HealthPartners Enhanced Collaborations Project Semi-Annual Report July-December 2014 OAA-A-11-00010
Authors: Dr. Nakiwala Stella Regina, Deputy Chief of Party Maale Julius Kayongo, Chief of Party David Muhumza, Monitoring and Evaluation Manager Jennifer Stockert, Director International Development
Date: December 31, 2014 Abbreviations and Acronyms
AGM Annual General Meeting ADHIC Ankole Diocese Health Insurance Cooperative ADMHC Archdiocese of Mbarara Health Cooperative BCC Behavior Change Communication CDP Cooperative Development Programs Coop Cooperative COVOID Community Volunteers Initiative for Development CRI Criterion Referenced Instruction DHC Diocesan Health Coordinator DHT District Health Team EOP End of Project FY Financial Year HP HealthPartners HSA Health Savings Account ID Identification IRA Insurance Regulatory Authority KIDA Kitojo Integrated Development Association KIUTH Kampala International University Teaching Hospital NAD North Ankole Diocese NHIS National Health Insurance Scheme MGLSD Ministry of Gender Labor and Social Development HPAC Health Policy and Advisory Committee MOH Ministry of Health MOU Memorandum of Understanding OB Opportunity Bank PNFP Private not for profit provider PQA Provider Quality Assessment SCORE Sustainable Comprehensive Responses SDS Strengthening Decentralization Services UCBHFA Uganda Community Based Health Financing Association UPMB Uganda Protestants Medical Bureau UGX Uganda Shillings UHC Uganda Health Cooperative VHT Village Health Teams VSLA Village Savings and Loan Associations WAD West Ankole Diocese Cooperative WRA Women of Reproductive Age BUREDO Buhweju Real Community Organization Table of Contents
Abbreviations and Acronyms...... 2 Table of Contents...... 3
I. Summary...... 4 II. Progress Report...... 4 III. Progress Report Table...... 8 IV. Priorities and Lessons Learned...... 11 V. What Works and What Will be Changed...... 12 VI. Plans for the Next Six Months...... 12 VII. Work Plan Matrix for the Next Six Months...... 13 VIII. Communication of Innovation...... 16
Annex A: Health Coops in the News and Other Publications...... 19 I. Summary
HealthPartners development hypothesis is that by building the capacity of rural stakeholders, including health care providers, women of reproductive age (WRA) and the poor, enabling them to maintain community owned prepaid health coops with linka ges 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. As a result of these investments, six health cooperatives and twenty six health care providers are serving 34,422 members.
Interest in health coops increased over the year with stakeholders ranging from national religious leaders to local health care providers to implementing partners who are looking to add value to their initiatives. Training of trainers allowed HealthPartners team to leverage investments however membership enrollment by large stakeholders is taking longer than expected. While financial cost recovery of health care providers who offer coop services has improved, several providers continue to allow new coop members to enroll and seek care before having ID cards on file. Enforcing on time payment is also proving challenging for health care providers especially those offering coverage to schools. HealthPartners Uganda leaders expanded their networks at the national level which resulted many opportunities including being invited to present on health coops at the Makerere University School of Public Health Maternal New Born Health Symposium and newspaper articles that highlight how health coops save lives (see Annex A.)
Next steps, based on lessons learned and monitoring data results, include increasing the capacity of coop leaders in transparent financial management and consistent communication to their stakeholders; continued support to high level stakeholders like the Uganda Protestant Medical Bureau and Kampala International University to ensure their ownership and capacity to maintain effective health coops; and an increased emphasis on engaging women. The team plans to continue to apply Communication of Innovation, using data and strategic channels of communication to increase demand and ownership and to help stakeholders build strong, dynamic partnerships.
Purpose of this Report
HealthPartners shares project achievements biannually and routinely seeks to incorporate lessons learned in order to increase impact. The July-December 2014 Semi-annual report includes a progress report with a focus on priorities and lessons learned.
II. Progress Report A total of 34,422 members have joined six locally owned and managed health cooperatives: Uganda Health Cooperative (UHC), Ankole Diocese Health Cooperative (ADHIC), Archdiocese of Mbarara Health Cooperative (ADMHC), West Ankole Health Cooperative (WAD), North Ankole Health Cooperative (NAD) and the Mama Coop.
One hundred thirty-three (133) member groups have signed Memorandums of Understanding (MOUs) detailing roles and responsibilities for access to care at 26 health care provider locations. The cooperative surplus for care providers (premiums plus co-pay minus treatment costs) year to date for 2014 is 90,862,382 Ugandan Shillings (UGX) ($35,500) for all six cooperatives.
Objective 1: Annual stakeholder workshop reports for six coops detail public/ private partnership action plans for improved health.
HealthPartners Collaborations project team focused on strengthening partnerships with and between the existing private for-profit and not-for-profit health stakeholders to ensure that stakeholders are effectively manage their coops. These stakeholders include: Uganda Community Based Health Financing Association, North Ankole Diocese, Uganda Protestants Medical Bureau, Integrated Community Based Initiatives, Kabwohe Clinical Research Centre (KCRC), Kampala International University Teaching Hospital (KIUTH), Rurama Health Centre, Bahamagara Health Centre, Kibaare Health Centre, Naama Health Centre, Engari Health Centre, Rushere Community Hospital, Kazo Health Centre, Kitojo Integrated Development Association (KIDA), Magondo Health Centre, Kabuyanda Health Centre, Kyabirikwa Health Centre, Ddembe Clinic, Butare Health Centre, St. Lucia Kagamba Health Centre, Kakoma Health Centre, Buhungiro Health Centre, St. Mary ’s Kyiebuza Health Centre, St. Joseph Rubindi Health Centre, Kathel Medical Care, Ruharo Mission Hospital, Kathel Medical Care, St. John’s Community Health Centre Biharwe, Ibanda Mission Health Centre, Comboni Hospital, Kyamuhunga, Rugazi Health Centre, Nyakatsiro Health Centre, Mitooma Central Clinic, Rubare Health Centre, BUREDO, and Katungu Mission Hospital Project.
