National Health Insurance Coverage and COVID-19 vaccine acceptance in Uganda. Implications on Uganda's achievement of Universal Healthcare Coverage and Sustainable Development Goals.

BackgroundWith the advent of the novel coronavirus disease (COVID-19) and the severe second wave that caused high-profile deaths, hospitalization, and high treatment costs in Uganda, the population has raised concerns about the enactment of the national health insurance coverage bill. As of March 31, 2021, when Uganda was beginning to experience the second wave of COVID-19, the Parliament of Uganda passed a national health insurance bill that outlined the general structure for the first national health insurance scheme. The bill had pre-set benefit packages including a wide range of essential health services such as family planning, vaccination, and counseling. The plan was proposed to be financed by a combination of employers and government contributions and aimed to cover all Ugandans when fully implemented. The policy and implementation details would evolve when the President enacts it into law. However, the President has not assented to the bill. This study aimed to determine the prevalence of health insurance coverage and factors associated with COVID-19 vaccine acceptance among participants in northern Uganda and use findings to show its implications on Ugandas achievement of Universal Health Coverage and Sustainable Development Goals. MethodsWe conducted a cross-sectional study among seven hundred and twenty-three adult participants from northern Uganda. Participants were selected randomly and consecutively. We used a questionnaire with an internal validity of Cronbachs a=0.772 to collect quantitative data from participants. A local IRB approved the study, and we used SPSS version 25.0 for data analysis. A p-value less or equal to 0.05 was considered significant. ResultsThe prevalence of health insurance coverage among the study population was low, 57/723(7.9%), with most insured 42/57(73.7%), accepting the COVID-19 vaccine with a mean age of 33.81 years SD+8.863 at 95% CI:31.46-36.16 and a median age of 35 years. Participants without insurance coverage but accepted the COVID-19 vaccine were 538/723(74.4%) with a mean age of 31.15 years SD+10.149 at 95% CI:30.38-31.92 and a median of 29 years. The insured and uninsured ages range from 18-52 years and 18-75 years, respectively. COVID-19 vaccine acceptance was higher among the insured 42/57(73.7%), and the likelihood ratio for insured participants to accept than reject the COVID-19 vaccine was 9.813; df=4; p=0.044. Widows, divorcees, and married separate, participants from remote districts (Nwoya and Lamwo), and those without formal education had no health insurance cover. However, in a multivariable logistic regression analysis, health insurance coverage was not an independent predictor of COVID-19 vaccine acceptance AoR=1.501,95%CI:0.807-2.791; p=0.199. ConclusionAs the world grapples with the control of COVID-19, vaccine acceptance and health insurance coverage have become critical issues to be handled by each country. The health insurance coverage among participants from northern Uganda was low at 57/723(7.9%). Most participants with health insurance coverage accepted the COVID-19 vaccines compared to those who did not. The lack of health insurance coverage among most study participants is problematic as the world looks toward attaining UHC and SDGs. We proposed that Ugandas national social health insurance scheme, which is not legal, is urgently reviewed and signed to allow Ugandas population access to the needed health services.