BUSHENYI MEDICAL CENTRE (BMC) “we care but life comes from god”

1. BUSHENYI MEDICAL CENTRE (BMC)“we care but life comes from god” OVC health insurance JULY 2011 Dr. mugadu jairus OVC Health Insurance - July 2011

2. Presentation Outline: • BMC Background • Services offered at BMC • OVC Health Insurance • Achievements/Successes • Challenges • Way forward/Sustainability plan. OVC Health Insurance - July 2011

3. BUSHENYI MEDICAL CENTRE FRONT VIEW IN CONTAINER SHEMES OFFICE OVC Health Insurance - July 2011

4. BMC Background • BMC was founded in May 1998 as a private-not-for-profit health facility taking over a facility established by West Ankole Diocese in 1979. BMC was started with a mission of providing affordable, high quality and reliable health care to rural and often hard to reach population. OVC Health Insurance - July 2011

5. BMC Background – Cont’d • Its Core Values are : Hard training, Hard work, High quality, Low cost • It is governed by a Board Committee and has a secretariat of over 40 staff members headed by a Medical Superintendent • It has its headquarters at Katungu in Bushenyi-Ishaka Municipality along Mbarara-Kasese highway. OVC Health Insurance - July 2011

6. Background – Cont’d • In order to serve students and other clients in different areas of Bushenyi, BMC started Satellite clinics in various locations in the District. Amongst these was the one at Kabwohe which was started in 1999. This BMC-Kabwohe satellite was expanded in infrastructure and renamed Kabwohe Clinical Research Centre (KCRC) in 2006. OVC Health Insurance - July 2011

7. BMC – Kabwohe (KCRC) campus OVC Health Insurance - July 2011

8. Services Currently at BMC & KCRC • General Medical Care (IPD & OPD) • Eye Care • X-ray & Ultrasound Diagnostic • Laboratory & Blood Transfusion • Family Planning as well as Maternal & Child Health • HIV Testing & Counseling • Prevention of Mother to Child HIV Transmission (PMTCT) • Orphan & Vulnerable Children (OVC) Program • Information, Education & Communication Material (IEC). BMC Health Insurance 2009

9. Services offered at BMC/KCRC • Pre-paid Health Insurance • Dental treatment: Check-ups, Extractions, Filling and cleaning. • We carry out normal deliveries and minor surgical operations. • Bushenyi Medical Centre (BMC) and KCRC cover a significant percentage of Bushenyi District through outreach clinics conducted from Monday to Friday. OVC Health Insurance - July 2011

10. Services offered at BMC • Medical care to Adults and Children with HIV/AIDS including Anti-retroviral therapy (ART). We conduct home visits to follow up problem cases and those with poor adherence. The ART program is implemented with support from PEPFAR through the AIDSRelief Consortium including Catholic Relief Services, Children’s AIDS Fund, Institute of Human Virology – University of Maryland and the Futures Group. OVC Health Insurance - July 2011

11. BMC Micro-Health Insurance SCHEMES/plans • In order to make health care affordable and more accessible, BMC has been offering the following micro-health insurance schemes: • School Health Made Easy Scheme (SHEMES) • Community health insurance (Group Health) Plans • OVC Health Insurance • Corporate Health Insurance: BMC has been treating clients from National Water and Sewerage Corporation, Compassion OVC Centers plus other organizations providing medical insurance like IAA, AARand St. Catherine’s Clinic Limited. OVC Health Insurance - July 2011

12. BMC HEALTH INSURANCE School Health Made Easy Scheme (SHEMES). • In Oct 1998, BMC with a resolution of Bushenyi District Council initiated a unique low cost health insurance scheme for students in primary and post-primary schools called School Health Made Easy Scheme (SHEMES). OVC Health Insurance - July 2011

13. School Health Made Easy Scheme (SHEMES). • SHEMES was the first health pre-payment scheme in Bushenyi District & the first school health Insurance scheme in Uganda. • Students pay termly premiums and are cared for throughout the year including holidays. BMC and KCRC have staff dedicated to this scheme who visit different schools from Monday to Friday providing care to the students. OVC Health Insurance - July 2011

14. Current SHEMES Benefit Package • General Medical Care (IPD & OPD) • Dental Care • Eye Care • X-ray & Ultrasound Diagnostic • Laboratory & Blood Transfusion • Family Planning as well as Maternal & Child Health • HIV Testing & Counseling • Prevention of Mother to Child HIV Transmission (PMTCT) • ARVs is given under BMC free Program of AIDS Relief • Information, Education & Communication Material (IEC) • Meals & Transport for admitted students only • Screening/Medical Inspection • Preventive , Health Education & Promotion OVC Health Insurance - July 2011

