Uganda’s Healthcare System: Organisation, Access to Care, Emergencies and Health Risks

The Ministry of Health provides leadership for the sector. The national system comprises public facilities, a private sector (independent practitioners, for-profit facilities and private not-for-profit organisations), as well as traditional medicine and communities. The WHO recalls, in a press release, that Uganda spends about USD 57 per inhabitant on health, that nearly half of the funding depends on donor aid and that direct household payments represent 28% of total expenditure.

For a French resident, this means that the quality of provision varies greatly between Kampala and the rest of the country, and that access to reliable care is organised around a few facilities in the capital and insurance that covers costs and evacuation. The page on living in Uganda recalls the other France Diplomatie advice.

The Ministry of Health publishes a question-and-answer booklet on the “planned” National Health Insurance Scheme: a national health insurance scheme therefore remains, according to the pages consulted, a project, and insurance coverage is below 5% according to the WHO. The full text of the booklet could not be read; the progress of the project is confirmed with the ministry. According to the sources consulted, there is therefore no automatic public cover for an expatriate.

• Local employee: the employer may offer private insurance; it should be read carefully (ceilings, network, evacuation).
• Seconded employee: the French scheme remains applicable for 3 years renewable once (CLEISS, the French liaison centre for international social security); see healthcare reimbursement in Uganda.
• Other profiles: the CFE (Caisse des Français de l’étranger, the French social security fund for French nationals abroad) or international insurance with medical repatriation.

France Diplomatie does not detail facilities, but it recalls the essentials: without cover, access to care may be refused, even in a life-threatening emergency, and the embassy cannot cover any costs. The first-contact doctor is chosen in Kampala or Entebbe, through the embassy or the employer; the reference hospital is identified before you need it, taking into account the journey time at times of heavy traffic. The number of road accidents is particularly high, above all at night.

Emergencies: the Ugandan police give 999 or 112. France Diplomatie advises saving in your phone the numbers of hospitals and trusted contacts, as well as that of the embassy (+256 205 479 888). The assistance number of the insurance contract is kept on you.

France Diplomatie recommends bringing only the medicines that are strictly necessary, in their original packaging, with a prescription giving the names as international non-proprietary names. You must check that the medicines are authorised in Uganda and never buy medicines in the street, because of counterfeits. For a chronic treatment, a sufficient reserve and the prescription ease checks; the conditions for reimbursement are confirmed with the insurer before departure.

The country is classed in zone 3 for malaria, and France Diplomatie specifies that the risk is constant as soon as you leave Kampala. Prevention combines protection against bites and preventive treatment decided after medical advice.

• Mosquito-borne diseases: chikungunya, dengue, Rift Valley fever (epidemic reported in Mbarara), Crimean-Congo haemorrhagic fever, yellow fever (upsurge in cases), lymphatic filariasis and Zika.
• Water and food: bilharzia, present notably in Lake Victoria; cholera, with regular cases, notably imported from South Sudan; typhoid fever and hepatitis A.
• Haemorrhagic fevers: Ebola virus disease (incubation of 2 to 21 days) and Marburg virus disease, with several sometimes fatal cases in recent years; consult immediately in case of symptoms.
• Others: meningococcal meningitis, with frequent epidemics in the dry season (November to June), mpox, rabies present across the whole territory and chronic tuberculosis.

Yellow fever: vaccination is compulsory and is done in an approved centre, preferably at least ten days before departure; the certificate is required for entry according to France Diplomatie. The traveller must also be up to date with the French vaccination schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles).

Depending on the situation, a doctor or an international vaccination centre may recommend hepatitis A and B, typhoid, meningitis ACWY (dry season or epidemic), tuberculosis for children under fifteen on frequent or prolonged stays, rabies, chikungunya, dengue and mpox. The consultation is booked well before departure to spread out the injections.

France Diplomatie considers imperative an assistance contract or insurance covering medical costs, hospitalisation and medical repatriation. With no social security agreement between France and Uganda (CLEISS list), no coordination exists between the schemes. The choice is between the employer’s insurance, the CFE and international insurance; reference points can be found in the pages on expat health insurance and repatriation and assistance; Expavy helps you weigh these options against your situation.

Abroad, the CFE reimburses according to a rate or flat amount specific to the country of care, applied to actual expenses: a GP consultation under the national agreement at €25 in France is reimbursed at 70%, i.e. €21. The plans have contributions that depend on age and the plan chosen, for the main plan, the youth plan (under 30) and the retirees’ plan. Care is covered immediately if enrolment takes place before departure or within three months of settling; beyond that, a waiting period of three months before age 45 and six months from age 45 applies. A seconded employee keeps the French scheme for 3 years, renewable once, with reimbursement on paid invoices and form S 3125c (CLEISS).

Before signing a contract, several points are compared: the annual ceiling, direct billing in suitable facilities, evacuation and repatriation, maternity, paediatrics, the handling of medical history and the exclusions. It is useful to keep, with your identity papers, the contract number, the number of the assistance platform and a list of current treatments, which you share with a relative and with the employer.