Design and Implementation of Community-Based Health Insurance Schemes in Northern Uganda: Evidence and Policy Implications
Abstract:
Achieving Universal Health Coverage remains a global challenge. Globally, over 100 million people are pushed into poverty annually due to high out-of-pocket expenditures. In Uganda, community-based health insurance penetration remains low. The gap is widest in post-conflict Northern Uganda, where poverty is high and health financing is fragile. This study investigated the status, design and implementation of community-based health insurance schemes in Northern Uganda. A descriptive cross-sectional study was conducted in Northern Uganda between March and May 2026. Using purposive and stratified sampling, 27 participants were engaged through Key informant interviews, In-depth interviews and Focus group discussions to generate qualitative data. Data were analyzed thematically using Braun and Clarke’s framework. Four themes and 12 related sub-themes emerged. By status, schemes were mainly characterized by operational discontinuity. By design, participants proposed shifting from a member-managed to a provider-managed model, but implementation relied mainly on costly grassroots mobilization. Findings showed that scheme sustainability is structurally dependent on donor subsidies, and the recent withdrawal of support compromised operations. The absence of the National Health Insurance Scheme and formal regulation has weakened the schemes, while expectations of free care remain a major socio-cultural barrier. Community-based health schemes in Northern Uganda remain trapped in a cycle of weak design, low enrollment, and donor dependence. The sector needs to transition to legally recognized, government-subsidized, provider-managed schemes with expanded benefits and integrated governance.References:
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