MOTION SEEI{ING LEAVE OF PARLIAMENT TO INTRODUCE A PRIVATE

MEMBER'S BILL ENTITLED NATIONAL HEALTH INSURANCE BILL, 2019

(Moued under Articles 79 and 94 (4) (b) of the Constitution of the Republic of
Uganda and Rules 120 and 121 of the Rules of Procedure of Parliament)

{IHEREAS Article 79 of the Constitution of the Republic of Uganda empowers

Parliament to make laws on any matter of peace, order, development and good
governance;

AND WHEREAS Parliament enacted its Rules of Procedure pursuant to Article

94 (1) of the Constitution of the Republic of Uganda;Article 94 (a) ft) of the
Constitution of the Republic of Ugandaand Rule 120 of the Rules of Procedure
of Parliament empower a Member of Parliament to move a Private Member's
Bilt;

AWARE that Objective XX of the National Objectives and Directive Principles of

State Policy mandates the State to take all practical measures to ensure the
provision of basic medical services to the population and Goal 3 of the
Sustainable Development Goals aims at ensuring healthy lives and promotion
of well-being for all at all stages;

FURTHER AWARE that Article 16 of the African Charter on Human and

Peoples'Rights of 1981 is to the effect that every individual shall have the right
to enjoy the best attainable state of physical and mental health, and State
Parties to the present Charter shall take the necessary measures to protect the
health of their people and to ensure that they receive medical attention when
they are sick;

NOTING that Uganda lacks a National Health Insurance Scheme which would
ideally assist in improving universal coverage and accessibility to health care
services, regulate health insurance across the country and avert financial risks
that arise from high out-of-pocket expenditure on sickness, disability and
others;

FURTHER NOTING thatcurrently in Uganda, there are two health insurance

arrangements that is the private commercial health insurance by Health
Membership Organizations (HMOs) and commercial insurance companies and
communitlr health insurance schemes however the existing communit5r health
insurance schemes cover about 1% of the population while the private
commercial health insurance equally covers a very small segment and whereas
health insurance cover is a great idea for all Ugandans, the repercussions for
not having one are much more severe especially for those in lower income
groups;

CONCERNEDthat an analysis of Uganda National Household Survey 2016l17

data showed ttrat I4.2 per cent of Ugandan households incur catastrophic
health expenditures due to direct household out-of-pocket payments which
compromises the household welfare and affects their ability to consume other
basic needs such as food, education and shelter and eventually driving them
into absolute poverty;
CONVINCED thatthere is an urgent need tohave a lawaddressing cost as one of
the barriers to accessing quality health care in Uganda and a means by which
government fullills its obligation to provide citizens with the highest attainable
standard of health ultimately contributing to healthy human capital that will
facilitate social and economic development;
NOW THEREFORE be it resolved that:
l. This House grants me leave to introduce a Private Member's 8i11, for an
Act entitled "NATIONAL HEALTH INSURANCE BILL,2OI9",
2. Do order the publication of the said BilI in preparation for its first
reading.

Moved by;

Hon. Dr. Bukenya Michael Iga (MP, Bukuya Count Y, Mubende D

Seconded by;

Hon. Rwakimari Beatrice (Woman MP, Ntungamo districtl

Hon. Khainza Justine (Woman MP, Bududa Districtf
 N atio nal H e alth htsur ance

ARRANGEMENT OF SECTIONS

PART I -
PRELIMINARY PROVISIONS

1 Object of the Act

z Interpretation

PART II -THE NATIONAL

3. Establishment of the National Health Insur
4. Membership of Scheme
5. Object of the Scheme
6. Functions of the Scheme
7. Contributions and benefits from the
8. Establishment of Board of Directo e
o
i0.
11.
t2.
13.

t4.
15.

t6.
t7.
1 8. Exemptioi"ir:from. taxes
19. Powers to 6orroto
20. Financial yeai'
2 1 . Accounts and audit
22. Annual report
23. Financial management
24. Compliance with the Public Finance and Accountability Act, 2003

PART VI - REGISTRATION

25. Registration of contributors and beneficiaries of the Scheme

Identity card

PART VII -HEALTH CARE BENEFITS

26. Benefits under the Scheme
27. PortabiliLy of benelits
28. Choice of health care provider

PART VIII -HEALTH CARE PROVIDERS

29. Accreditation of health care providers
30. Accreditation committee
31. Functions of the accreditation committee
32. Minimum requirements for accreditation
33. Application for accreditation
34. Accredited health care providers
35. Inspection
36. Quality assurance
37. Safeguards against over and under u n alth c
38. Payment of accredited health care
39.Payment mechanisms

PART INS OFFICES

40. Establishment of re ul
41. Complaints to regional offi

42.
43.

