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Community Health Financing in Uganda

Community Health Financing in Uganda. Uganda Health Cooperative Dr. Grace Namaganda, Director. Presentation Outline. CHF in Uganda UHC Background UHC’s CHF Model Performance of the schemes Lessons learnt Challenges. Background to CHF in Uganda.

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Community Health Financing in Uganda

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  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

  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.

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