Uganda’s healthcare crisis: A nation that buries its people at the theatre door

Two personal tragedies expose the catastrophic cost of Uganda’s failure to build a national health insurance system.

By Mukama Phillip Kahigiriza

Uganda has no functioning national health insurance scheme, and its citizens are dying and losing limbs at the doors of public hospitals while their leaders fly to Nairobi and New Delhi for treatment.

That is not rhetoric. It is the lived experience of the man writing this article. The author’s father died on the cold cement outside an operating theatre at Mulago Hospital, waiting for surgical gloves and iodine that the state had failed to stock. The theatre stood ready. The doctors stood ready. The system did not. He did not die because medicine failed him. He died because planning failed him — decades of deliberate neglect dressed up as fiscal constraint.

Last week, a classmate of the author, a young civil servant barely into his career, was struck by a speeding vehicle on the Entebbe Express Highway. He lost his leg. He now lies in the accident and emergency ward at Mulago, on the same floor where that father breathed his last. Doctors have told his mother he will need plastic surgery and an artificial limb to walk again. His starting government salary cannot cover one night at a private hospital in Nairobi. The government he was serving had no plan for him.

These are not isolated tragedies. They are the daily arithmetic of a broken system. Visit Mulago at six in the morning and you will find a mother who delivered at midnight still lying on the floor, holding her newborn, because the beds are full. Beside her, a young man with a fractured leg is told to go and buy his own gloves, iodine and syringes from a private pharmacy before anyone will touch him. The government says healthcare is free. The hospital hands you a shopping list.

Travel to Mbarara Regional Referral and you find a motorcycle rider told the X-ray machine has been broken for three months. He must pay UGX 80,000 privately. He does not have it. He sits, his leg swelling, waiting for a miracle that should have been in the budget. According to available data, 53 percent of Ugandan families borrow money to pay medical bills. Twenty-one percent sell land, livestock or household assets. This is not healthcare. It is economic cannibalism.

The numbers behind the crisis are damning. The World Health Organisation and Uganda’s own Ministry of Health data show that households contribute 49 percent of all health financing in the country, donors 35 percent, and government a mere 15 percent. UNICEF puts health insurance coverage at just 1.1 percent of the population. Afrobarometer puts it at one percent. That means 99 percent of Ugandans are one serious illness away from financial ruin. Uganda allocates between 6.1 and 7.8 percent of its national budget to health, a figure that has barely moved in two decades despite the Abuja Declaration of 2001, in which African governments — Uganda among them — pledged to commit at least 15 percent.

Parliament passed the National Health Insurance Scheme Bill in March 2021. It was returned. The government has promised to re-table it every year since 2023. It has not. In the vacuum, private insurers collected an estimated UGX 2 trillion in premiums in 2025 alone, with Jubilee Insurance recording UGX 131.68 billion in a single quarter — while routinely excluding pre-existing conditions, capping coverage at age 65, and limiting their networks almost entirely to Kampala.

Meanwhile, the state has found UGX 166.8 billion to purchase vehicles for 529 members of parliament, at UGX 315.3 million each. That sum alone could build 13 to 14 community hospitals. The combined budget of the presidency and parliament stands at UGX 1.648 trillion — nearly double the entire allocation to the Ministry of Health. Uganda has UGX 83 billion set aside for presidential donations and UGX 20.25 billion for fuel and vehicle maintenance at the Ministry of Finance alone.

This is not a poor country. It is a country with catastrophically poor priorities.

Rwanda, working with far fewer resources, has achieved 90 percent health insurance coverage at a cost of approximately six US dollars per person annually. Uganda has Village Health Teams, mobile money infrastructure that reaches every corner of the country, and a population accustomed to making small regular payments. The architecture for a workable national scheme exists. What is missing is political will.

The path forward is clear to those willing to walk it: pass the National Health Insurance Scheme Bill with income-banded contributions modelled on the Pay As You Earn system; have government fund premiums for the indigent; regulate private insurers to prevent exclusionary practices; introduce a two percent levy on betting, alcohol, airtime and sugary drinks to bolster the health fund; and take enrolment to the village, communicated in Runyankole, Luganda and Acholi.

Public health insurance is not a favour the state extends to its citizens. It is a constitutional obligation and a debt long overdue.

Uganda made its promise at Alma-Ata in 1978. It renewed that promise at Abuja in 2001. It has spent the years since converting its hospitals into auction floors and its theatre entrances into waiting graveyards, while purchasing first-class tickets to Nairobi for those who write the budgets.

Today it was a father who died at the door. Last week it was a young man who lost his leg on the highway. Tomorrow, if nothing changes, it will be someone you love.

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