44.
45.
46. Disclosure of interest
47. Registrar of the Appeals Tribunal
 A Bill for an Act

ENTITLED

THE NATIONAL HDAITH INSURANCE B.l,lzI,;2

An Act to establish the National Health Insurance Schem to de for the

functions of the Scheme; to establish the Board of the Sch d th sition,
functions and powers of the Board; to provide for the staff the of cheme;
to provide the registration of contributors and their ben to de the benelits
available under the scheme; to provide for the ac c providers; to
provide for the accreditation committee and its s; to the payment of
health care providers; to provide for bli nt of health insurance
oflices and their functions; to provid e nt of e Appeals Tribunal;; to
provide for offence and penalties und Act an rre d matters.

eptable and quality healthcare

1r age or economlc, health or
social status;,

(b) to develo p',he alth: ihsurance as a complementary mechanism of health care financing
in Uganda;

(c) to ensure that every citizen and resident has access to good quality, accessible,
equitable and affordable health care;

(d) to ensure quality and equity of care, appropriate utilization of services, fund viability,
patient satisfaction and overall accomplishment of health insurance;

(e) to ensure equitable distribution of costs among the different income groups;
(f) to improve and harness private sector participation in the provision of health care
servrces;

(g) to provide finance to subsidize the cost of provision of health care services to the
indigent; and

(h) to ensure the availability of funds to the health sector for improved servlces.

2. Interpretation
In this Act, unless the context otherwise requires

"Accreditation" means the process by which a healthcare p ve alified

and capable to p rovide healthcare services under the Sche

"actuary" means a person who is a member, ASSOC o ,,,a professional

institute faculty, society or association of act and thorized by that
institute, faculty, society or association tuari ns of insurance
business and who is recognized as su e

"beneliciary" means a person enti heal efits under this Act and
includes a contributor;

"community health insurance scheme" means a not-for-profit health insurance scheme

established in-the infoimal sector and created on the basis of an ethic of mutual aid and
collective pooliry-oihealth risks, in which the members of the scheme participate in its
management; ineludes quality assessment and corrective action to remedy a beneficiary
who may be identilied in the quality of direct patient, administrative, and support
services;

"resident" means a person who has permanent residence in Uganda or has obtained
authority to stay in Uganda for a consecutive period of more than one year;
"Scheme" means the National Health Insurance Scheme established by section 4.

PART II -THE NATIONAL HEALTH INSURANCE

3. Establishment of the National Health Insurance Scheme

as

4. Membership of Scheme
Every person who stays or is a member of a shall be a member of the
na

Th

of health services;
(f) determine after negotiations, capitation and other pa5rments due accredited
health care providers ( liaise with the insurance Regulatory Authority on the
regulation of private commercial health insurance schemes;
(g) carry out research and provide statistics on matters relating to health insurance
in Uganda;
(h) license, supervise and monitor community health insurance schemes and also
carry out other functions necessary for the implementation of the act.
 6. Contributions and benellts from the natioaal health insurance scheme

(1) The Board shall, basing on the actuarial determine the contribution to be made by
a member of the scheme.
(2) The Board shall categorize members into different groups based on income leve1s.

7. Establishment of Board of Directors of the Scheme

There is established a board of directors of the Scheme com o

(a) the chairperson;
(b) eight members;
(c) the Executive Director of the scheme. D

8. Composition of the Board

(1) The members of the Board shall include-
(a) a representative of the Ministry re onsl r
(b) a representative of the Minis le
(c) a representative of the Mini respon fo ce;
(d) two representatives of trade s, NO dc
(e) a representative of the National Se Fund;
(f) a representative of the private heal c ers;

and

:i.::.'i':.'
9. Functlong:of the Board
The Board shall-
(a) determine the poiicies for the Scheme;
(b) ensure the effective implementation of the policies of the Scheme;
(c) manage the Scheme in accordance with this Act;
(d) cause to be carried out financial and medica-l audits of the regional offices;
(e) carry out any other functions that may be necessary for the purposes of
achieving the objectives of the Act.
 10. Payment of benelits for benellciaries of the Scheme
(1) The Board shall make payment from the Scheme, to a health service provider, for the
expenses incurred by the provider, for the beneficiaries of the Scheme.