15. Exclusions under SHEMES • Eye glasses • Cosmetic Dental Surgery • Self Inflicted condition • Transport except for emergency cases and admitted students on discharge • Abortion or post abortion care • Delivery (incase of staff/Group) if the pregnant member has not attended antenatal care at BMC at least three times in the nine month of her pregnancy. • Drugs for Chronic illness only check ups are covered • Cost of medical care for referred clients. OVC Health Insurance - July 2011

16. Community Insurance Schemes • BMC has Community Insurance Schemes for organized community groups who pay quarterly premiums and are cared for at BMC-Katungu and KCRC. These community groups include; • Bwera women Music Dance & Drama group. • Kanyinya Agro-forestry • Bumbire Coffee Farmers. • West Ankole Diocese (WAD). OVC Health Insurance - July 2011

17. OVC Medical Insurance. • In June 2009, BMC was contracted to offer health insurance to 12,462 Children in 22 sub counties of the greater Bushenyi district after a competitive bidding process. • We started with a medical screening exercise of all the beneficiaries. This enabled us identify common infections in the community and also take photos for children IDs. OVC Health Insurance - July 2011

18. Sample ID ID Member Identity Card This card remains the property of CHILD ID:01/20/01/05/01/01 Photo OVC Empower HEALTH INSURANCE NAME:Atukwase Baron SEX: M ADDRESS:Kashozi, Shuuku BUSHENYI DISTRICT If found please return to: Bushenyi Medical Centre ( BMC) or Kabwohe Clinical Research Centre (KCRC) P.O. Box 347 Bushenyi Authorized by: Scanned Signature Issued: July 2009 FRONT BACK OVC Health Insurance - July 2011

19. Areas covered under OVC health insurance • Outpatient services treating common diseases like Malaria, Typhoid fever, Brucellosis, Respiratory tract infections, etc. • Inpatient services. • Dental services including Check-ups, Extractions, Filling and cleaning. • Medical treatment of eye diseases. • Health Education on general disease prevention measures. OVC Health Insurance - July 2011

20. Prevention of diseases and promotion of Hygiene. • It is concerned with helping people take greater responsibility for protection and promotion of their own health. • Bushenyi Medical Centre and KCRC give health education on every outreach. • We empowered community volunteers to offer health education. • Health Education is aimed at promoting health lifestyles of the individual and the community. OVC Health Insurance - July 2011

21. Health promotion - contd • In Nov 1999, BMC initiated the Triple~S (Stay Safe and Smart) Initiative under which live Triple~S Talk Shows have been held on an FM Radio station every Sunday in partnerships with different partners including ICOBI Health promotion – Topics • Malaria prevention • Prevention of contact diseases like fungal infections • Community Sensitization to seek for early diagnosis and treatment. OVC Health Insurance - July 2011

22. Health promotion – Topics • Diarrheal diseases prevention • Making water safe for drinking. • Hygiene and sanitation improvement in homes and schools • Proper breastfeeding and immunization • Control and prevention of STI’s in the community as well as in schools • Prevention and control of HIV/AIDS. • Nutrition and food hygiene. Curriculum Curriculum OVC Health Insurance - July 2011

23. Conditions excluded from OVC Medical insurance • Radiological investigations like CT scan and MRI. • Dental and Laparoscopic Surgery. • Cosmetic and Plastic surgery. • Treatment and Hospitalization for congenital conditions • Physiotherapy – surgical appliances such as crutches, prosthetics etc. OVC Health Insurance - July 2011

24. Exclusions - contd • Severe Cardiac disease. • Mental illness. • Self inflicted harm. • Anti Retroviral Therapy except as part of ART programs provided by BMC. • Orthopedic services like fixing fractures • Eye and ENT surgery OVC Health Insurance - July 2011

25. OVC Medical Insurance: Implementation Strategy. BMC has been using the following models of service delivery; • BMC premises for clients within its close proximity. • Outreach clinics run by BMC staff targeting areas far from health centres. • We contracted 9 private clinics to offer health care to OVC. Referral network and linkages: • Bushenyi Medical Centre (BMC) has a memorandum of understanding with Ishaka Adventist hospital to which a few cases are referred. OVC Health Insurance - July 2011

26. Referral network and linkages - cont’d BMC has been working closely with KCRC in the provision of medical care to selected OVC’s because: • There is already an existing referral system between BMC and KCRC especially regarding investigations. • KCRC has the capacity to provide quality medical care because of the reliable well trained staff and modern diagnostic tools including X-ray, Ultrasound, CD4 equipment plus many serological and hematological laboratory investigations. OVC Health Insurance - July 2011

