Uganda — Kisiizi Hospital Community-Based Health Insurance

A hospital-anchored cooperative insurance model, organized through community associations, that has run for nearly three decades.

Since

1996, at Kisiizi Hospital — the first community-based health insurance scheme in Uganda; roughly 30 similar schemes have since been established nationally

Mechanism

Families join through community associations of twenty or more households, known locally as ‘Bataka’ or ‘Engozi’ societies; members pay an annual premium plus a co-payment at the point of service

Scale

Kisiizi's own scheme: 41,500 registered members across 210 community associations. Nationally, an estimated 155,000 people are enrolled across all schemes combined — roughly 5–10% of the eligible catchment population

What's documented as working

Researchers studying the scheme identified a strong network of trusted community associations, consistently rated quality of care at the anchor hospital, affordable premiums, and trusted local leadership as the specific factors making further expansion feasible

Documented challenge

After nearly three decades, enrollment nationally still reaches only an estimated 5–10% of the eligible population. Long travel distances to anchor hospitals, low general awareness of health insurance, and inability of some households to pay even modest premiums were identified as the specific limiting factors.

Uganda's first community-based health insurance scheme was established at Kisiizi Hospital in 1996. Families join not as individuals but through community associations — locally called "Bataka" or "Engozi" societies — each requiring a minimum of twenty member households. Members pay an annual premium along with a co-payment at the time they use services. Since Kisiizi's founding, roughly 30 similar community-based schemes have been set up in other parts of the country, generally organized around a local anchor hospital in the same way.

At Kisiizi specifically, the scheme has grown to 41,500 registered members organized across 210 separate community associations. Nationally, researchers estimate that all of Uganda's community-based health insurance schemes combined reach approximately 155,000 people — an estimated 5 to 10% of the population within their combined catchment areas.

A study examining the feasibility of scaling up the Kisiizi model identified specific, concrete reasons the scheme has sustained itself where others have struggled: a strong existing network of trusted community associations, consistently rated quality of care at the anchor hospital, premiums residents described as affordable, and trusted local leadership and management. The same study, and separate national research on Ugandan community health insurance more broadly, identified the specific barriers limiting further growth: long travel distances and transport costs to reach the anchor hospital, low general public awareness of how health insurance works, competing financial priorities at the household level, and, for some households, a continued inability to pay premiums even at modest levels.

Separately, Uganda's abolition of user fees at public health facilities in 2001 — intended to improve access for the roughly half of the population previously excluded by cost — has coexisted with, rather than replaced, the community-based insurance movement, which continues to operate mainly through private, not-for-profit hospitals like Kisiizi that still charge for services.

Sources

Feasibility and desirability of scaling up Community-based Health Insurance (CBHI) in rural communities in Uganda: lessons from Kisiizi Hospital CBHI scheme — BMC Health Services Research
Community health insurance in Uganda: status, obstacles and prospects — academic review
Low enrolment in Ugandan Community Health Insurance Schemes: underlying causes and policy implications — BMC Health Services Research