CRITICS could suggest that the recent changes in the Cabinet and the wider mood in our country have an element of not knowing where exactly the government stands on the issue of the wide-ranging insurance rollout occupying the airwaves for most of the past year.

Just how far the plan was feasible looked like an experiment and, despite private sector convergence with the prerogatives in the newly promulgated legislation, at least one major city hospital in the country opted out and was permitted. Others are likely to follow suit.

On the whole, the insurance rollout is based on efforts by key United Nations agencies to show something at the middle of the implementation period of the 17 global Sustainable Development Goals (SDGs) – from 2015 to 2030.

We regularly hear of progress in this or that area but all too often this is tied up with specific foreign-funded programmes and, when standing alone, not much progress is registered.

There was a notable increase in health sector budgets for several years chiefly from cuts in unnecessary recurrent expenditure from the middle of the past decade that was carried on during the Covid-19 pandemic days.

Employment in the sector to fill the new vacancies just as in education as secondary school networks, cutting distances from home to school were also on the high end, complemented work on infrastructure.

How far this programme is sustainable has not been at issue for a while, in part because the government is assured of higher revenues from all sorts of new investments.

Yet this doesn’t encompass what it takes to make a feasible rollout of universal health insurance coverage as the government sought to do, and at a certain point it was said that the relevant legislation had been signed into law.

It was also interesting to figure out or to see in print whatever specific regulations the minister concerned would have run in the Government Gazette. Experts in the ministry would presumably ensure that there were no gaps in implementation.

The latest development is that our next-door neighbours to the north have started putting on the rails a workable national insurance cover intended to be universal in character, exactly the way ours is meant to be.

But there is a considerable difference in design between the two, with the version supposed to be applied here is loosely tied to quasi-voluntary contributions instead of taxation.

Additionally, it is fare from equitable, directed at lump-sum dues by each family or family head, or some sponsor Across the border, revenue experts sat down to figure out the portion of salary necessary to support the facility.

This is therefore the preliminary change of design needed if we are to have a workable insurance format, and then adding a marginally preliminary dimension – which also didn’t cross the minds of local health sector strategists.

Nor don’t their United Nations back-up strategists appear to have imagined that the most equitable thing to do would first be to spare public dispensaries and primary care hospitals payments both for consultation and for the issuance of medicine.

Only in case of being referred to district or regional referral hospitals would payment come up, with insurance also becoming applicable.

If we can take a leaf from the two parameters, our universal coverage design surely stands to work.