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Community Health Financing in Uganda

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Presentation on theme: "Community Health Financing in Uganda"— Presentation transcript:

1 Community Health Financing in Uganda
Uganda Health Cooperative Dr. Grace Namaganda, Director

2 Presentation Outline CHF in Uganda UHC Background UHC’s CHF Model
Performance of the schemes Lessons learnt Challenges

3 Background to CHF in Uganda
CHF was introduced by the planning department of the MoH as an alternative financing mechanism in 1995 CHF continues to emerge, attempting to mitigate the equity, affordability and sustainability problems of other health financing mechanisms

4 CHF in Uganda In 1998 an NGO association was formed to co-ordinate and promote the activities of CHF schemes in Uganda Currently, the association has 12 registered CHF schemes in 7 districts with a catchment population of over 4.5 million Of the 12 registered schemes, 11 use the Health Provider Based model while only one uses the Community Based model

5 CHF Schemes in Uganda

6 CHF Partners Ministry of Health
HealthPartners Uganda Health Cooperative EED thru CHeFA-EA CORDAID Save for Health Uganda Health Providers

7 Uganda Health Cooperative
HealthPartners Uganda Health Cooperative (UHC) is an NGO affiliated to HealthPartners, a Minnesota not for profit health maintenance organization. UHC started implementing prepaid health schemes in Bushenyi in 1997 with a USAID cooperative development sub grant from Land O’ Lakes

8 UHC objectives Improve the health of the community
Educate members on how to access timely, quality, affordable health services without selling or losing property or assets Improve provider cost recovery and financial planning ability Create link between providers and community

9 UHC Today Has six provider based scheme partnerships
Membership ranges from 3,500- 4,000 members Members are from 22 groups Most groups are agriculturally based or schools The largest group is composed of tea factory workers with over one 1000 members

10 UHC’s CBHF Model Mobilization/sensitization of communities
Scheme marketers Attend CORP sessions to identify groups Have standard marketing presentations Eligibility Open to organized groups e.g. formal and informal sector employees, schools 60% rule applies before enrollment

11 UHC’s CBHF Model Selection of provider and benefit package
Coverage depends on members’ ability to pay and Availability of services

12 UHC’s CBHF Model Scheme covers: Out patient and In patient care,
Maternity care Opportunistic infections for HIV/AIDS patients The health plan does not cover: HIV/AIDS drugs Chronic illness like high blood pressure/ hypertension, diabetes…

13 UHC’s CBHF Model Provider contracts UHC has MoUs with the providers
Groups also sign MoUs with providers Payment of premiums Varies with group size and group characteristics Most groups pay 5,000 (abt 3$) per quarter Schools pay 4,000 per term i.e. (3 times a year) Igara factory workers pay 2,100 per quarter

14 UHC’s CBHF Model Issuing of IDs
Members requested to bring family photo for ID Accessing services Members pay co payment to curb frivolous use 1,000 for out patient services and 3,000 for in patient services

15 UHC’s CBHF Model Preventive care
Health education talks on disease prevention, detection and early care seeking behavior Discounted health products like ITN and PUR Free nets for pregnant women and under fives

16 UHC’s CBHF Model Scheme management Each scheme has a scheme manager
Monthly reports on % cost recovery, Member loss or gain, Surplus/deficit, etc.

17 UHC’s CBHF Model Sustainability Elected a Board of Directors
Trained in scheme management and community mobilization

18 Providers Name of provider Level Type of facility Total members
Comboni Hospital PNFP 1,314 Nyakasiiro HCIII 819 BMC HCIV Private 1,051 Ishaka 590 Mitooma central clinic 247 BB clinic 25  Total membership 4,046

19 Scheme performance Average loss/gain Ishaka -11.6% BMC -14.7% Mitooma
31.0% Nyakasiro 0.2% Comboni -6.5% 0.3%

20 Scheme performance-cost recovery
Ist quarter 2nd quarter 3rd quarter 4th quarter Annual Totals Ishaka 105,792 86,790 130,500 72,322 2,809,050 BMC 53,090 -61,731 -44,697 330,380 1,319,650 Mitooma -280,208 -197,278 -1,152,250 Nyakasiro 556,800 538,500 1,095,300 Comboni -15,540 -60,067 -17,640 -42,480 -678,633 Total 143,342 -35,008 344,755 701,444 3,393,117

21 Challenges Low recruitment and retention rates Limited providers
Low uptake by poor people Exclusion of chronic diseases Dwindling financial support with SWAP High management costs

22 Lessons Learned Mobilize existing cooperatives first
Preventive health is key Community participation Scheme management Remobilization Cost Recovery Existing cooperatives have experience working together–reduces time necessary for mobilization and management. Preventive health is a key factor in sustainability of the schemes because it improves health and maintains member satisfaction when they remain healthy. Community participation in scheme management increases satisfaction, management and sustainability. Community includes providers, government agents, community leaders, cooperative leaders, the health association, faith based organizations, and other partners. Scheme management must include monthly reports listing membership totals, cost recovery, and issues and challenges. Cooperatives and providers need periodic remobilization to maintain understanding of scheme structure. Preventive care sessions provide perfect timing to revisit simple concepts. Cost recovery is traditionally lower with new groups but rises and stabilizes after over utilization and untreated previous illnesses are addressed.

23 Caveats Prepaid schemes cannot replace a national health system, but they can contribute to it at a local level. The potential for cost-recovery in rural areas is limited. Prepaid schemes cannot solve the financial problems by themselves.

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