In addition to conservatives in the MOPH, the contra-reform alliance that was
highly vocal during the first decade of UCS included the private sector and
professional organizations. This alliance was often at odds with the NHSO’s propoor
policies, which were supported by reformists and civil society organizations.
While the private sector fared well in providing services to more than 60% of SSS
members, fewer than 5–6% of UCS members were registered with them. The alliance
between MOPH conservatives and for-profit private hospitals was clear,
for example, in their opposition to including dialysis in the UCS benefits package.
The policy supported the use of home-based peritoneal dialysis, which was well
suited to rural patients unable to travel to urban centres for haemodialysis, but
represented a huge potential loss of profit to hospitals providing haemodialysis
services.
Redefining institutional roles and relations: muddy and murky waters
The separation of purchaser from provider created governance problems that
have yet to be resolved. As the main purchaser for the UCS, the NHSO is accountable
to the National Health Security Board, which in turn is accountable to
tax payers and reports to Parliament. The MOPH, the main health-care provider,
is responsible to the Minister of Public Health. The NHSO was established as an
autonomous body while the MOPH is a government ministry. Both the NHSO and
MOPH have their own policies and development plans and there is no overarching
national health policy coordination.