27. Implementation Strategy – Cont’d • At the beginning of the program, BMC conducted a screening exercise for all the children under the OVC program to identify those with complicated conditions so that these are handled appropriately. • ID photos for all children were taken during this screening exercise. OVC Health Insurance - July 2011

28. OVC Health Insurance - July 2011

29. NYAKATSIRO HC III- Partner clinic OVC Health Insurance - July 2011

30. Rugazi Mission Dispensary OVC Health Insurance - July 2011

31. Laboratory OVC Health Insurance - July 2011

32. OVC statistics (June 2009 -March 2011) - 22 months. Sumay OVC Health Insurance - July 2011

33. Partners/Collaborators BMC Health Insurance 2009

34. Successes of BMC Health Insurance schemes. • The Schemes have been embraced by most of the important schools and other stakeholders in the district. • Schools were assisted to acquire qualified nurses and refresher course was organized covering most common diseases. • BMC has been able to organize regular mobile medical team visits to schools and out-reach centers BMC Health Insurance 2009

35. Successes • Radio Talk show has been maintained with the help of organisations like ICOBI & KCRC every Sunday • Increased awareness about the scheme in the community. • Reduction in disease outbreak in schools OVC Health Insurance - July 2011

36. Success story 7 year old Precious from Rushozi Parish (Kyangenyi subcounty) was diagnosed with a haemangioma. She was operated in Ishaka Adventist Hospital and recovered very well. OVC Health Insurance - July 2011

37. Baby Precious & her Mother OVC Health Insurance - July 2011

38. Challenges in implementing OVC Health Insurance • Transport has been a big challenge because most places are far with bad roads and terrain. • Only few children/ families were picked, yet there is a big need for medical care. • Being upcountry, at times attracting and maintaining good doctors has not been easy. BMC Health Insurance 2009

39. Challenges – Cont’d • Programme catered for children only not their care- takers yet the later are also very needy. • Medical equipments are very expensive and if they were availed, people are too poor to afford them making cost recovery difficult. OVC Health Insurance - July 2011

40. Challenges – Cont’d • We would have wanted to do more if we had more funds like; - Routine check-ups - More health education in homes - Girl child immunization against Ca cervix - Male circumcision. OVC Health Insurance - July 2011

41. Sustainability For sustainability to occur, more communities, schools and households are being encouraged to join health insurance schemes. This will increase intra & inter community/household risk sharing accruing from large numbers enrolled. This will help cushion challenges associated with low premiums, help BMC to acquire more modern equipment, establish its own home and increase the range of services for its clients. BMC Health Insurance 2009

42. Sustainability • Children and their care givers will be encouraged to form community groups. Then it can be easy to lobby for other sources of income from Micro-Health insurance organizations like International Labour organization (ILO), EED (A German based Organization) ,world bank and even the Government of Uganda. OVC Health Insurance - July 2011

43. Sustainability There are foreseen challenges with expanding existing community schemes to involve OVC such as; • Misconception of the whole idea of solidarity when a member has contributed in a particular year & does not fall sick, the contribution is considered to be a loss. • High level of Poverty among the members affect premium contribution in communities OVC Health Insurance - July 2011

44. Sustainability & Foreseen challenges. • Abuse of the scheme mainly by students who seek care even for minor complaints. Well as regular visits to facilities may be harmful to the scheme, it can be looked at as a good indicator that people are accessing health care services OVC Health Insurance - July 2011

45. BMC 2015 VISION • To be with its own home with modern facilities and having Uganda’s largest self sustaining micro-health insurance scheme providing low cost, good quality health care to its members. OVC Health Insurance - July 2011

46. Conclusion Health is not merely absence of disease but rather a state of complete physical, mental and psycho-social well being” “Health is made at home and only repaired in Health facilities when it breaks down” “ A Health mind is an indispensable pre-requisite for academic success but can only thrive on a healthy body” OVC Health Insurance - July 2011

47. Conclusion Contd • The scheme will certainly succeed if all stakeholders give it unparalleled support, make health a top priority and not putting all their focus and debates only on the amount of money to be paid but also more importantly realize that the scheme is one of the most cost effective health interventions that could be available in society in terms of cost per health-life year saved. OVC Health Insurance - July 2011

48. PHOTO GALLERY OVC Health Insurance - July 2011

49. Outreach OVC staff during a community visit after introducing community concept. OVC Health Insurance - July 2011

50. Outreach A clinician during an outreach. OVC Health Insurance - July 2011