How a Ugandan hospital delivers health insurance through burial groups

A SICK PERSON would once have to sell land or cows to pay hospital bills, says Owen Orishaba, a teacher in the Kigezi highlands of Uganda. But now “a goat can solve your problem.” Four years ago he joined a community health-insurance scheme managed by Kisiizi Hospital, a church-run institution. With 45,000 members, it is the largest of its kind in the country. Its success illustrates a wider truth: to deliver services to poor, rural people, begin with the systems they have built themselves.

In principle, Ugandans can get free health care at public clinics. In practice, government health centres are short of money, medicine and staff. The state accounts for only 15% of health spending, with another 42% coming from donor aid. Almost all the rest comes straight out of people’s pockets at private or faith-based facilities. Uninsured patients sometimes run from their beds to evade bills, says Moses Mugume, an administrator at Kisiizi Hospital. Even as he talks, a tearful woman, who is not in the insurance scheme, is brought into his office after being caught doing so.