Knowledge, perceptions and attitudes of health managers towards the proposed social health insurance scheme in Uganda

Abstract

The government of Uganda planned to start Social Health Insurance (SHI) in July 2007, beginning with the formal employment sector, with a view to attain universal coverage in 15 years. Health workers in general and managers in particular, have a crucial role to play in the successful design and implementation of the SHI. This study, conducted in June 2007, meant to assess the knowledge and attitudes of Ugandan healthcare managers about SHI. In so doing, it assessed their readiness to play their role in the implementation of the policy and, generally, gave a clue about the readiness of the country to start the process. The situation does not seem to have changed much in 2009. A cross-sectional survey of health managers in 24 key public, private-not-for-profit and private hospitals, and 8 districts was done. The managers were found to be well aware of the proposed policy but ignorant of its context. They had very high hopes of a large benefit package and yet expected to contribute very little. They felt they had been marginalized in the process of designing the proposed scheme and their roles were not clear. There was no formal training in what they were expected to do once the scheme started. They also had doubts about the integrity of the proposed fund collection and disbursement mechanism. The paper recommended formal training of managers on the policy and its context, their roles, and involving them in the design of the scheme. It also supports postponement of the scheme until key infrastructure and capacity building has taken place.