Improving User-fees Collection in Pwani Region
RHMT/RRHMT Ubungo Plaza
10th September 2015
Problem statement • Inadequate Service Provision at Tumbi Designated
Regional Referral Hospital (TDRRH) due to insufficient funds. (Budget, Waivers, RTA casualties)
• User-fee collection amounting to average of TShs 300,000/= per day not sufficient to procure medicines and medical supplies from local suppliers when these items are stock-outs at MSD…eg gauze
• The Facility was not receiving Other Charges or Basket Funds and this created huge debts of internal as well as external clients.
Implementation Strategies 1. Strengthen Control on User-fees collection -
minimizing “Pipeline Leakage”: • Centralization of Collection points to a SINGLE, at
hospital reception. • Strict Control of Exemptions by implementing
criteria for waivers. 2. Implementing Referral System for non-emergency
cases:
• Clients are required to present referral letters except emergency cases
• Clients not wishing to follow referral system are treated as private and pay cost-recovery and not cost-sharing.
FIXED VALUE RECEIPTS
SPOT THE DIFFERENCE
Implementation Strategies 3. Computerization of User-fees collection:
• To generate receipts in order to minimize conventional receipt forgeries
• To generate reports on total costs of health care services (collections & waivers) and 37 more reports on other items
4. Computerization of Pharmacy store stocks and dispensing rooms:
• To control receiving of stocks from suppliers
• To control dispensing to clients
• To facilitate payments against “computer received stocks” print-outs to suppliers.................HOW.......??
Results and Achievements /Impact 1. User-fees collection raised:
• After centralization of user-fees collection to a single point, the amount collected daily raised to an average of TShs 900,000/= per day
• After computerization of user-fees collection, the amount raised to 3,000,000/=
2. Controlled Pharmacy Stocks:
• Computer-generated early notification of RE-ORDER Levels, Stock-outs reduction
• Early warning of approaching expiry dates of Medicines
• Purchase of medical supplies depends on instantly computer-generated stock balance
Name Location
Average Number of
patients attended per
day
Date of Installati
on
Date of commission
Average Daily Cash Collection
before HMIS adoption
Daily Cash Collection after HMIS adoption
Tumbi RRH Kibaha Pwani 500 2012 2012 338,000 3,000,000
Mawenzi RRH Moshi, Kilimanjaro 500 2014 2014 500,000 1,500,000
Morogoro RRH Morogoro 400 2013 2013 800,000 2,000,000
Shinyanga RRH Shinyanga 120 2013 2013 400,000 1,200,000
Sekoutoure RRH Mwanza 408 2013 2013 900,000 2,500,000
Sumbawanga R RH Sumbawanga 120 2014 2014 500,000 900,000
Mtwara RRH Mtwara 2015 2015 300,000/= 1,100,000
Songea RRH Ruvuma 2015 2015 280,000/= 1,350,000/=
Iringa RRH Iringa 2015 2015 1,200,000/= 2,200,000/=
Mkoani Health Center
Pwani 150 2015 2015 70,000 400,000
Rolling-out the Success Story
4PAY Hospital Management System Modules • Patient Registration
• Revenue collection
• Pharmacy Management
• Exemption Management
CHALLENGES of 4PAY System:
• Inadequate capacity of patients information sharing across the health facility
• Weak in capturing intra-referral system
• No storage of other patients information eg Lab/imaging
• The problem of staying with too much cash at Cashier’s
• Lack of compliance with eHealth standards and systems interoperability
These are basic
functions at all levels
of health facility and
was named as 4PAY
Strategy : Upgrading 4PayHMS to GoT HoMIS
Government of Tanzania - Hospital Management Information System (GoT HoMIS)
The GoT HoMIS an Overview • The GoT HoMIS is a comprehensive web and
modular based developed system, which contain >25 hospital management modules.
• The system has 38 different reports concerning Patients Mx and collections (Graphical, Summaries and Details)
• The modules are technically designed to support: patient care services, diagnostic services, and overall hospital administration.
• The GoT HoMIS is a locally designed system with capability to introduce modules (new HoMIS functionalities) and ability to be integrated with other management information systems (MIS) as the source code belong to the PMO-RALG.
GoT HoMIS Modules
Patient Care Services
Diagnostic Services
Hospital Administration
Registration
Patient verification
OPD and IPD
Pharmacy
Billing
Nursing care
Referral System
Laboratory (pathology, microbiology, biochemistry)
Ultrasound
X-ray
Hospital administration
Patient Waiting Counter
MTUHA Reports
Clinical Diagnosis
NHIF and other Health Insurances
CHIF and TIKA Patient management
Exemption Management
MoHSW Reporting tools
Mortality and Morbidity analysis
Implementation Reports
Cost-sharing financial reports
Secret of Success o Prototyping mode of approach for
system development
o Local talent specialists
o Adhering to guidelines and
standards
o Involvement of key stakeholders
o ICT Competency Capacity building
o Proper System Documentation
o Commitment of Top Management
and GoT HoMIS Team work
GoT HoMIS MoHSW
Hospital 1
Hospital 2
Hospital 3
Hospital 4
Hospital 5
Hospital 6
Hospital 7
Importance of Integrated GoT HoMIS • One Medical Record Number (MRN) for One
Patient
• Will enable MoHSW and PMORALG to track financial collections of all public health facilities in real time
• The MoHSW will be able to determine the status of drugs consumption per region and district hence correct estimations for MSD procurement plan
• Improvement of data collection at OPD and IPD for self generating (automated) report for HMIS and others hospital administrative data from the system
• It has support bulk cashless at hospital as money is transferred electronically to the hospital account (use of ePAY)
• It monitors practitioner’s performance as she/he use the system so it increases decentralized governance and transparency
Why choosing GoT HoMIS • Involving local experts in its
generation and therefore easy to re-engineer (RS/LGA IT experts, MU-DICT, PMO-RALG-DICT and KEC-DICT)
• Being overseen in terms of guidelines and policy from EGA which increases synergy in terms of security and compliances as per government directives
• Capable of maintaining the validity, integrity and confidentiality of individual private health information
• Capable of ensuring security through integrated system checks to prevent access and misuse of data
• Owned by PMO-RALG housed at Kibaha Education Centre.
•Very light in such a way it can be installed and operated in a standard desktop computer •Easy to deploy no complex technical skills are needed •Easy to translate to Swahili language which is dominant in primary level facility •Designed to meet different needs of health facilities according to facility size, technical capacity, the presence or absence of specialised health services
ASANTE KUSIKILIZA
For more INFO:
CONTACT
• KIBAHA EDUCATION CENTRE
0754294538