Leveraging on traditional practices to address contemporary healthcare inequities: a case of Kisiizi Community-based Health Insurance Scheme.

Abstract

Engozi, a traditional health and social-services system has existed for centuries in southwestern Uganda. Members contributed funds for: healthcare, transport for patients to hospitals and burial ceremonies for members. Membership focused on clanship or neighbourhood. The establishment of “free public healthcare services” led to the decline of the engozi system. However, due to inadequate government resource allocation to health sector, the government health services cannot meet the needs of the rural communities. Equitable access to healthcare is still unachievable even after the abolition of user fees. Cost of services is still a key barrier, and the poor have limited access to quality healthcare services. CBHI was fronted as one strategy to address such inequities. In 1996, the Kisiizi community leveraged on the engozi groups’ traditions to establish the first Community-based Health Insurance (CBHI) Scheme in Uganda, promoting access to quality healthcare at a low cost. CBHI has been successful in reducing out-of-pocket payments, obtaining financial protection against catastrophic health expenditures and improving access to healthcare in low-income communities. The goal of this study was to explore the significance of community values and traditions in addressing healthcare inequities through a CBHI approach. This study adopted a case study methodology and qualitative methods., The study was guided by Woolcock’s social capital theory. Conclusion: This paper affirms that communities characterized by solid intra-community ties are more likely to experience success with CBHI. It adds that compliance to society values and traditions; and active involvement of community leaders in the planning and execution of CBHI are essential determinants of success. Consequently, the CBHI scheme addresses contemporary healthcare inequities through; breaking financial barriers to accessing quality healthcare, promoting early healthcare-seeking behavior, and leads to increased equity in healthcare access and utilization.