HealthPartners team provides integrated support supervision through a graduated sequence to increase provider capacity to manage their health coops including support for orienting and launching new member groups following insurance principles and support for tracking and using coop performance data to make results-based decisions to improve care and health outcomes.
Health coop leaders attended quarterly review meetings to assess cooperative performance and address key challenges. The coop leaders were oriented on coop follow up tools and later participated in this exercise which enabled them to learn health coop provider challenges. Four out of six health coop leaders have developed and filled board members’ self-assessments. The most recent self-assessment results were 88.8% for UHC, 67.5% for ADMHC, 84.2% for Mama Coop and 84% for ADHIC.
Two Village Savings and Loan Association (VSLA) follow up quarterly meetings were conducted for the 472 coop members who are participating in 18 VSLAs. Testimonies from coop members confirm that VLSA participation is highly valued and helps members to pay health coop premiums on time. A total of 40,910,050 UGX ($14,742) has been saved by VSLAs trained through the Collaborations project. Of the total saved, 28,913,400 UGX ($10,419) has been given out in loans to fellow VSLA members who are also coop members.
HealthPartners applied Communication of Innovation strategies to expand partnerships and to prioritize resource investments to overcome the long-term challenge of coop member identification (ID) cards being expensive and time consuming to make. Replacing photo ID cards with thumb-print IDs was initially rejected by stakeholders. A major lesson was, how we say what we say matters. HealthPartners began to reference the new ID technology as “Instant IDs.” Support supervision tools were adjusted and strategic campaigns targeting early adopters were led to create positive examples for the impact of Instant IDs. Opportunities for making it easy for the early majorit y to learn from early adopters are ongoing. For example, several providers shared success stories about Instant IDs during coop provider quarterly meetings this month.
Objective 2: Six health coop boards maintain their cost balance with annual provider surpluses and reserve fund.
On a monthly basis, HealthPartners staff led coop follow up with health care provider staff to build their capacity to make and follow through on their own action plans.
The HealthPartners Uganda Monitoring and Evaluation (M&E) team continues to conduct monthly provider meetings to increase capacity to track and use data and to share lessons learned. These meetings create a platform for health care providers to learn from one other even as their priorities and needs change. From July-November 2014, 69.2% of providers offering coop services registered a surplus, see table below. Member groups include 14 VSLA, 4 VHT, 61 schools, 10 employer groups and 44 other like burial societies. All 26 health care providers are turning in monthly membership and financial data detailing their coop performance.
# Care Total # Health # of Member Year to Date Coop Member Coop Provider Provide Members Coops Groups Profit by Coop Benefits Benefits rs Served ADHIC 4 29 4,497 $ 10,025 Protection and Reduced bad debt, ADMHC 6 12 2,131 $ 134 reduced cost of care early treatment seeking Mama 5 11 3,542 $ 4,427 due to risk pooling. from members; NAD 1 1 206 $ 225 Reduced delays to improved planning, UHC 7 31 5,005 $ 2,304 seek care. supplies and quality of WAD 3 43 19,041 $18,385 Empowered to care. demand quality. Sustaining a Healthy Community TOTAL 26 127 34,422 $ 35,500 through Partnership
In collaboration with district commercial officers, HealthPartners continues to build the capacity of health cooperative boards or leaders on sound governance and management. The UHC reserve fund stands at 5,074,326 UGX ($1,829) while the other health cooperatives are in the process of establishing their reserve fund bank accounts with commercial banks of their choice.
Objective 3: CDP partner collaborations outputs on lessons learned in coop health financing shared with MOH and partners.
In partnership with Global Communities DESIGN project, and HealthPartners Health and Economic Livelihoods Partnership project, Collaborations Project staff participated in the National Cooperative Stakeholders’ Workshop conducted in December 2014 at Hotel Africana in Kampala. The theme was “sharing cooperative experiences for sustainable development”. This forum enabled cooperative stakeholders to discuss coop promising practices, lessons learned, and challenges.
HealthPartners Collaborations project continued to promote learning between scheme managers from different community health financing organizations in south western Uganda. In September, Uganda Community Based Health Financing Association (UCBHFA) was facilitated to conduct a second scheme managers’ meeting for 35 participants with the theme “Managing Scheme Information.”
In September 2014, HealthPartners Deputy Chief of Party attended a two day UCBHFA retreat to provide input on the design of the National Health Insurance Scheme (NHIS.) In September, leaders from each health coop led quarterly meetings to share experiences and learn from one other. A total of 107 (48 female and 59 male) participants discussed strategies and developed plans to increase membership and financial performance.
In November, HealthPartners Chief of Party and Deputy Chief of Party attended a workshop organized by Makerere University School of Public Health to identify research priorities for the revision of the NHIS bill from 2012. It was a great opportunity to bring the impact of the health coop model to the attention of these national decision makers.
HealthPartners signed an MOU with Uganda Medical Protestants Bureau (UPMB) and a training of trainers’ workshop was conducted to build UPMB staff capacity to train providers to manage health cooperatives. The workshop created a pool of trainers that will support cooperative development under UPMB member health facilities. UPMB will initially train five health care providers in Mukono diocese in Central Uganda and membership is anticipated to reach at least 10,000 in the first year. Kathel Medical Care and Ibanda Mission health centers were invited by UPMB to share their coop success stories at the National UPMB Annual Symposium which took place in Kampala in December 2014.
HealthPartners team supported Kampala International University Teaching Hospital (KIUTH) to develop tiered benefit packages at Staff, Student, Gold, Silver, and Platinum benefit levels and prices. Their staffs’ were trained to implement health cooperative insurance. KIUTH signed MOUs to offer services to four schools so far. KIUTH is targeting enrollment of 10,000 members by June 2015.
HealthPartners leaders continue to attend quarterly Bushenyi district feedback and review meetings organized through the USAID funded Strengthening Decentralization Services (SDS) project to share progress toward project goals with other implementing partners so as to identify, and take advantage of cross over opportunities. As a result of attending these meetings, HealthPartners is following up with Community Volunteers Initiative for Development (COVOID) to ensure that the Sustainable Comprehensive Responses (SCORE) project supported VSLAs for care givers of Orphans and Vulnerable Children to get linked to health care providers who offer coop services.
