In this paper, the authors provide a contextual and political-economic analysis of health financing reforms in Uganda and in particular dispelling the fears and misconceptions related to introduction of a National Health Insurance Scheme (NHIS). The path to health financing reforms in Uganda began in 1986 when the current government took power. In 2001, Uganda publicly abolished user fees in all public healthcare facilities to improve health care access and remove the financial burden of accessing care especially for the poor households. However, despite the free healthcare services, over the years out of pocket health expenditures have increased exposing households at a risk of incurring catastrophic health expenditures. Nevertheless, the government has not introduced any new reforms to reduce the financial hardship being faced by Ugandan. Using the Grindle and Thomas model the authors depict how various factors affect decision making by policy elites concerning a particular policy at a particular time. Drawing lessons from the sub-Sahara region and in particular, Ghana and Rwanda’s experience, the authors conclude that the political will of the executive led by the president in many countries is a key determinant in the successful implementation of health reforms including the establishment of national health scheme.
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