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.