During the period under review, Joel Kisubi from the USAID Mission visited HealthPartners Uganda in Bushenyi. During his site visit, he attended the ADMHC stakeholders meeting and visited both Katungu and Kathel Medical Centres. He recommended increased involvement of district leaders in health coop activities as one of the strategies to build support and ownership, and he enabled HealthPartners to overcome transportation challenges through the provision of retired USAID project vehicle. Emily Hillman, a USAID representative who works with Saving Lives at Birth partners, visited HealthPartners in September 2014 to observe Mama Coop impact.
One Ministry of Health (MOH) support supervision visit was conducted in the districts of Bushenyi and Mbarara. The MOH team consisted of health officials from the planning department who are part of the steering committee on the development of the NHIS. During this support supervision visit, MOH officials reviewed progress on implementation of health coop activities, observed activities and shared recommendations.
HealthPartners continues to support and participate in collaborative efforts with the Overseas Cooperative Development Council (OCDC.) HealthPartners staff attend quarterly collaborative and board of director’s meetings along with participating on monthly calls. We contribute to the IMPACT project by providing financial data to OCDC from the health cooperatives we support. That data is aggregated with data from other cooperatives to demonstrate the financial impact cooperatives have on low income communities. Team members participated in a CLARITY working group mapping future uses of CLARITY over the next five years.
Objective 4: Evidence that health coop impact data results or lessons learned were used to inform one donor and one coop development organization’s priorities and policies
Terms of reference were developed to solicit applications from consultants for a health coop impact assessment. The consultant will be chosen from a pool of applicants. The terms of reference were sent to Tom Carter, USAID Washington and Joel Kisubi, USAID Uganda. Recommendations from Dr. Wilberforce Owembabazi and Dr. Kassahun Belay, USAID Uganda, were incorporated in the assessment design. Dr. Basaza at the Uganda Ministry of Health, who also works at Makerere University, provided input and applied to serve as the lead consultant for the study. The purpose of this study is to explore the hypothesis that health cooperative members (particularly women) in south west Uganda are better off than non-health cooperative members (out of pocket payers) using indicators for measurement at a statistically significant level. The results will guide and inform the Uganda Ministry of Health, Makerere University, the USAID Mission in Uganda and other leaders and donors, regarding cost effective, sustainable investments to save lives. The key questions this survey seeks to answer are:
1. What is the difference in preventive and treatment seeking behaviors between coop members versus patients who pay out of pocket? Key indicators: Antenatal Care, delivery with skilled health professional, seeking treatment within 48 hours onset of fever; sleeping under long lasting insecticide treated bednets. 2. What is the difference in provider financial cost recovery between patients who pay out of pocket versus health coop payments? 3. Do health coops improve maternal health in the Ugandan context? How and how much compared to vouchers and other development investments?
The objective of the consultancy is to quantify the impact of health cooperatives on members and health care providers. The assessment will measure the health status of women who had a child within the past 2 years using standard indicators to compare health status and health seeking behaviors of coop and out of pocket payers. The assessment will also measure the financial impact of health coops on members and will factor Daily Adjusted Life Years (DALYS) for comparative analysis of health coop impact versus other models that encourage early treatment seeking for improved health outcomes. A health care provider survey and key informant interviews for men will enable the consultant to answer key questions, to analyze data results and to be able to provide culturally relevant comparisons and recommendations.
Objective 5: Female participation and leadership in health coop events increases from 30% to 50% as documented in member elected coop boards of directors and coop activity reports
Out of 51 total coop board members from the 5 coops who have elected board so far, 16 or 31% are female. Discussions to increase female representation began within the Collaborations project team. Why are we focusing on women? What are the statistics that show women are a higher impact investment? It was noted that emphasis on female engagement has often been planned in program design, but for one reason or another, plans were often adjusted at the last minute to include men. In one example a focus group discussion was planned for women only however when the report came back, men had also been included. Discussing why our emphasis on women is important and how even our best intensions can and have been side lined, was the first step to raise awareness.
A partnership meeting was schedule with Ms. Dorah Musiimire from the Ministry of Gender Labor and Social Development in order to request culturally appropriate posters and recommendations for messaging to initiate gender balance discussions during coop events. Ms. Musiimire joined the cooperative forum held in December in Kampala. At that forum, Mr. Simple Wagaba was invited to provide input on the draft national Health Cooperative bill by the senior cooperative officer of the Ministry of Trade, Industry and C ooperatives. Mr. Wagaba’s first recommendation was to adapt language to be gender inclusive noting also that the Uganda Cooperative Association has recommended that all coops come up with affirmative action on women and youth in their coops. III. Progress Report Table The table below summarizes achievements between July-December 2014 compared to FY14 Work Plan targets and End of Project (EOP) goals.
