March 31, 2025 Newswires

Most Ugandans Lack Medical Aid Coverage and Worry About Being Unable to Afford Care

Raymond Mukiibi and Lythn NaggayiAllAfrica

Little-known National Health Insurance Scheme has strong public support among those who have heard of it.

Key findings

Six in 10 Ugandans (61%) say health is one of the three most important problems in the country, placing it at the top of citizens' agenda for government action, ahead of education (36%) and infrastructure/roads (34%). o The share who rank health among their top priorities is up by 15 percentage points since 2022 (46%).
More than four-fifths (82%) of Ugandans worry that they will be unable to obtain or afford essential medical care when they or someone in their family falls ill.
Among citizens who had contact with a public hospital in the past year: o About two-thirds (65%) say they found it "difficult" or "very difficult" to obtain the medical care they needed. o Two-thirds (68%) report that high costs prevented them from obtaining medical care or medicines, including one-third (33%) who say this happened "often."
Health insurance is still very limited in Uganda: Only 4% of respondents say they have medical aid coverage. o Among those who lack health insurance, one-third (33%) say they are not aware of any health insurance schemes, while a similar proportion (32%) cite unaffordability as the main reason for lacking medical aid.
More than three-fourths (78%) of Ugandans have not heard of the National Health Insurance Scheme. o Among the minority of respondents who have heard of the scheme, most are supportive of its implementation (76%) and confident that it will be effective (75%).

Access to health care is a significant challenge for many Ugandans, particularly in rural areas, where health facilities are scarce (Ministry of Health, 2024). Even when services are available, high costs and widespread poverty create financial barriers that prevent many from obtaining necessary medical care (Ministry of Health, 2020). Marginalised groups face further obstacles due to cultural barriers and a lack of culturally sensitive health care services (Real Health Uganda, 2024). As a result, the prevalence of preventable illnesses, maternal and infant mortality, and untreated chronic conditions remains high (Moses & Igwe, 2024).

Health insurance has been identified as a potential solution to improve health care access. Research in other countries indicates that insured individuals are more likely to seek medical care, receive preventive services, and manage chronic conditions effectively, leading to better health outcomes (Institute of Medicine, 2002; Huguet et al., 2023). However, health insurance coverage in Uganda is extremely low, with private insurance covering only 1% of the population (Ministry of Health, 2020). This lack of coverage results in high out-of-pocket health care expenses, making medical care unaffordable for many.

To address these challenges, the Ugandan government passed the National Health Insurance Scheme (NHIS) Bill in 2021, aiming to establish a nationwide system to reduce financial barriers to health care access (Advanced Family Planning, 2021). The NHIS seeks to provide comprehensive coverage, including preventive and curative services. Proposed compulsory membership fees would be UGX15,000 (about U.S. $4) per month. However, President Yoweri Museveni has yet to sign a revised version of the bill, which is currently awaiting cabinet approval (Daily Monitor, 2025). Activists and media organisations have called on the government to expedite the implementation of the NHIS, especially in the wake of aid freezes by the U.S. government (Daily Monitor, 2025; Serugo, 2024).

Afrobarometer's latest survey explores Ugandans' access to health care, medical aid coverage, and perceptions of the NHIS. The findings highlight persistent financial barriers, low awareness of health insurance options, widespread anxiety about being unable to afford health care, and strong support for the NHIS among those who have heard of it.