INSURANCE WILL FAIL WITHOUT PDM: THE ECONOMIC TRUTH BEHIND THE DEBATE: A Response to Hassan Basajjabalaba’s Argument

By Nabimanya Ronald

Businessman and NRM Entrepreneurs League chairperson Hassan Basajjabalaba recently argued that Uganda should prioritize a national medical insurance system instead of spending taxpayers’ money on the Parish Development Model (PDM). His concern about the cost of healthcare is genuine, and on that point, many Ugandans agree with him. No family should be pushed into poverty because a loved one fell sick.

But the suggestion that PDM is a misallocation of funds or that it stands in the way of medical insurance is a misunderstanding of how national development and social protection actually work. Uganda does not have to choose between the two. In fact, PDM is the economic foundation needed for any durable national health insurance system to succeed.

This is the part missing in Basajjabalaba’s argument.

1. Medical insurance cannot survive in a poor, subsistence economy

Basajjabalaba rightly points out that medical costs in advanced countries are manageable because insurance covers the bills. What he misses is why their insurance works:

• Most citizens earn predictable income
• A large portion of the population is in the formal, taxable economy
• Millions of people pay insurance premiums monthly

Uganda is not yet there.

According to UBOS, more than 60% of Ugandans still live in the subsistence economy producing mainly for survival, not the market. A national medical insurance scheme introduced in this context would face two predictable risks:

1. It would collapse because too few Ugandans would be able to contribute regularly.
2. Government would shoulder most of the costs, leading to higher taxes or unsustainable borrowing.

So while the desire for insurance is correct, the foundation for sustaining it is still weak.

This is where PDM matters most.

2. PDM tackles poverty where it actually lives at the parish

For decades, Uganda designed development programmes from Kampala, not from the villages and parishes where poverty is deepest. PDM is the first major reform to correct that error.

It:

• Brings planning and decision-making closer to the community
• Provides structured financing through SACCOs
• Develops real-time data at the parish level
• Builds financial literacy and local accountability
• Encourages households to transition from subsistence to income generation

PDM is not a “Shs1 million giveaway” as critics present it. It is a structural change in how Uganda identifies poverty, plans for development, and measures results.

That shift is technical, slow, and quiet but it is one of the most important governance reforms Uganda has undertaken in decades.

3. The “tragedy awakening” problem

Basajjabalaba’s painful experience caring for his late mother abroad is deeply human and deserves compassion. But it also reflects a national pattern:
Elites often confront systemic problems only when tragedy hits close to home.

Ordinary Ugandans have struggled with catastrophic medical bills for years. Insurance should not wait for private loss among the powerful.

His call for insurance is legitimate. What is not accurate is framing PDM as the obstacle. The obstacle is poverty  not PDM.

4. PDM is not a competitor to medical insurance, it is the precondition for it

Even in his own speech, Basajjabalaba unintentionally reveals the real issue:
Uganda lacks advanced medical equipment because investors worry that a “common person” cannot afford the services.

Exactly. That is why raising incomes is step one.

Higher household incomes → stronger financial inclusion → more people paying premiums → sustainable national insurance → better health facilities.

PDM strengthens the first two steps in that chain.

You cannot build a national insurance system on a foundation where most people have no market income, no savings, and no formal participation in the economy. PDM’s mission is precisely to fix that.

5. PDM has challenges but it is improving, not failing

A balanced argument must acknowledge reality:

• Some SACCOs have delayed formation
• Some funds were mismanaged
• Some technical officers were incompetent
• Some monitoring structures were weak

These are implementation weaknesses, not program defects.

Government has already begun addressing them through:

• Strengthened PBMIS monitoring
• Regular SACCO audits
• Increased funds per parish
• Expansion of extension services
• Stricter parish accountability structures

Every major national reform; UPE, USE etc,   went through similar early turbulence. What matters is whether it improves. PDM is improving.

6. Avoiding the trap of elite diagnosis

Uganda’s development debate is often shaped by experiences of the top 5%  people who can fly to Germany, South Africa, or the UK for treatment. That perspective is important but cannot define national policy.

The majority of Ugandans do not need air tickets.
They need income, markets, savings, and affordable credit.

PDM speaks to this majority.
Insurance will eventually serve everyone  but it must be built on an economy where most citizens can contribute meaningfully.

7. The smart path forward: Build both systems, but in the right order

Uganda does not face a choice of:

PDM vs. medical insurance.
The real issue is sequencing.

The logical national pathway is:

1. Grow incomes through PDM
2. Formalise more Ugandans into predictable economic activity
3. Expand the tax and contribution base
4. Attract private sector investment into modern health infrastructure
5. Launch a strong, sustainable national medical insurance system

Skipping step 1 is the fastest way to make insurance fail.

What This Means for Uganda: PDM is not Uganda’s problem. Poverty is.

Basajjabalaba is right about one thing: Uganda urgently needs a national medical insurance scheme. No one disputes that. But blaming PDM is a misdiagnosis.

A functioning insurance system requires a population with income.
A population with income requires rural monetisation.
Rural monetisation is exactly what PDM was created to achieve.

If Uganda truly wants a future where no family sells land to pay hospital bills, then we must first build communities that can actually afford to contribute to insurance.

PDM is not a distraction.
It is the foundation upon which a sustainable, inclusive, national health insurance system will stand.

The author, Ronald Nabimanya, is a concerned citizen, an author and publisher focused on development communication and African narratives. He can be reached via: bishanga.ronald@gmail.com. (For comments on this story, get back to us on 0705579994 [WhatsApp line], 0779411734 & 041 4674611 or email us at mulengeranews@gmail.com).