(2) The payments payable sha11 be limited to expenses incurred in respect of the benefits
package specified in Schedule I of this Act.

(3) The Board may refuse or reduce a payment for a claim by a health care provider
where

(a) the Board is satisfied that the claim is based on false or

justifiable caus
(b) the health care provider fails without
requirements of this Act or regulations made under this

11. Powers of Board to lnvestlgate

(1) The Board may conduct inves

(a) to establish whether a health accordance with the

requirements of this Act; or
' ttt,,.,,...
..:,.
(b) Where a complaint is made against a h ealth,rC.are€.rovider.

(2) The Board may delegate vestigate, to the Execu tive Director or any
officer of the Scheme.

t2. Meetings

for the proper discharge of its

two months.

erson, the Executive Director sha1l call the meetings and

sent t from amongst themselves, a person to act as the

::..::::
(3) The quorum'bf'the Board shall be five members; except that where a member
declares an interest in an agenda item, or a matter before the Board, the member in
question shall not be counted for the purpose of forming a quorum in relation to the
agenda item or matter in question.

(4) A decision of the Board shall be by a majority of the votes and where there is an
equality of votes, the chairperson sha1l have a casting vote.
(5) Subject to this Act, the Board shall regulate its procedure in the conduct of its
business.
 PART IV -STAFF OF THE SCHEME

13. Executive Director

(I) There shall be a Executive

Director of the Scheme appointed by the Board, on terms
and conditions as shall be specilied in his or her instrument of appointment.

(2) The Executive Director shall be the Chief Executive Officer me and shall
be a full time employee of the Scheme and shall not engage ss, profession,
occupation or paid employment elsewhere.

accordance with their terms s of appointment

...,.
(5) The Executive Director,shall ora term of four years which may be

r for

of performing the

without

(f) conviction of an offence involving moral turpitude;

(g) being adjudged bankrupt by a court of law; and
(h) any other reasonable ground.

14. Other Stalf

The Board shal1 appoint such officers and employees as may be deemed necessary for
(1)
the proper and efhcient discharge of the functions of the Scheme.
(2) The Executive Director shall, on the directive of the Board, appoint other staff as may
be required for the performance of the functions of the Scheme, on terms and conditions
of service determined by the Scheme

PART V .FIITANCIAL PROVISIONS

15. Funds ofthe Scheme

(1) The funds of the Scheme shall consist of
(a) a1i sums received by the Scheme in respect of
(i) contributions;
(ii) income on investment;
(iii) fees, fines, penalties; and
(iv) interest on dues;

(b) monies appropriated by Parliament for the fun

(c) grants received by the Scheme with

(d) any other money as may with the of be received by or made

available to the Scheme for the purpose o tions.

(2) The funds of the Scheme shall be:

(2) Thetotal amount of the reserve funds sha11 not exceed the amount actuarially
estimated for the projected expenditure of the Scheme for a period of three years.
(3) Where the reserve funds exceed the amount specilied under subsection (2), the
Minister on recommendation of the Board shall prescribe that

(a) the benelits package be increased; or

(b) the contributions be decreased.

(a) The reserve funds shall be invested in

(a) interest-bearing bonds, securities or other evidences of indebtedness to the

Government, or in bonds, securities, promissory notes and other evidences of
indebtedness to which full faith and credit and unconditional guarantee of the
Government is pledged;

(b) interest-bearing deposits or loans to or securities in any ted in

Uganda, in which case the deposits shall not at any time aired capital
and surplus or total private deposits of the depository bank r1 a11er;

(c) any other investment approved by the Minister responsi or e

17. Exemption from taxes

The Scheme shall be exempt from the pal,rnent of n tions to the
Scheme.

