The passing on of Dr. Lawrence Kaggwa Nakaana is sad. The Doctor was at St. Mary’s College Kisubi for his HSC from 1967 to 1968. He then joined Makerere Medical School where he graduated in 1974.
Dr. Kaggwa passed on Friday morning, 10thNovember at 9.25am at Uganda Heart Institute – Mulago where he was admitted on 16th October over heart related complications. The Doctor was among the visiting Doctors who would call at the Sick Bay at the school. We thank God so much for his roles as an Old Boy.
The Doctor has been a retired Senior Consultant Surgeon. He was Executive Director of Mulago Referral Hospital from 1993 to 2005. He practiced surgery at Makerere University Medical School for a long time.
Dr. Lawrence Kaggwa’s last communication to me was on September 2, 2017
Thank you for the brilliant updates on the developments of St Mary's.
Lawrence Kaggwa.WHEN I COMMUNICATEas below:
“The initiative is welcome but the methods and processes have not been spelt out. We promise to participate when the project proposal comes out with clear
Architectural drawings, rooms and Bills of Quantity”.
Lawrence Kaggwa.
On July 29, the communication was as below:
“Thank you so much for the drawings which now bring about the picture better.
I have not counted the rooms but I hope they have catered for lecture rooms.
I also expect that this planning fits into the Master Plan of St Mary's College,” Lawrence Kaggwa.
DR. LAWRENCE KAGGWA’S RESPONSES ON DIFFERENT DEVELOPMENTS TO DO WITH SMACK COMMUNITY MEMBERS. globally. Thank you for making us so proud and May the Lo
FOLLOWING DEATH OF MPOZA DAVID
“It is a shock the untimely death of a brilliant and philanthropic Financial Manager! May his soul rest in eternal peace.”
Lawrence Kaggwa.marriage vows at Namirembe Cathedral. He was soft-spoken,
UGANDANS AND THEIR GOVERNMENT NEED TO SERIOUSLY CONSIDER THE HEALTH INSURANCE SCHEME AS PRIORITY
Dr. Lawrence Kaggwa on the National Health Insurance
Background:
Today medical expenses for elucidative procedures, sophisticated surgeries, cancer and other treatment protocols are extremely high, and to pay for them entirely out- of- pocket has been found to be catastrophic to the families and individuals. Many families have lost plots of land, houses and other important assets to fund medical treatment, and benefactors have equally suffered in the process. The MRI costs SHS 850,000 per area visualized; medium surgery SHS 4.000,000 and cancer treatment is in the region of SHS 40,000,000-80,000,000. Admission for a week in a Private Hospital may cost SHS 7,000,000 for medical treatment.
Those on kidney dialysis may incur SHS 1,000,000 weekly during the period they are looking for kidney transplants (what if this is to be 5 years?).
In Britain, the National Insurance Act 1911, marked the first steps towards national health insurance, covering most employed persons and their financial dependents and all persons who had been continuous contributors to the scheme for at least five years whether they were working or not.
Elsewhere it did not become important for most people until advances in modern technology produced many expensive procedures and drugs required for efficient and effective cure of injury and disease.
Health insurance is a type of insurance that covers costs incurred for unexpected medical expenses. By estimating the overall risk of health care expenses among a targeted group, an insurer develops a routine finance structure, such as a monthly premium, to ensure that money is available whenever need arises to pay for the health care benefits specified in the insurance agreement. While the benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity, the insurance health providers have to be accredited after complying with the documented quality standards.
Historical background of Health Insurance in Uganda:
In Uganda, health insurance was traditionally seen in the non-monetary scheme of Engozi of Kabale, Munno mu Kabi of Buganda (but which required consideration of backward/upstream integration) and other forms of social support extended to the sick relatives and neighbours as deemed most suitable for each tribe and region.
These approaches are still encouraged to grow and partly convert into monetary systems to meet the hospital expenses.
For over 15 years, the Ministry of Health started exploring possibilities of alternative funding mechanisms as the national budget remained small in the midst of a sea of competing national priorities. So the tax base then and now has failed to fully fund health care. There has been consistent failure, for it is only 8.5-9.5% of the National budget instead of the 15% of the Abuja declaration many years ago.
Ten years ago Harvard University was contracted to design the Social Health Insurance scheme, around which further consultations were made with other Academic Institutions in Belgium and elsewhere. Key partners like WHO, World Bank, ILO and GTZ were consulted.
Countries with the young health insurance schemes (about 10 years), such as Tanzania, Rwanda, Ghana, Nigeria, Kenya, Burundi; those with about 50 years like Thailand, South Korea and India and those with over 100 years like Germany and Belgium were visited to compare experiences. At the moment the Draft Bill, prepared by the National Task Force and Inter ministerial Committee, is ready for enactment by Parliament.
Nature of the Uganda National Health Insurance:
The National Health Insurance Scheme will be an umbrella organization accommodating all sectors in Uganda- the public, private and communities in the form of: 1. Social Health Insurance, 2. Community Health Insurance (like Kisiizi, Kitovu, Bushenyi), 3. Private Health Insurance (like ICEA and SANLAM) and 4. Third Party Health Administrators (to link up individuals and organizations to health services). Thus the doors are open for the private sector to freely join the social scheme and the Private Insurance for products such as evacuation that may not easily be provided by the National Scheme.