Objective/Activity Indicator Results July EOP Target Comments to November 2014 Indicators
O1: Annual stakeholder workshop reports for six coops detail public/ private partnership action plans for improved health 2.12.1: Provider While support supervision surplus averages at of providers is having least 500,000 some impact, it is not 15 support supervision 1.1. Conduct closing the gap of visits were conducted by 1.1 integrated providers allowing new coop leaders (BOD) and 100% health cooperative follow up member groups to 66 coop follow up visits facilities with all to increase provider access care before they conducted by HPU staff nationally- skills on managing have ID cards on file to to 26 health care mandated health coop activities verify membership. New providers guidelines for care strategies are being of children available explored to overcome this and accessible on gap. day of survey Four coop providers were trained on how to Exchange site visits 1.2. Conduct manage HC and sustain continue to be a priority exchange visits partnerships with 2.1: Provider and important way to between stakeholders exchange visits, these surplus averages at empower coop care to learn from early included: BUREDO, least 500,000 providers to learn from adaptors KIDA Hospital, UPMB one another and Butuuro Medical Centre BCC/IEC messages aired on three local FM stations were: 1.3. Air radio spots • Radio talk show radio talk shows Results and lessons and talk shows to conducted: 8 and radio learned from the radio promote health • 15 minute recorded jingles/spots aired campaign will be included financing using segments: 8 to increase health in the next quarterly HealthPartners • DJ mentions : 180 coop membership report. cooperative model • Radio spots aired: 180 • Radio Jingles: 60 1.4. Print and 1.5 distribute 1,041 brochures, 310 16,030 IEC Strategies for distribution IEC/Behavior Change posters, 59 branded T- materials distributed were adjusted based on Communication shirts, 27 branded bags, to support VHT to lessons learned from (BCC) materials to and 40 badges were help people join previous efforts. the community to distributed health cooperatives promote Health Coop. Start-up kits enable providers to offer quality 1.5. Provision of care and track coop health coop startup Four (4) health coop 1.1.2 services. Metallic plates kits to providers to start up kits were 25 coop providers to brand the front support providers to provided to new health sign MOUs with entrance of buildings with start and launch new care providers member groups USAID logos are included member groups in kits per Mission recommendations. 1.6. Conduct provider No provider quality 1.1.3 Provider quality quality assessments assessments were 90% of providers assessments are an and share results done. have improved important strategy to 1.7. Conduct ratings on their drive both member quarterly coop 61.2% of clinical staff in member quality satisfaction and the leaders meetings to health facilities were assessment scores quality of care provided. share Coop follow up working on the day of 1.1.4: 90% of staff These activities were results, Cooperative the survey in health facilities postponed however due performance working on the day to the higher priority need summary, and 90% of co-op health of the serve to increase coop board mapping tool facilities were found with 1.1.5: 100% of coop capacity to make first line medication on health facilities with decisions on behalf of the day of the survey first line medication their stakeholders and 1.1.6: 100% of keeping stakeholders 95.8% of health facilities health facilities with informed quarterly. had guidelines for care guidelines for care The leadership team has of children and adults on of children and been meeting routinely to the day of the survey adults plan training and support 2.1: Provider activities to identify and 2.1. Provider annual surplus averages at close coop leadership surplus to date: least 500,000 challenges. UHC:5,898,416 UGX 2.2 Total annual WAD:47,065,917 UGX coop reserve ADHIC: 25,644,883 balance of at least UGX 3,000,000 ADMHC: 342,133 UGX 2.3: 80% of Health Mama Coop: care providers with 11,333,883 UGX annual surplus NAD: 577,150 UGX 2.4: 80% of coop members pay premiums on time 2.1.2: 100% of health facilities maintain up to date records on sick clients 1.8: Healthcare Coop orientation days 1. 85,000 people providers conduct were held at Rugazi, St. covered by US cooperative Josephs and Beverly supported health orientation days to Health Centers financing increase coop following radio show arrangements enrollment announcements 2,835 (899 females & KIDA, KIUTH, Butuuro 1,936 males) new 42 MOUs signed 1.9: Provider SACCO, NAD and members enrolled (4 annually between enrollment of new ADHIC are actively schools and 11 coops and local member groups enrolling new member community groups) health stakeholders groups (32%F) 1.10: Quarterly 19 health care providers Quarterly meetings are meetings between have been supported to proving to be an effective providers and group conduct quarterly 42 MOUs signed strategy to increase members to deliver meetings with group health education, members to deliver annually between communication between review scheme health education, review coops and local coop stakeholders so performance and coop performance and health stakeholders both providers and close health coop close identified health members feel their needs gaps coop gaps. are being met O2: Six health coop boards maintain their coop cost balance with annual provider surpluses and a reserve fund Provider capacity is increasing but challenges 2.1. Support Coop continue due to the fact leaders to conduct that, while provider quarterly support 69.2% of the providers 2.1: incharges and financial supervision of registered an annual Provider surplus managers tend to value providers to increase surpluses for the period averages 500,000 increased surplus and ownership and under review or more per coop patronage from coop management of members, coop health coops managers often do not have incentive to enforce rules. 2.2. Conduct monthly 87% (26/30) health care meetings with providers turned in co- 2.1.1: 100% of administrators and op performance tracking providers turn in data entrants to tool on a monthly basis coop tracking tools strengthen their for the period under on time capacity in data review. management 2.2 Total annual coop reserve UHC average score: 2.3. Support Coop balance of at least 88.8% Self-assessment tools board committees to 3,000,000 ADMHC: 67.5% were developed and filled conduct quarterly 2.2.1: Self- Mama Coop: 84.2% by four coops review meetings assessment scores ADHIC: 84% by coop boards average 95% 2.4. Quarterly Key local stakeholders planning meetings like HUMC Encouraging coop between BOD representatives are now 2.1.1 stakeholders to expand representative, being invited to coop 100% providers turn their networks is HUMC planning meetings which in coop increasing ownership and representatives, is increasing correct performance opportunities for learning group leaders, VHT information and raising tracking tools and expansion parish coordinators the profile of health and service providers coops Dr. Basaza from the MOH is on the NHIS 2.9. Facilitate MOH to 2.2.4 planning committee and 1 MOH support conduct semi-annual 2 MOH support has appreciated the supervision visit field visits to health supervision visits health coop model conducted coops conducted supporting advocacy for health coops at the national level 2.10. Conduct 14 VSLA groups with VSLAs continue to be quarterly refresher 358 members are appreciated by training for VSLA accessing health care stakeholders and 2: 30,000 trainers to review under the health coop contribute to new health cooperative VSLA performance, arrangement. coop members who can members are WRA and increase trainers To date VSLA have join due to this organized skills on VSLAs for saved 40,910,050 UGX. savings plan that includes coop members (US$14,742) social reinforcement. O3: CDP partner collaborations outputs on lessons learned in coop health financing shared with MOH and partners 3.1. Conduct biannual 3 quarterly meetings meetings with District with DHTs of Bushenyi, Increased partnership Health Teams (DHTs) Buhweju and Mbarara with local stakeholders to share progress on 1: 85,000 people were conducted. 