Community Health Financing in Uganda

1
Community Health Financing in Uganda

• Uganda Health Cooperative
• Dr. Grace Namaganda, Director

2
Presentation Outline

• CHF in Uganda
• UHC Background
• UHCs 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
UHCs 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
UHCs CBHF Model

• Selection of provider and benefit package
• Coverage depends on members ability to pay and
• Availability of services

12
UHCs 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
UHCs 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
UHCs 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
UHCs 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
UHCs CBHF Model

• Scheme management
• Each scheme has a scheme manager
• Monthly reports on
• cost recovery,
• Member loss or gain,
• Surplus/deficit, etc.

17
UHCs CBHF Model

• Sustainability
• Elected a Board of Directors
• Trained in scheme management and community
  mobilization

18
Providers
19
Scheme performance
20
Scheme performance-cost recovery
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

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.