18. Powers to borrow

The Board may, for the purposes ofthe tives e, with the prior approval
of the Minister, borrow money, in form of or rdraft, and upon such terms
and conditions as the Board may consider ap na

19. Financial year

The financial year of the Sch e same as the financial year of Government.

20.

bject to audit by

Minister within

(3) The Minist€f, shall'on receipt of the audited accounts, submit the accounts to Cabinet
and shall after:dppioval by Cabinet, lay the accounts before Parliament.

(a) The Minister shall present to Parliament, at least every three years, the actuary
evaluation of the Scheme.
 21. Annual report
(1) The Board shall within three months after the end of each financial year, submlt to
the Minister a report on the activities of the Scheme in respect of the linancial year,
containing such information as the Minister may require.

(2) The Minister sha1l lay the annual report of the Scheme together with the audited
accounts of the Scheme before Parliament.

22. Flnanclal management

(1) The use, disposition, lnves tment disbursement admin anagement o f
the funds of the Scheme, including any subsidy, grant or by the
Scheme shall, subject to section 28, be governed by a resolu eB
(2) The Board may charge a health service provider for din
administration of the Scheme in respect of that health s ce der

(3) The costs under subsection (2) shall include th tof

(a) administering the Scheme;
(b) monitoring and evaluation of the SC
(c) marketing and promotion of the S C e and ice provider;
(d)

(0
(g) Scheme.

(4) eed, the lesser of

(a)
(b) in the preceding
financialyear. .'.,.. ,- ,,i1,,,..
'., .,,,,
(5) TheGovcrnme'.t of:Uganda shall be the guarantor of the Scheme.

23. ComplianGO,.wtth the Publlc Flnance and Accountability Act, 2OO3

The Scheme shall at all times comply with the Public Finance and Accountability Act,
2003. :

PART VI -REGISTRATION

24. Registration of contributors and beneficiaries ofthe Scheme

Every contributor and every beneficiary of the Scheme shall be registered as such, by the
Scheme.

25. Identity card

(1) Every beneficiary of the Scheme shall be issued with an identity card for purposes of
identification and verilication and for the validation *d accessing of health care benefits
under the Scheme.

(2) The identilication card shall bear the name and registration number of the beneficiary
and any other particulars as may be prescribed.

VII .HEALTH CARE BENEFITS

PART
26. Beneflts under the Scheme

(1) Every beneficiary shall be entitled to the benefits package s ln dule 1.

(2) For th e avoidance of doubt, a beneliciary shall no tbe to benefi 'pa ckage
specified in schedule 2.

(3) Where the cost of health care offered to a benefi th ount prescribed

tions issued by the

er in Uganda.
..::..:.
(2) The Board may prescribe fo r ae€eising specified health care benefits,
outside Uganda.

care this Act, shall choose from the list of health

e Scheme.

VIII -HEALTH CARE PROVIDERS

29. Actre.dltation of health care providers

'..'
(1) The Scheme shall use only the services of a healthcare provider accredited to t11e
Scheme under this Part
(2) The Board shall issue, in the prescribed , a certificate to a health care provider
accredited to the Scheme.
(3) The Board shall, at least once every year, pubiish a list of all health care providers
accredited to the scheme, in at least three daily newspapers with wide circulation in
Uganda.
(a) The Board shall prescribe the period of the year for issuing accreditation certificates
and for renewing them.

(5) The Board shall issue guidelines for the minimum accreditation criteria for the level
of care to be provided by the health care providers.

30. Accreditation committee

(1) Accreditationto the Scheme sha-Il be done by the accreditation committee which shall
be appointed by the Board

(2) The accreditation committee shall comprise

(3) A person appointed to the accreditation com mittee shall h
ten years.
(4) A member of the accreditation committee shall hold o thr be

the

roviders to

32. Miirimum 'requirements for accreditation

,i.r::.:.

A health care proVider shall not be accredited to the Scheme unless the Board is
satisfied that -
(a) the health care provider meets the minimum accreditation criteria for the level of care
determined by the Board;

(b) the human resource, equipment and infrastructure of the health care provider
conform to the standards determined by the Ministry responsible for health;
(c) the health care provider recognizes the rights of patients, health workers and their
safety;

(d) the health care provider accepts the payment mechanism for the payment of health
care providers under this Act;

health care provider adopted referrals protocol and health resource sharing
(e) the
arrangements;

(1) The Scheme may enter into a con with a provider accredited under
this Part, to provide health services to ne fici of Scheme.

