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One Question One Expert: Is it possible to identify the ‘poor’ in the context of setting up a national health insurance scheme?

Monday, July 29th, 2019

Cabinet recently approved the proposed National Health Insurance Scheme which is meant to improve the provision and access of health services to all Ugandans. The bill has been tabled before parliament awaiting debate and approval into law. While the bill shows how those in formal and informal employment will contribute, there is a big number of those who are vulnerable and poor, and require someone to foot their bill. However, it becomes harder when data which may help identify them doesn’t come easily. Recently, the Initiative for Social and Economic Rights in partnership with the Ministry of Health convened stakeholders meeting on identification of the poor and and vulnerable for the proposed national health insurance scheme. On the sidelines of the meeting we posed our question ( Is it possible to identify the ‘poor’ in the context of setting up a national health insurance scheme?) to Dr Elizabeth Ekirapa-Kiracho (above), who also heads the Department of Health Policy Planning and Management at Makerere University School of Public Health:

“It is possible to identify the poor although it is difficult especially in countries where you don’t have enough information like background characteristics, social demographic characteristics that can help you to be able to categorise and determine who is poor and who is not poor.

One of the most effective methodologies is referred to as Means Testing where you would need to do a survey and determine people’s income levels and expenditures. But doing such a survey in a resource constrained setting like ours can be very expensive.

Another method is the Proxy Means Test that some people have used next to the first one i mentioned. This  allows you to describe a situation where information on household or individual characteristics correlated with welfare levels is used in a formal algorithm to proxy household income, welfare or need.

The other methods that are easy to use are things like geographical targeting where you target a whole geographical area that has been deemed poor. Similarly, there is categorical targeting where you decide on a certain criteria that you are going to use then use that to categorise .

Another method is participatory wealth ranking where a community decides who they feel is poor and they choose variables they think can be used to identify the poor.

But even these methods can have challenges. Some are related to the high cost of doing them. There is potential capture and abuse by politicians for example in some settings they may want to include people that do not qualify.

That said, stakeholders may have to look at a combination of methods that will be able to include most of the vulnerable and poor, but at the same time exclude most of those who are not poor. It must be a delicate balance. And usually in resource restrained countries, when you are deciding on any targeting method, it’s recommend that it should be affordable to the country.”

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