32 (8 increases the profile of health coop covered by USG female & 24 male) DHT health coops among key performance and supported health members attended. leaders and stakeholders integrate their financing (25%F) recommendations arrangements UCBHFA is an apex Through UCBHFA, one 2: 30,000 3.2. Support organization for health regional scheme cooperative UCBHFA to organize financing schemes managers meeting was members are WRA and conduct a however they did not conducted and it was national community focus on sustainability attended by 35 (6 Health insurance planning and are female and 29 male) forum struggling now that donor participants. (17% F) funding is dwindling. 3.3. Conduct a semi- annual inter health Inter-health cooperative 2 district meetings were cooperative leaders meetings are expected to conducted through SDS meeting to share contribute positively and impact of health experiences on toward building a coops was shared. sustaining health sustainable environment coops O 4: Health coop impact and strategies inform donor and CDO strategies, priorities or policies Terms of Reference Improving utilization 4.1 completed and shared of data for evidence- Commission for input and consultant based decision independent applications. Budget, making at all levels. assessment in Knowledge, Practice Uganda to measure and Coverage health impact questionnaire with cross indicators and tabs, a health facility contributing factors questionnaire and focus comparing coop and group discussion guides non-coop members have been developed. 4.2 Use C of I Mission, MOH, Health coop impact strategy to Makerere University, strategies and disseminate results University of Minnesota lessons learned from impact and additional leaders inform at least 1 assessments to were consulted for input donor and 1 CDO inform donor and on the assessment as evidenced by DCO priorities and design to build interest reports or plans policies
O 5: Increased rate and percentage of female enrollment in health coops Initiated partnership with 5.1 incorporate GIDA MGLSD. Began staff results and MOH discussions about gender equity gender equity and Female leadership resource highlighted stories about in coop activities dissemination and how our emphasis on increases from 30% discussions into women has been to 50% health coop events at sidelined in the past to national, district and increase awareness community levels about what can happen. 5.2 Integrate activities Female leadership to promote equal 37 (14 females, and 23 in coop activities opportunity and males) were oriented. increases from 30% gender equality in (38% F) overall to 50% coop action plans 294 (Female: 131; Male: 163) (46% F) institutional heads have been oriented on HealthPartners coop model from 10 institutions.
This training has not yet taken place but lessons learned from previous Increased number 5.3 Train and support training are being of female coop 40 new WRA to start reviewed to avoid gaps members and VLSAs with HSA like providers inviting members who pay men to training when premiums on time requested to invite female VHT.
IV. Priorities and Lessons Learned
• Use of radio campaign program to promote health coop has increased awareness among coop members who are demanding better quality healthcare and reduction of premiums to 5,000 UGX as marketed in the campaign. The non coop members are seeking information about health coops and new community groups have enrolled into health coops as a result of listening to the radio programs. • Working with health stakeholders who shared goals but have access to powerful existing systems is expected to significantly leverage project impact. Examples include UPMB and KIUTH. • HealthPartners leaders have engaged in different national events to create awareness about health coops and service cooperatives with officials from Ministry of Health, Ministry of Industry, Uganda Insurance Regulatory Authority (IRA), and Uganda Cooperative Alliance. • Ministry of Trade and Industry have taken up interest in service cooperatives and promised to support health cooperatives by reviewing bylaws to enable health coops to register. HealthPartners staffs were invited to provide input on the draft national Health Coop Bylaws including the importance of gender equity. • Working closely with health stakeholders to review progress, share challenges and update joint action plan has significantly leveraged project impact. Example is KIUTH where HealthPartners leaders and KIUTH health coop committee sit monthly; KIUTH has signed four memorandums of understanding within one quarter. • Buy in by top leadership positively impacts interest of implementing health coop activities by stakeholders. Example is KIUTH proprie tor gave instructions that all staff and university students should enroll into the health coop. • Performance Management Program indicator results show that the project is on track to achieve all objectives by September 2017. Some progress was lost for the following indicator results. These issues will be discussed with the MOH and district health teams to develop a plan of action. 1.1.4. % staff in Health Facility staff who provide clinical services and were working (either in HF or in outreach activities) on the day of the survey results decreased from 2014 when they were 73.2% to 61.2%. • There was mass recruitment by Ministry of Health resulting in a significant number of health workers who moved and in many cases, they have not been replaced • New providers came on board this year (Rushere, Rurama, Kibale, etc.) with lesser clinical staff than the established positions, thus affecting the overall percentage
1.1.5. % of coop health facilities that have first line medications on the day of the survey decreased from 95.4% in 2014 to 90%. • Some drugs were out of stock on the day of the survey, but procurement was in progress as reported by some providers • Some people with experience in drug forecasting left the facilities and joined MOH facilities, thus leading to some inaccuracies in procurement……reported as a gap by some providers
V. What Works and What Will be Changed
• Due to increased awareness about health coop benefits, support is needed to increase provider capacity in strategic allocation of resources, especially time. • Requests for support are coming from other regions of the country. In the past, these requests were turned down however for KIDA, provider training was offered as long as the trainees traveled to Bushenyi. This worked well and may be r eplicated for other stakeholders. This also made it easy to include exchange site visits as part of initial training. • Provider staffs are learning to identify where seeds show growth in order to prioritize their time to follow up interest in coop membership. • HealthPartners leaders mentor implementing staff to follow through initiated partnerships with national and local stakeholders. The follow up this done through regular review meetings with partners and updating action plans to ensure all parties are accountable.