Preparation has taken into account the economic and actuarial analysis; provider accreditation and quality (public, private and PNFP); quantity, complexity and scope of health services to be provided at the beginning and nascent phase; the legal and regulatory aspects by the Insurance Regulatory Authority of Uganda (IRAU); and the administrative structure of NHIS. This has been largely supported by the wide plethora of consultations with key stakeholders and technical experts.
i Management of the scheme:
The scheme is to be a body corporate with perpetual succession, with powers to sue or be sued, governed by a Board of Directors and responsible for the development, management and coordination of health insurance activities in the country, now and in the future. The Managing Director and the NHIS team will be carrying out planning and managerial functions through a widely spread out National and Sub-National Coordinating Mechanism, which will be charged, inter alia, with collecting, depositing and investing premiums. They will also negotiate and enter into contracts with the accredited health care providers about the scope of health services and payment mechanisms- capitation or after-service payment. Some of the departments will include the financial, legal, accreditation and quality, health care packages and verification.
The Board of Directors is to be made up of 11 members - from Government, workers’ organizations, employers, accredited health providers, community insurance scheme, the Private health insurance scheme and the Chairperson. They will be responsible for overall governance, direction, development and growth of NHIS.
ii. Health care package:
The package has inclusions and exclusions, the relationship of which will change as the scheme matures with more reserves and better control of moral hazard. Initially the inclusions will be all outpatient services, most inpatient services, drugs (generic rather than brands), maternal deliveries and neonatal care, preventive services, referrals and moderate surgeries and early cancers. Exclusions are plastic surgery for beauty and not reconstruction; dentures, eye glasses, accidents following high risk sports like motor rallying, organ transplant etc.
Health service will be provided by accredited providers (public, private and PNFPs), selected on the basis of quality, nature of service, clinic or hospital and showing compliance with the agreed rates per medical condition and intervention. The selection of theses providers will be jointly done by the policy holder, the employer and the Insurance. Identification of the policy holders and their beneficiaries at the time of accessing the service at the clinic or hospital will be done by special identity cards and later on electronic SMART cards, to be utilized in all parts of the country where the policy holder happens to be at the time of the illness episode.
iii .Financing and financial management:
Actuarial analysis recommended the formal public employee to contribute 4% of the salary on which the employer adds 4% to make it 8% per month. The risk is pooled together irrespective of the pre-recruitment health status; and the fact that not everyone falls sick at the same time, this fund will be able to provide health care to 4 other members of the family of the policy holder. The formal private sector will be persuaded to join but those who prefer the Private Insurance will be free to do so. With time, the informal sector, after developing some reliable and predictable fund management structure and books of accounts, will be recruited to increase the volumes of subscribers who will then share and support each other for the health risks.
Conclusion:
Out-of-pocket payment for health services is catastrophic to the individuals and families in asset and financial loss, and is responsible for high morbidity and mortality. This is borne out by stories of transactions at the critical moment of illness which resulted in grisly complications and untimely death especially due to cancers. A robust and transparent health insurance scheme with water tight controls will improve health financing, provide more efficacious and accessible health care and ensure financial stability for households.
WHAT OTHERS
SAID ABOUT DR. LAWRENCE KAGGWA
Dr. Kaggwa has served this country's medical industry for over 40 years. He among others started the Cancer Institute at Mulago National Hospital and headed the same institution for over 12 years. He helped in the training of hundreds of doctors and was involved in a number of charities including being part of the founding directors of Malcom Childrens' Foundation. He was a great brother to me and advisor. He always cared much for my diabetic son and was always ready to help. Dr. Kaggwa has run a good race and we shall remember him for his humility and humanity. We shall definitely miss him,” says Kato Mukasa his brother in law.
Mutengu Tonny Gtct says, “A great Man, A great Dad, A Brilliant Surgeon. You grew me and advised me tenfold. You served your Nation well. Dr. Lawrence Kaggwa, Can't believe that now you are gone. May your soul rest in peace. Will always miss you”.
Mutumba John writes:
Very sad news, Dr. Lawrence Kaggwa passed away at Mulago hospital!
Fare thee well truly Lawrence...
You did well to serve in a country where:
1. Service above self is not quite well appreciated with medical practitioners;
2. Being reduced to polite beggars;
3. Bribery is honorable;
4. Nepotism is a tactic to subjugate natives to refugees!
Rest in Peace Musawo Kaggwa Lawrence.
DUC IN ALTUM!
Quirinus Muyingo has written, “It has been an awful day with news coming in of the passing of a dear friend and onetime workmate...a brilliant surgeon and one time Director of Mulago Complex...God keep you in eternal peace...May the intercession of Mother Mary secure you that place in her Son's Kingdom. Fare thee well Dr. LAWRENCE KAGGWA”.
In an interview with Daily Monitor, the late spoke about the state of health sector in Uganda. He blamed the fall of public systems on lost values.
“I blame the fall of the system to all of us Ugandans as a people we have lost our values. We take everything we are given without asking why. Health workers have been emasculated with low pay, making them do things they used not to do professionally because they want to survive. The ministry has also lost its oversight role; it’s no longer as sharp and effective as it used to be”, he stated.
His reflective thought comes at a time when doctors are carrying out a nation-wide strike over pay and working condition.
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