Community Health Financing

in Uganda

Uganda Health Cooperative Dr. Grace Namaganda, Director

Presentation OutlinePresentation Outline

CHF in UgandaUHC BackgroundUHC’s CHF ModelPerformance of the schemesLessons learntChallenges

Background to CHF in Background to CHF in UgandaUganda

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

CHF in UgandaCHF 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

CHF Schemes in UgandaCHF Schemes in Uganda

CHF PartnersCHF Partners

Ministry of HealthHealthPartners Uganda Health CooperativeEED thru CHeFA-EACORDAIDSave for Health UgandaHealth Providers

Uganda Health Uganda Health CooperativeCooperative

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

UHC objectives UHC objectives

Improve the health of the communityEducate 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

UHC TodayUHC Today

Has six provider based scheme partnershipsMembership ranges from 3,500- 4,000 members Members are from 22 groupsMost groups are agriculturally based or schoolsThe largest group is composed of tea factory

workers with over one 1000 members

UHC’s CBHF Model

Mobilization/sensitization of communitiesScheme marketersAttend CORP sessions to identify groupsHave standard marketing presentations

Eligibility Open to organized groups e.g. formal and

informal sector employees, schools 60% rule applies before enrollment

UHC’s CBHF Model

Selection of provider and benefit packageCoverage depends on members’ ability to

pay and Availability of services

UHC’s CBHF Model

Scheme covers:Out patient and In patient care,Maternity careOpportunistic infections for HIV/AIDS

patients The health plan does not cover:

HIV/AIDS drugsChronic illness like high blood pressure/

hypertension, diabetes…

UHC’s CBHF Model

Provider contractsUHC has MoUs with the providersGroups also sign MoUs with providers

Payment 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

UHC’s CBHF Model

Issuing of IDsMembers requested to bring family photo for ID

Accessing servicesMembers pay co payment to curb frivolous use1,000 for out patient services and 3,000 for in patient services

UHC’s CBHF Model

Preventive careHealth 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

UHC’s CBHF Model

Scheme managementEach scheme has a scheme managerMonthly reports on

% cost recovery,Member loss or gain,Surplus/deficit, etc.

UHC’s CBHF Model

SustainabilityElected a Board of DirectorsTrained in scheme management and

community mobilization

Providers

Name of provider LevelType of facility

Total members

Comboni Hospital PNFP 1,314

Nyakasiiro HCIII PNFP 819

BMC HCIV Private 1,051

Ishaka Hospital PNFP 590

Mitooma central clinic HCIII Private 247

BB clinic HCIII Private 25

 Total membership     4,046

Scheme performance Scheme performance

Average loss/gain

Ishaka -11.6%

BMC -14.7%

Mitooma 31.0%

Nyakasiro 0.2%

Comboni -6.5%

Average loss/gain 0.3%

Scheme performance-cost Scheme performance-cost recovery 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 0 0 -280,208 -197,278 -1,152,250

Nyakasiro 0 0 556,800 538,500 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

Challenges Challenges

Low recruitment and retention ratesLimited providersLow uptake by poor peopleExclusion of chronic diseasesDwindling financial support with SWAPHigh management costs

Lessons Learned

Mobilize existing cooperatives first Preventive health is key Community participation Scheme management Remobilization Cost Recovery

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.