Presentation on theme: "Community Health Financing in Uganda"— Presentation transcript:
1Community Health Financing in Uganda Uganda Health CooperativeDr. Grace Namaganda, Director
2Presentation Outline CHF in Uganda UHC Background UHC’s CHF Model Performance of the schemesLessons learntChallenges
3Background to CHF in Uganda CHF was introduced by the planning department of the MoH as an alternative financing mechanism in 1995CHF continues to emerge, attempting to mitigate the equity, affordability and sustainability problems of other health financing mechanisms
4CHF in UgandaIn 1998 an NGO association was formed to co-ordinate and promote the activities of CHF schemes in UgandaCurrently, the association has 12 registered CHF schemes in 7 districts with a catchment population of over 4.5 millionOf the 12 registered schemes, 11 use the Health Provider Based model while only one uses the Community Based model
6CHF Partners Ministry of Health HealthPartners Uganda Health CooperativeEED thru CHeFA-EACORDAIDSave for Health UgandaHealth Providers
7Uganda 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
8UHC objectives Improve the health of the community Educate members on how to access timely, quality, affordable health services without selling or losing property or assetsImprove provider cost recovery and financial planning abilityCreate link between providers and community
9UHC Today Has six provider based scheme partnerships Membership ranges from 3,500- 4,000 membersMembers are from 22 groupsMost groups are agriculturally based or schoolsThe largest group is composed of tea factory workers with over one 1000 members
10UHC’s CBHF Model Mobilization/sensitization of communities Scheme marketersAttend CORP sessions to identify groupsHave standard marketing presentationsEligibilityOpen to organized groups e.g. formal and informal sector employees, schools60% rule applies before enrollment
11UHC’s CBHF Model Selection of provider and benefit package Coverage depends on members’ ability to pay andAvailability of services
12UHC’s CBHF Model Scheme covers: Out patient and In patient care, Maternity careOpportunistic infections for HIV/AIDS patientsThe health plan does not cover:HIV/AIDS drugsChronic illness like high blood pressure/ hypertension, diabetes…
13UHC’s CBHF Model Provider contracts UHC has MoUs with the providers Groups also sign MoUs with providersPayment of premiumsVaries with group size and group characteristicsMost groups pay 5,000 (abt 3$) per quarterSchools pay 4,000 per term i.e. (3 times a year)Igara factory workers pay 2,100 per quarter
14UHC’s CBHF Model Issuing of IDs Members requested to bring family photo for IDAccessing servicesMembers pay co payment to curb frivolous use1,000 for out patient services and3,000 for in patient services
15UHC’s CBHF Model Preventive care Health education talks on disease prevention, detection and early care seeking behaviorDiscounted health products like ITN and PURFree nets for pregnant women and under fives
16UHC’s CBHF Model Scheme management Each scheme has a scheme manager Monthly reports on% cost recovery,Member loss or gain,Surplus/deficit, etc.
17UHC’s CBHF Model Sustainability Elected a Board of Directors Trained in scheme management and community mobilization
18Providers Name of provider Level Type of facility Total members ComboniHospitalPNFP1,314NyakasiiroHCIII819BMCHCIVPrivate1,051Ishaka590Mitooma central clinic247BB clinic25 Total membership4,046
19Scheme performance Average loss/gain Ishaka -11.6% BMC -14.7% Mitooma 31.0%Nyakasiro0.2%Comboni-6.5%0.3%
20Scheme performance-cost recovery Ist quarter2nd quarter3rd quarter4th quarterAnnual TotalsIshaka105,79286,790130,50072,3222,809,050BMC53,090-61,731-44,697330,3801,319,650Mitooma-280,208-197,278-1,152,250Nyakasiro556,800538,5001,095,300Comboni-15,540-60,067-17,640-42,480-678,633Total143,342-35,008344,755701,4443,393,117
21Challenges Low recruitment and retention rates Limited providers Low uptake by poor peopleExclusion of chronic diseasesDwindling financial support with SWAPHigh management costs
22Lessons Learned Mobilize existing cooperatives first Preventive health is keyCommunity participationScheme managementRemobilizationCost RecoveryExisting 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.
23CaveatsPrepaid 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.