(2) The Board shall by notice in at least two n pers of wide circulation,
ction (1) to be an accredited

with identification prescribed by

place at the premises of the health

(4) The Board shall terminate the contract with a health care provider who fails to meet
the requirements of this Part.

(S)Where a contract of an accredited health care provider is terminated, the Board shall
by notice in at,least trro daily news papers of wide circulation, revoke the declaration
made under subsection (2).

35. Quality assurance

(1) The Board shall through accreditation and other means as may be prescribed by the
Board, ensure that the health care providers have in place programmes that secure
quality assurance, utilization review and technolory assessment.

(2) The purpose of quality assurance, utilization review or technolory assessment is to

determine that
(a) the quality of health care services delivered, measured in terms of inputs, process
and outcomes, is reasonable;

(b) the acquisition and use of scarce and expensive medical technolory and equipment is
consistent with actual needs and standards of medical practice;

(c) the performance of medical procedures and the administration of medicines is

appropriate, necessary and consistent with acceptable standards of medical practice and
ethics;

(d) the medicines paid for are those included in the national en s list

36. Safeguards against over or under utilization of

(l) The Board sha1l prepare guidelines to regulate against ti

e easures against

S;

for services rendered

to a contributor and a
der subsection (1) shall

(3) An accredited health'rcare provider shall be paid within thirty days of submitting a
claim to a regional -office

38. Payment mechanisms

(1) The Board shall determine a payment mechanism to be used to pay an accredited
health care provider for services rendered to a contributor or a beneficiary.
(2) The payment of fees for the services rendered mechanism sha1l be used to pay for
services rendered by a health care provider who serves a remote area or an area that
does not have medical personnel.
(3) A regional office shall recommend to the Board, the payment mechanism appropriate
for the payment of a health care provider within the region.
 PART U(.REGIONAL HEALTH INSURANCE OFFICES

39. Establishment of regional health insurance oflices

(1) The Board shall establish regional health insurance offices and sub- regional offices
to be in charge of national health insurance within the respective regions and sub-
regions.

(2) The Board shall determine the officers and employees to be employed at the regional
offices, for the proper and efficient discharge of the function o es.

(3) A regional health insurance office shall

(a) supervise, monitor and evaluate the activities of the Scheme:, f the ity
health insurance schemes located within the region;

(f) perform any other functlg4 gned Board

Complaints tir,.re gio es

a health care provider may lodge a complaint, in the
nal health insurance office, regarding

(a) tio ts ofa beneficiary;

(b)willfu1n ect of d s by an officer of the Scheme which results in loss to a

beneficiary;

c unreason in the processing and payment of claims to a hea_lth care

provider; and

(d) any other reason that tends to undermine, delay or defeat the objectives of the
Scheme

(2) A regional health insurance office shall hear and determine a complaint within
fourteen days after the complaint is lodged with the office
 PART X - APPEALST TRIBUNAL

47, Establlshment of the Appeals lfibunal

42. Appeals Tribunal

(l)There is established the Appeais Tribunal to review decisions by the Board or Regional
Heaith Insurance Offices.

prrvate sector.

1S1 ffretemUers of tlle:Appeals T?ibunal shall hold office on such terms and conditions
as the tvtiniSter may prescribe, including terms and conditions relating to remuneration
and allowances

43. Tenure of'office of members of Appeals Tribunal

(1) The membefuJ:f the Appeals Tribunal shatl hold office for three years and are eligible
for re-appointmeht for one further term.

(2) Where necessary, the Minister may extend the tenure of a member for a period not
exceeding six months from the date of expiry of the period of appointment
(3) A member of the Appeals Tribunal may be removed from office by the Minister for:
(a) inability to perform the functions of his or her office arising
from infirmity
of body or mind;
 (b) Misbehavior or misconduct;
o incompetence;
(d) failure to attend at least three consecutive meetings of the
Appeals Tribunal without reasonable grounds

(e) corruption;
(f)conviction of an offence involving moral turpitude; or
(g) being adjudged bankrupt by a court of law.
(a) Any member of the Appeals Tribunal .;:i,,. . ::::,,. ,,..

notice of one month, in writing to the

Minister
,.'t"'"'''"'t,,,.. "..='
Management of the Appeals Tribunal | ,,,,;,..

