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Healthpartners Collaborations Project HealthPartners Collaborations Project Semi-Annual Report July-December 2012 OAA-A-11-00010 Photo by Ilia Horsburgh Authors: Jennifer Stockert, Director Maale Julius Kayongo, Operations Manager David Muhumuza, Monitoring and Evaluation Manager Paul Walters, Coordinator Herbert Asiimwe, Transitional Manager Date: December 21, 2012 1 | Page Abbreviations and Acronyms AGM Annual General Meeting BOD Board of Directors CDO Cooperative Development Organizations CDP Cooperative Development Program CHI Community Health Insurance CI Communication of Innovation CLARITY Cooperative Law and Regulation Initiative Co-op Cooperative COP Chief of Party CRI Criterion Referenced Instruction DHT District Health Team FY Financial Year HIV/AIDS Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome HMIS Health Management Information System HPC HealthPartners Cooperative HSSP Health Sector Strategic Plan ID Identification IEC/BCC Information, Education and Communication/Behavior Change Communication IR Intermediate Result KPC Knowledge, Practices and Coverage Survey LOP Life of Project MCP Malaria Communities Program METRICS Measurements for Tracking Indicators of Cooperative Success M&E Monitoring and Evaluation MOH Ministry of Health MOU Memorandum of Understanding OCDC Overseas Cooperative Development Council OVCAT Operational Viability and Capacity Assessment Tool PAR Prioritized Allocation of Resources PMP Performance Management Plan PQA Provider Quality Assessment SF Sustainability Framework UCBHFA Uganda Community Based Health Financing Association UCCC Uganda Crane Creameries Cooperative UGX Uganda Shillings UHC Uganda Health Cooperative USAID United States Agency of International Development VHT Village Health Team VSLA Village Savings and Loan Association WAD West Ankole Diocese WRA Women of Reproductive Age 2 | Page Table of Contents I. Project Summary..................................................................................................... 4 II. Progress Report....................................................................................................... 6 III. What Works and What Will be Changed ............................................................... 12 IV. Key Issues.............................................................................................................. 21 V. Plans for the Next Six Months ............................................................................... 26 VI. Success Stories ...................................................................................................... 31 Annex A: Site Visit Report from Joel Kisubi, Uganda Mission ............................................... 32 Annex B: Site Trip Report—Paul Walters, September 7-21, 2012 ......................................... 34 Annex C: Prioritized Allocation of Resources ....................................................................... 36 3 | Page I. Project Summary HealthPartners Cooperative is a community based health insurance model that provides resources for capacity building and network development that empower local stakeholders including women and the poor to access care, recognize and demand quality and improve health outcomes. HealthPartners Collaborations Project development hypothesis is that by empowering and building the capacity of rural stakeholders, especially women of reproductive age and the poor, enabling them to maintain community owned prepaid health co-ops with linkages to strengthened health systems, local stakeholders can sustain increased access to quality preventive care and treatment with increased accountability and improved health outcomes for the community. Development Challenge Development goals of the Government of Uganda include accelerating economic growth to reduce poverty ensuring that all people have equitable access to the basic package of health care and improving the health status of the people of Uganda. Thirty-one percent of Ugandans were living below the poverty line in 2005 and Uganda remains one of the poorest countries ranking 145 on the global Human Development Index. A direct relationship has been demonstrated between poverty and health. Poverty reduces access to health care and catastrophic illness can lead to poverty. Incidence of malaria, dysentery and diarrhea are more prevalent among the poor than the rich1. Nearly two-thirds of the households in the Central and Western regions of Uganda descended into poverty over the past 25 years as a result of ill health and health related costs2. The Ministry of Health in Uganda has been working to put in place a National Health Insurance Scheme for many years; a national health plan has been drafted but the implementation of this plan and its impact on the rural poor may still be years away. The lack of a comprehensive social security system makes the poor more vulnerable in terms of affordability and choice of health provider. This situation is compounded for women in Uganda since the rural birth rate is 7.13 children per woman, women are traditionally primary care takers, culturally women lack power and control to make decisions, and women have less access to capital. The Collaborations project design includes strategic approaches that draw on the significant motivation that co-ops have to deal with endemic disease threats, increased purchasing power of the group, taking advantage of their potential roles in education and service delivery, and the availability of the resources needed to realize that potential. 1 Government of Uganda Health Sector Strategic Plan III 2010/11-2014/15 2 Krishna, Anirudh. “The Stages of Progress: Methodology, Assets, and Longitudinal Trends: Results from a Five-year Study in 236 Communities of Five Countries.” Brookings/Ford Workshop Paper. 2006. 3 Uganda Demographic and Health Survey 2006 4 | Page The Collaborations project has a been crafted to avoid contributing to dependency by 1) including stakeholders in program design and planning to ensure their priority needs are being addressed and to build ownership; 2) basing all activities and interventions on sustainable systems including using Ministry of Health (MOH) Health Management Information System (HMIS) tools and timelines; 3) promoting partnerships based on documented responsibilities with measures of accountability; 4) developing a graduation plan with stakeholders as a measure of success; 5) including the Uganda Health Cooperative (UHC) as a “graduate” from direct development assistance, now in a position to mentor new co-ops through the process of orientation, implementation, support supervision and eventually leading to their graduation from external support. HealthPartners believes that these design, planning and management principles will significantly accelerate progress toward self-reliance while, at the same time, minimizing the possibilities of creating dependency. Expected Outcomes and Impact The Collaborations project addresses quality, accountability and accessibility of health care through the development of six new community owned health co-ops that will serve at least 30,000 women of reproductive age (WRA) and at least 85,000 members overall in Southwestern Uganda. Forty-two co-op member groups will elect private providers based on measures of quality and will establish memorandums of understanding (MOUs) with them for quality service and accountability. Each co-op will be empowered to develop private and public partnerships creating annual action plans for improved health. At least five partnerships per co-op will be developed with local organizations including district health teams (DHT) whose village health team (VHT) volunteers will be offered discounted rates for co-op membership since their services have been shown to directly increase community health through disease prevention and treatment seeking behaviors which in turn directly increases cost savings for health co-ops. Eighteen Private health care providers will employ data entrants to track monthly co-op performance and fill MOH HMIS forms contributing to their own and the MOH ability to make results-based decisions. All six co-ops will elect their own board of directors to maintain a sustainable financial co-op cost balance with annual provider surpluses and a reserve fund. Co-ops will be linked nationally to the Uganda Community Based Health Financing Association (UCBHFA) and to other in-country Cooperative Development Program (CDP) partners for work on The Cooperative Legal and Regulatory Initiative (CLARITY) and to address the issue of measuring co-op performance through Measurements for Tracking Indicators of Cooperative Success (METRICS). HealthPartners will join CDP workshops and working groups to contribute to CLARITY, METRICS and IMPACT initiatives (comparing the co-op model impact to business and other development models.) By the end of the project, evidence will show how the project model, strategies and lessons learned have been adopted by the MOH and partners. 5 | Page II. Progress Report Objective/ End of Project Goals 2012 Target Achievements to date, Dec. 2012 Activity O1: Annual stakeholder workshop reports for 6 co-ops detail public/ private partnership action plans for improved health Three (3) district level meetings were 1.1. Sensitize conducted reaching a total of 253 leaders. district leaders 4 stakeholder Participants included 85 (63 male and 22 1.1: 6 stakeholder on the HPC workshop reports females) district leaders from Ntungamo workshop reports model, share detailing public / district, 85 leaders (66
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