSBAG).
Donfouet, H., & Mahieu, P.-A. (2012). Community-based health insurance
and social capital: a review. Health Economics Review, 2, 5.
Esrey, S. (1995). Incremental improvements in water and sanitation and incremental
improvements in health. American Journal of Epidemiology.
Esrey, S., Potash, J., Roberts, L., & Shiff, C. (1991). Effects of improved
water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm
infection, schistosomiasis, and trachoma. Bulletin of World Health Organisation.
FP2020. (2019, November 23). Commitments. Retrieved from Family Planning (FP)
. Healthy People 2020. (2020, February 1). Environmental Health. Retrieved from healthy people.gov: https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health
Hogrewe, W., Joyce, S., & Perez, E. (1993). Unique Challenges of Improving
Peri-Urban Sanitation. Washington, DC, USA,: US Agency for International Development
Hove, M., Ngwerume, E., & Muchemwa, C. (2013). The urban crisis in Sub-Saharan
Africa: a threat to human security and sustainable development. Stability, 2, 1.
. Index Mundi. (2020, March 3). Uganda. Retrieved from Index Mundi: https://www.indexmundi.com/uganda/
Jütting, J. (2003). Health insurance for the poor? Determinants of participation
in community-based health insurance schemes in rural Senegal, Working Paper No.
204. OECD Development Centre.
Mathauer, I., Mathivet, B., & Kutzin, J. (2017, February 12). Free health
care policies: opportunities and risks for moving towards UHC. Geneva: World Health
Organization (WHO). Retrieved from World Health Organization (WHO):
MoFEP. (1994). National Integrated Household Survey 1992/3. Ministry of Finance
and Economic Planning (MoFEP).
MoFPED. (2004). Background to the Budget 2004/2005. Kampala, Uganda: Ministry
of Finance, Planning and Economic Development (MoFPED).
MoFPED. (2019). Background to the Budget Fiscal Year 2019/20. Kampala, Uganda:
Ministry of Finance, Planning and Economic Development, Uganda (MoFPED).
MoH. (1997). Concept Paper on promotion of sanitation in Uganda. Ministry
of Health, Uganda (MoH).
MoH. (1997). Health Planning Unit Statistics. Ministry of Health, Uganda (MoH).
MoH. (2010). Health Sector Strategic Plan Promoting People’s Health to enhance
Social Economic Development (2010/11-2014/15). Kampala: Ministry of Health, Uganda
MoH. (2014). Uganda Family Planning Costed Implementation Plan, 2015-2020.
Kampala: Ministry of Health (Uganda).
. MoH. (2020, February 20). Environmental Health. Retrieved from Ministry of Health, Uganda (MoH): https://health.go.ug/community-health-departments/environmental-health
Morgan, J. (1997). Environmental Health Situation in Uganda, Task No: WELL
25. UK: London School of Hygiene & TropicalMedicine.
Mukama, T., Ndejjo, R., Musoke, D., & et al. (2016). Practices, concerns,
and willingness to participate in solid waste management in two urban slums in
central Uganda. Journal of Environmental and Public Health, 2016, Article ID 6830163,
Nnaggenda-Musana, A., & Vestbro, D. (2013). Upgrading with Densification
- Learning from Kampala, Uganda. Global Journal of Engineering, Design and Technology,
NZDL. (2020, February 24). Characteristics of low-income settlements. Retrieved
from The Newzealand Digital Library (NZDL) : http://www.nzdl.org/gsdlmod?e=d-00000-00---off-0cdl--00-0----0-10-0---0---0direct-10---4-------0-0l--11-en-50---20-about---00-0-1-00-0--4----0-0-11-10-0utfZz-8-10&cl=CL2.20&d=HASH7881d52d0f19bf4fb3eb4b.5>=1
PRB. (2019, December 23). Family Planning Worldwide 2013 Data Sheet. Retrieved
from Population Reference Bureau : https://www.prb.org/family-planning-worldwide-2013/
Prüss-Üstün, A., Bos, R., Gore, F., & Bartram, J. (2008). Safer Water,
Better Health: Costs, Benefits and Sustainability of Interventions to Protect and
Promote Health. Geneva, Switzerland: WHO.
PSI. (2020, February 3). Environmental Health and Universal Healthcare in
Nigeria. Retrieved from Population Services Internatinal (PSI): https://www.world-psi.org/en/environmental-health-and-universal-healthcare-nigeria
Sudha, v. (2006). Health Security for rural poor: study of community based
health insurance. Munich Personal RePEc Archive, 1649.
The World Bank. (2020, March 2). The World Bank In Uganda. Retrieved from
The World Bank: https://www.worldbank.org/en/country/uganda/overview
UBOS and ICF. (2018). Uganda Demographic and Health Survey 2016. Kampala,
Uganda and Rockville, Maryland, USA: Uganda Bureau of Statistics (UBOS) and ICF.
UN-HABITAT. (2007). Situation analysis of informal settlements in Kampala.
Kampala, Uganda: United Nations Human Settlements Programme (UN-HABITAT).
UNICEF. (2020, March 3). Water, sanitation and hygiene (WASH). Retrieved from
United Nations Children's Fund (UNICEF): https://www.unicef.org/uganda/what-we-do/wash
USAID. (2014). ImpactNow Model. Washington, DC: Health Policy Project, U.S.
Agency for International Development, and Marie Stopes International and Futures
WHO . (2014). Preventing Diarrhoea through Better Water, Sanitation and Hygiene:
Exposures and Impacts in low- and Middle-Income Countries. Geneva, Switzerland:
World Health Organization (WHO).
WHO. (2003). Community based Health Insurance Schemes in Developing Countries:
facts, problems and perspectives: Discussion Paper Number 1. Geneva, Switzerland:
World Health Organization (WHO).
WHO. (2006). Preventing disease through healthy environments. Geneva, Switzerland:
World Health Organization (WHO).
WHO. (2015). Cholera. Geneva, Switzerland: World Health Organization (WHO).
WHO. (2015). Typhoid fever– Uganda. Geneva, Switzerland: World Health Organization
. WHO. (2020, February 4). Climate change and health. Retrieved from World Health Organization (WHO): https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
. WHO. (2020, February 3). Public health, environmental and social determinants of health (PHE). Retrieved from World Healtyh Organization: https://www.who.int/phe/health_topics/en/