44. Arrangement of business

(1) Subject to this Part, the Chairperson is responsible for ensuring the orderly and
expeditious discharge of the business of.!!q,AB-p,gals Tribunal and sha11 for that purpose

(a) the arrangement of the business of th6-ltopea1s Tribr-rnal;

(b) the place at which the Appeals Tribunal m{:si

1

(c) the procedure of the eppeais:Tiibnnal- generally; and

lace

bunal shall be determined by

rtunity for the parties to the
little inconvenience and

(3) In carrying out its i writs, processes, orders, rules, decrees or commands, the
Appeals Tribun a1 shall:.have the assistance available to a court in Uganda
......'
45. Constitution, ofthe Appeals Tribunal
(1) The Appeals Tribunal sha11 be constituted for proceedings by three members.

(2)At a hearing of proceedings before the Appeals Tribunal at which the Appeals
Tribunal is constituted bv three members

(a) If the chairperson is present, he or she shall preside; or

(b)
In any other case, a member elected by the members present
 from amongst themselves

46. Disclosure of Interest

47. Registrar ofthe Appeals Tribunal

A currency point is equivalent to

BENEFITS PACKAGE TO BE PROVID ER

Area Benefits prlckage Items not lncluded ln
the benefits package
Out patients I .
Consultation a Designer
2. Laboratory tests lenses and
3. ApprovedXiRay frames
'4.' Preisc.ribed dfugs and a Complicated
',,.,,...',' *"6fii;*.,,,,,.. hearing aids
5.,. .,DiagnosiS''ilnd treatment of a Evacuation
i,,,'. common ailments
l-1,'"'6. Refetral to medical officers
and high level of care
..
tTii:but patient surgery
' B. Preventive services like
immunization screening of
breast, cervical and Prostate
cancer
9. Ophthalmoiogic and optical
services
10. Ear-Nose-Throat
services
I 1. Health Education
12. Counseling
13. Removal of foreign
 bodies
14. Emergency cases
Laboratory Laboratory tests including
Investigations pregnancy tests , hematolory ,
chemistry, serologr, and hormone
tests, including Reproductive
Health , micro biologr ,
parasitolory , blood transfusion
and histologz
Dental Services o Extractions D s and
o Fillings
. Oral diseases smeti

Reproductive Health 1 Ante natal care

services 2 Normal Delivery
'J Emergency repro ducti
Health servi ud
episioto orc
delivery, uum ex
and caes section
4 Post abortio n
Adolescent re pro
he rvlces
6. including
servrces
In patient Ad private and a Conditions
,,,'1",'
gen covered by other
r 'r :I.nvestigative and diagnostic afrangements
medical examinations ( for a Dangerous sports
exarnple CT scan , ultra like motor racing
sound and X-ray) and sky diving
r: :r. . Inpatient treatment of a Cosmetic
different diseases Procedures
. Nursing care a Alternative
r Minor and major surgeries medicine
r Orthopedic treatment and t Evacuation
surgery
. Referral to specialists and
other units
. Emergency cases
r Ambulance services for
referral purposes
. Psychiatric and neurotic
 conditions

Minor and Major 1. Amputations

surgical operations 2. Appendectomy
3. Orchiectomy
4. Male circumcision
5. Debridement
6. Post abortion uterine
evacuation
7. Excision
8. Herniorraphy
9. Hydrocelectomy
10. Incision and drainage
11. Laparotomy
12. Plaster of Paris ( PO
13. Surgi cal Toilet an
suture/ Su bic
puncture
14. al ofu
fibroids
15. Hyste
L6. Choleste
t7. emorrhoi
18. ction of re
epses
Sigm ctomy
my
oophorectomy
.,:::,. Disarticulation
oa '' : Fistula and rectal
repalr
24.
' '25.
Anal dilation
Surgical methods of
contraception
:ll'-'-.1.'

.Iija:=