Uganda's plan to adopt a compulsory national health insurance scheme is still facing opposition even after its architects say it will make health care affordable to the majority Ugandans who live below the poverty line.

The health care financing scheme, which has recently faced resistance especially from workers and other trade unions, will enroll people in formal employment in a compulsory monetary contribution who, in turn, are entitled to health care benefits from gazetted health centres.

The scheme is expected to be operational from July 2009. The Commissioner for Planning in the Ministry of Health, Dr Francis Runumi, said while the plan is to have universal coverage of health care for all in the next 15-years, Uganda has been left behind in debates and skepticisms.

"We are pushing to have the scheme in place. Health insurance with a legal mandate towards universal coverage is a possibility here,"Dr Runumi said.

With increasing cases of new emerging diseases, health experts say having a health insurance scheme in place will ensure that many people are able to afford the cost of health care delivery.

"Because of the emerging and re-emerging diseases like HIV/Aids, malaria, diabetes hypertension and other diseases cause by lifestyle changes, the government alone cannot manage and thus needs an alternative source of financing," said Dr Richard Alia, a health specialist with the World Bank in Kampala.

Dr Alia said having a health insurance scheme in place, provides additional funds for health financing and is a means of subsidising the poor.

"It's the obligation of every government to provide social protection for its citizens and a health insurance scheme will protect people from financial shocks when they become sick," he said.

Uganda's per capital health spending, according to the World Health Organisation, is $7.28 (about Shs13,644 ), which is well below the WHO's minimum recommendation of $30 to $40 (Shs54,000 to Shs72,000) per annum.

But giving a private sector perspective on the plan, Dr Ian Clarke who is the Chief Executive Officer of International Hospital Kampala said the Health Insurance Bill does not address realities on the ground as regards to health care provision.

"How can we subsidise an already inefficient delivery of health service? If the health services that are already paid for now are inefficient, how are we going to manage the scheme? "he wondered.

According to the draft bill, every employer will be required to contribute 4 per cent of every employee's gross salary towards the scheme as health insurance and a further 4 per cent will be deducted from the employee's salary making it a total 8 per cent for every employee.

If it takes root, this will be the largest insurance premium in Uganda worth in excess of $ 40 million. According to Dr Alia, Social Health Insurance is wide in developed countries, with usually more than 90 per cent coverage and thus has great potential in developing countries like Uganda.

"Health Insurance Scheme especially universal coverage ensures that all citizens access health care when they need it," Dr Alia said. But Dr Alia said that the current status of medical services leaves a lot to be desired and thus poses a great challenge to the implementation of the scheme.

Dr Robert Basaza, a senior health planer in the Ministry of Health said at the scheme is dynamic and user friendly, with immediate access to benefits.

He said the scheme will start with the civil service and the formal private sector before being rolled out to other sectors.

"The scheme will be established in a phased manner and expanded progressively," Dr Basaza said. He said the scheme will operate concurrently with community and private commercial health insurance schemes.

The private sector is already offering a similar health insurance scheme. Dr Runumi said government will work with the private sector in implementing the scheme.

According to the draft National Health Insurance Bill, a person and his or her spouse and four dependants will be entitled to the health care benefits.

Dr Basaza, however, said the benefits will exclude illnesses and injuries arising from self destruction and other occupational hazards and accidents. "We all need to support this scheme because it will help," Dr Basaza said.