VI. Plans for the Next Six Months
• Address health facility staffing and drug stock training and management issues with DHT, MOH and IPs in order to find options to help providers close performance gaps • Support trainers of large, influential organizations with existing systems and shared goals o KIUTH, membership goal =10,000 June 2015 o UPMB, membership goal = 5,000 July 2015 o NAD, membership goal = 8,000 June 2015 o Butuuro SACCO, membership goal = 5,000 June 2015 • Build capacity on gender equity to increase female participation in coop activities and leadership positions • Continue to use strategies of Communication of Innovation to help health coop stakeholder to increase ownership • Promote local partnerships based on documented responsibilities with measures of accountability • Support health cooperatives to establish reserve fund bank accounts and to register nationally • Build the capacity of coop leaders to o Plan and lead effective AGMs to benefit coop stakeholders o Implement their action plans on time, holding one another accountable o Use self-assessment tools to identify needs and priorities o Use support supervision lessons learned to make decisions o Share financial performance, partnerships and goals to all coop stakeholders every quarter • Hire a consultant to conduct health coop impact assessment comparing adoption of preventive health behaviors between members and non-members. Impact assessment results will be shared with MOH, USAID, District Health Teams (DHT), Makerere University and other health coop stakeholders. • Support continued learning and sharing among health coop stakeholders through supporting exchange visits and stakeholder meetings
VII. Work Plan Matrix for the Next Six Months
Objective/Activity Outputs for Jan – EOP Target Tim Partner Locatio June 2015 Indicators elin s n e
Q Q 2 3 O1: Annual stakeholder workshop reports for six coops detail public/ private partnership action plans for improved health 2.12.1: Provider 80% of Health care surplus averages at Mbarara, providers with annual least 500,000 Busheny 1.1. Conduct surplus i, integrated 1.1 Health Mitooma cooperative follow up 90% health facilities 100% health facilities Coop x x , to increase provider with all nationally- with all nationally- provider Rubirizi, skills on managing mandated guidelines mandated guidelines s Buhweju health coop activities for care of children for care of children , available and available and Kampala accessible on day of accessible on day of survey survey 1.2. Conduct Health exchange visits 80% of Health care 2.1: Provider surplus Coop All between providers with annual averages at least x x provider above stakeholders to learn surplus 500,000 s from early adaptors MOH, 1.3. Air radio spots Radio talk shows, radio talk shows and UCBHF and talk shows to recorded segments radio jingles/spots A, promote health SW and radio spots aired aired to increase x x Health financing using Uganda to increase health health coop care HealthPartners coop membership. membership provider cooperative model s, DHT 1.4. Print and MOH, distribute UCBHF Brochures, roles and 1.5 IEC/Behavior A, responsibilities 16,030 IEC materials Change Health posters, calendars, distributed to support SW Communication x x care distributed to VHT to help people Uganda (BCC) materials to provider increase health coop join health the community to s, coop membership. cooperatives promote Health stakehol Coop. ders 1.5. Provision of health coop startup 1.1.2 Health SW 25 coop providers kits to providers to 25 coop providers sign care Uganda sign MOUs with x support providers to MOUs with member provider and member groups start and launch new groups s Kampala member groups 1.6. Conduct 70% of providers 1.1.3 Coop SW provider quality have improved 90% of providers have x x stakehol Uganda assessments and ratings on their improved ratings on ders, share results member quality their member quality provider 1.7. Conduct assessment scores assessment scores s, quarterly coop 1.1.4: 90% of staff in district leaders meetings to 70% of staff in health health facilities working health share Coop follow up facilities working on on the day of the teams x x results, Cooperative the day of the survey serve and performance 1.1.5: 100% of coop commer summary, and 90% of health health facilities with cial mapping tool facilities with first line medication officers guidelines for care of 1.1.6: 100% of health children and adults facilities with guidelines for care of Provider surplus children and adults averages at least 2.1: Provider surplus 300,000 averages at least 500,000 Total annual coop 2.2 Total annual coop reserve balance of at reserve balance of at least 500,000 least 3,000,000 2.3: 80% of Health 45% of Health care care providers with providers with annual annual surplus surplus 2.4: 80% of coop members pay 45% of coop premiums on time members pay 2.1.2: 100% of health premiums on time facilities maintain up to date records on sick 85% of health clients facilities maintain up to date records on sick clients Coop District 1.8: Healthcare trainers, 45,000 people 1. 85,000 people providers conduct District SW covered by US covered by US cooperative Health Uganda supported health supported health x x orientation days to Team, and financing financing increase coop Health Kampala arrangements arrangements enrollment care provider s Health 120 MOUs signed 120 MOUs signed workers, SW 1.9: Provider annually between annually between health Uganda enrollment of new x x coops and local coops and local health care and member groups health stakeholders stakeholders provider Kampala s 1.10: Quarterly Coop meetings between District providers and group trainers, members to deliver 120 MOUs signed 42 MOUs signed District SW health education, annually between annually between Health Uganda x x review scheme coops and local coops and local health Team, and performance and health stakeholders stakeholders Health Kampala close health coop care gaps provider s O2: Six health coop boards maintain their coop cost balance with annual provider surpluses and a reserve fund 2.1. Support Coop DHT, leaders to conduct Coop quarterly support 2.1: SW Provider surplus BOD, supervision of Provider surplus Uganda averages 500,000 or x x health providers to increase averages 500,000 or and more per coop care ownership and more per coop Kampala provider management of s health coops 2.2. Conduct monthly meetings with Service SW administrators and 90% of providers turn 2.1.1: 100% of health Uganda data entrants to in coop tracking tools providers turn in coop x x care and strengthen their on time tracking tools on time provider Kampala capacity in data s management 10 quarterly 2.2 Total annual coop performance review 2.3. Support Coop reserve balance of at meetings held by board committees to least 3,000,000 Coop SW coop boards x x conduct quarterly 2.2.1: Self-assessment BOD Uganda Self-assessment review meetings scores by coop boards scores by coop average 95% boards average 80% 2.4. Quarterly planning meetings Coop between BOD 2.1.1 BOD, representative, 85% providers turn in 100% providers turn in health SW HUMC coop performance x coop performance care Uganda representatives, tracking tools tracking tools provider group leaders, VHT s parish coordinators and service providers 2.9. Facilitate MOH 2.2.4 to conduct semi- 1 MOH support field 2 MOH support SW x MOH annual field visits to visits conducted supervision visits Uganda health coops conducted 2.10. Conduct quarterly refresher 20 VSLA trainers’ training for VSLA capacity built on 2: 30,000 trainers to review Women SW implementation of cooperative members x x VSLA performance, groups Uganda VSLAs for health are WRA and increase trainers coop members skills on VSLAs for coop members O3: CDP partner collaborations outputs on lessons learned in coop health financing shared with MOH and partners 