Uganda is country with massive health problems and a high population growth rate. I think as she seeks to reorient her healthcare delivery there is a lot she can learn from Israel's public health system. Israel has a population of only six million people, compared to Ugandas 26 million.

Postgraduate education in medicine, nursing, and public health desciplines are well emphasised here than in Uganda. In addition the country has a very effective primary healthcare delivery system made of Mother-and-child care centers (Tipot Halav). These administer the necessary vaccinations to new-born babies and advise parents on proper care of infants.

State protection

In 1994, despite having only six percent of its population lacking private health insurance, the Israel Parliament (Knesset) enacted the National Health Insurance Law. Since then, all Israel citizens have their health insurance paid by a tax on income (up to 4.8 percent) For the working class, a portion is colected from the employe by the National Insurance Institute, established in 1994.

The funds are then passed on to indepent health insurance funds (Kupot Holim) of the individual's choice. The independent insurance funds then provide each citizen registered with what is termed a national basket of services or selected health services, whether clinical or surgical, etc. Uganda could adopt such a national health insurance scheme for its ever growing population and most importantly the working population.

Private health insurance is associated with many market failures and creates a lot of health inequities among those who can or cannot afford it. People who are not in gainful employment are left out of the improved healthcare services offered by insurers.

In the long run, it also reduces the country's competetiveness on the world market due to an ever increasing costs of healthcare to employers . It neither compels the employer nor the employee to seek health insurance and therefore creates unequal access to healthcare.

We therefore need a comprehensive social/public health insurance policy in Uganda. And the NRM leadership should be commended for having proposed and included this issue in its last manifesto. Social health insurance enables chance solidarity in that those earning more should pay more, albeit unconsiously, to the health insurance fund through taxes.

These therefore subsidise the less paid, and in the end, everybody irrespective of how much he orshe earns gets the same health services (basket of services). It also leaves the employers and employees with less trouble fixing premiums with insurance companies since the government does the bargaining with insurers.

However, it must be realised that the health insurance providers in the public system need to be numerous and independent of government influence. This ensures quality care, competetion and research by the insurance companies on how best to provide high quality care at a the lowest cost.

Competitive edge

Otherwise this may compromise on quality of services provided if another centralised government body or single provider is set up as is usually the case in Uganda.

The government's role should be regulatory, i.e. enacting laws, collecting taxes and then competitively offering contracts to insurance companies which pay for individual healthcare/services.

Individuals should also be given a chance to register with a health insurance company and/or provider of their choice. This too promotes competetion, ensuring that high quality health services are provided.

Examples of failed private health insurance systems include USA, and many develping countries in Africa and beyond. Successful social/public health insurance systems are many, but ,as I said earlier, Israel is a good example.

In the US about 30-40million people are not insured at any one time due to failures in the private health insurance market, and health inequities between the rich and poor.

In Israel every registered citizen is insured; they enjoy a better health status with relatively lower inequities among different income groups. This is despite the US' spending a big percentage of its GDP (15 percent) on healthcare compared to Israel's eight percent. I submit that a well thought after social/public health insurance policy will benefit all Ugandans.

Mr Kahiira is a student at Braun School of Public Health and Community Medicine-Hadassah, Hebrew University, Jerusalem.