3.1. Conduct Coop biannual meetings 1 meetings BOD, SW with DHTs to share conducted to share health Uganda progress on health 1: 85,000 people x x health coop care and coop performance covered by USG performance provider Kampala and integrate their supported health s recommendations financing 3.2. Support 1 national arrangements X X MOH, Kampala UCBHFA to organize stakeholder UCBHF and conduct a workshop conducted 2: 30,000 cooperative A national community members are WRA Health insurance forum O 4: Health coop impact and strategies inform donor and CDO strategies, priorities or policies 4.1 Improving utilization of Report detailing Commission data for evidence- preventive health and independent based decision making MOH, treatment seeking assessment in at all levels. DHT, behaviors and health Uganda to measure IPs, US and impact result X health impact UPMB, Uganda comparisons indicators and Universi between health coop contributing factors ties and non-coop comparing coop and members non-coop members MOH, DHT, Report results will be DCO, 4.2 Use C of I shared using different DCDO, strategy to approaches with Health coop impact UCA, disseminate results different stakeholders strategies and lessons Care from impact to support their learned inform at least provider X assessments to awareness, interest, 1 donor and 1 CDO as s, inform donor and evaluation, and evidenced by reports UPMB, DCO priorities and adoption and/or or plans employe policies advocacy of coop r, school approaches and other groups O 5: Increased rate and percentage of female enrollment in health coops 5.1 incorporate GIDA results and MOH gender equity Coop Increased Female leadership in resource member representation of coop activities dissemination and X s, women on coop increases from 30% to discussions into provider boards 50% health coop events at s national, district and community levels DHT, 5.2 Integrate Increased inclusion Female leadership in DCO, activities to promote of women’s health coop activities DCDO, equal opportunity X X needs in district increases from 30% to District and gender equality health action plans 50% Plannin in coop action plans g Unit 5.3 Train and support Additional women in 40 new WRA to start leadership positions VLSAs with HSA with experience in Increased number of democratic decision female coop members SW X WRA and accountability and members who pay Uganda processes and premiums on time increased access to funds by WRA VIII. Communication of Innovation
Channel of Objective Dissemination Strategy and Indicator Progress Communication Deadline Toward Goals Level 7: USAID Washington: Their objective: Support the development and dissemination of cross sector strategies and solutions to key cooperative development issues that sustainably increase the ability of coops to meet member needs in changing environments Email. Meetings. Make it easy Test innovations and Semi- The Demonstration of for document lessons learned annual narrative impact. stakeholders through effective reporting and reports section of to learn and communication of efforts that include this report adopt allows key stakeholders to documentati includes strategies to move from awareness, to on of how detail on increase interest, evaluation, trial and communicat increased impact adoption. Dec. 2014, June ion was networking and Dec. 2015 and Aug. 2016 shared and activities what was and the learned for positive each level C results of I stakeholder Level 6: Cooperative Development Organizations, University of Minnesota and others, TBD. Their objective: increase the ability of coops to meet member needs; improve sustainable technical assistance strategies; and increase accurate data collection and use of data to build support for cooperative development as a sustainable, self-help business model across sectors. Prepare interactive Create Watch for and create Document # 1 CDO presentations to opportunities opportunities to share lessons of CDO activity: allow CDOs to for CDOs to learned and LEAD strategies activities First Annual practice new learn and in unique and interactive ways led, with National strategies linked to apply to build interest and make it theme and Cooperative existing IMPACT strategies that easy for CDOs to try. outcome Forum, Blog and OCDC leverage and Quarterly Examples include established meetings. increase Shark Tank presentation for where impact CDO feedback at IMPACT stakeholder meeting Feb. 2014 and video s continue presentation Sept. 10, 2014. to discuss their goals and strategies for next steps Level 5: Uganda Mission, Saving Lives at Birth, others TBD. Their objective: Reduce dependency, increase value for investment, increase access to quality health care with improved health outcomes while empowering women Email for Build 1. Share LEAD and 1. 1 site 1. 1 site visit international awareness, Collaborations project visit by from contact; phone for interest and activity schedule with Uganda Mission securing meetings. eventually Mission contact every Mission staff advocacy for quarter to offer site visits staff to 2. Mission Meet routinely with the health that support Mission an HP recommend presentations that coop model as learning priorities activity ations: HP use data to show a strategy to Quarterly 2. Docume to consider impact. empower 2. Share external ntation involving women, assessment plan and of other Share what is not increase consultant or partner Mission stakeholder working too. treatment scope of work for Mission recomm s such as seeking, input and endation central and Always improve health recommendations. s district personalize facility cost Request recommendations 3. Mission government information to recovery and to expand network to meeting staff in make it easy for support coop include gender notes future them to see data leadership that Implementing Partners. 4. Mission health relevant to their meets member Dec. 2014 recomm cooperative priorities in order needs 3. After contracting for endation trainings to respect their assessment, meet with s based and other time constraints. Consultant and Mission for on project their input just prior to assess activities. implementation. Invite ment Branding – their participation. Feb. results would be 2015 and appropriate 4. Share assessment results plans for to brand and updated dissemination sharing Kathel plan for results with them medical Mission for input and 5. Evidenc center with recommendations. July e that USAID logo 2015 LEAD as an 5. Request meetings at the results acknowledg Mission when US staff were ement of conduct site visits to used to the support keep Mission informed of inform received. progress and lessons one learned for their feedback donor and to request copies of and one any of their reports or coop recommendations that develop have been informed by ment LEAD investments organiza tion’s strategie s, priorities or policies Level 4: Uganda Ministry of Health (MOH), Ministry of Gender Labor and Social Development (MGLSD) and Health Policy and Advisory Committee (HPAC). Their objective: Increase Uganda’s private health sector ability to increase access to health care; strengthen coordination of all health stakeholders to integrate the health system; harness consumer power to advocate for better health care; ensure equal access to quality care. Phone calls for Share 1. Request a meeting and 1. Plan 1 plan securing meetings. strategies and share a presentation with develop developed. results for graphics to demonstrate ed and 3 events Provide brief input to make how health coops work impleme were descriptions of them more and how they benefit nted to attended by reports to highlight effective and members, providers and leverage MOH, how content is to support the community. Highlight project MGLSD and relevant to MOH stakeholder results and opportunities activities HPAC goals shared with adoption of that support their goals. to reports. promising Share ideas for partnership support practices. with these key MOH, Meetings to learn stakeholders for planning. MGLSD MOH priorities. Ask for input and and incorporate it. Dec. 2014 HPAC 2. Share project activities goals. quarterly and invite 2. # of HP stakeholders to speak at events key events. Quarterly attended 3. Follow up invitations to by gauge interest and adjust MOH, approach. 1-2 weeks after MGLSD each meeting. and HPAC Level 3: Uganda Community Based Health Financing Association (UCBHFA), Uganda Cooperative Alliance (UCA), and Insurance Regulatory Authority (IRA), Global Communities (GC). Their objective: increase the ability of leadership organizations to meet their member needs and to coordinate activities to leverage impact and reduce redundancy. Direct investment Support coop 1. Share project activity plans 1. # of HP 1 in UCBHFA stakeholders quarterly and invite events leadership. to develop stakeholders to speak at attended Coordination of partnerships key events. Quarterly by efforts through that increase 2. Follow up invitations to UCBHF meetings when their ability to gauge interest and adjust A, UCA, shared objectives meet member approach. 1-2 weeks after IRA and are identified. needs. each meeting. GC staff. Level 2: District Commercial Officer (DCO); District Community Development Officer (DCDO); District Health Teams (DHT); Implementing Partners (IP) including but not limited to Peace Corps, Healthy Child Uganda, Strengthening Decentralization Services, STAR SW, COVOID, SPRING, Integrated Community Based Initiatives, Save for Health, and others as identified. Their objective: Build sustainable local capacity to reduce maternal and child morbidity and mortality. Attend District Coordinate 1. Attend district health 1. Number 32 DHT, Health meetings to efforts to avoid coordination meetings with of DHT DCDO and share updates and redundancy, handouts that detail and IP staff coordinate efforts; leverage activities for the next DCDOs attended invite DCDOs to resources and quarter in terms that make who HP events. attend coop impact, it easy for partners to attend meetings like increase local identify opportunities to each AGMs. Take capacity of coordinate our efforts event. advantage of leaders to together. Quarterly 2. Number opportunities to create strong, 2. Create opportunities for of IP leverage sustainable local stakeholders to share staff resources and networks to positive stories that who increase impact meet their support female leadership attend through needs. and empowerment. HP partnership. Quarterly events. 3. Follow up invitations to gauge interest and adjust approach. 1-2 weeks after each meeting. Level 1: Local Health Coop Stakeholders1 including but not limited to Uganda Protestant Medical Bureau, Kampala International University, Makerere University, Uganda Martys University, West Ankole Diocese Coop, Mama Coop, North Ankole Diocese Coop, Archdiocese of Mbarara Coop, and Uganda Health Cooperative. Their objective: Increase access to quality health care with improved health outcomes. Increase provider capacity to manage reliable consistent sources of revenue to improve their services and impact in the communities they serve. Email for UPMB. Build local 1. Require each coop 1. Accurat 0 reports to Phone invitations stakeholder stakeholder to share a e coop date. Plans for meetings with capacity to coop financial and financial for linking providers and develop performance report as a and this coop leaders. sustainable condition for providing perform requirement Support their local financial support for AGMs ance to continued development of partnerships to in 2015. Dec. 2014 reports capacity action plans to meet their 2. Require each coop board are building meet their needs. needs in ever of directors to share a shared support are Check in and build changing coop financial and with under way. capacity. Carefully environments. performance report as a local select data to condition for providing coop share in graphs additional support and stakehol and reports to opportunities. Quarterly ders address their 3. Create opportunities for and priorities. Keep local coop stakeholders to included messages simple. share coop performance in results and positive stories HealthP that support female artners leadership and USAID empowerment with one reports another and with national leaders. Quarterly 4. Increase exchange site visits for learning and document impact. Quarterly
Annex A: Health Coops in the News and Other Publications
Medics Warn Uganda On Maternal and Infant Death Rates 24 Jun 2014 | Uganda | Source : llAfrica News: Uganda
Kampala — Maternal and new-born death in the country is expected to increase if Uganda does not address the challenges in the health sector which are compromising the public to Access Quality reproductive health services in the country
Medics say that although the number of women delivering in the health units country wide has improved but pregnant mother are being attended on by under qualified staff like the nursing Assistants who cannot handle emergency complication s during delivery which may lead to the death of both the mother and the new born baby.
Now medics are calling for the recruiting more professional mid wives and Universalization of reproductive health services across the country if the country is meet the millennium development goals targeting the reduction of maternal motility rate
Dr Namala Hanifar Ssegendo the chief of party at save the children Uganda said the quality of reproductive health most expecting mothers and the new born babies in the country are getting especially in the up country districts is still wanting.
"There's big gap in quality services delivery between urban and the rural areas where poor reproductive services are concentrated as compare to the urban most health units are manned by inefficiency and under qualified staffs like Nursing Assistants who cannot handle emergency reproductive complications , Government should come up with interventions to solve such imbalances in health services delivery" she explained. Namara made the comments during the Symposium on maternal and New born health organised by Makerere University Scholl of public health(MUSPH) in Kampala.
The objective of the symposium was to assess how the different community interventions such as community cooperatives savings, community insurance scheme can improves maternal health services delivery in the remote parts of the country, The medics also used the meeting to assess the positive impacts which the schools programmes like Maternal and Neonatal Implementation for Equitable Systems (MANIFEST), how it has helped in improving on the access to quality reproductive health services in most parts of the country where the programme is being implemented
MANIFEST programme is being implemented in Districts of Kamuli , Pallisa and Kibuku all in eastern respectively, According to the programme implementers, The programme has enabled the participating Districts to improve on maternal and new born health services Delivery
Dr Ahmed Bumba the Kibuuku District( about 179kilometers from Kampala city on the Eastern Uganda route ) Health officer said with the support of MUSPH the district has registered an improvement of 46% services delivery in offering maternal and new borne health service as compare to the 36% which the district was at before the MANIFEST programme was introduced.
Bumba Explained that MANIFEST programme has supported the health department in the district to carry out community education about maternal and new born health according to him this has changed people's minds sets especially the men towards accompanying their wives to health units for the Antenatal check ups
"Pregnant mother going for the ANC has gone up to about 48% this is good because it helps to save the lives of the unborn baby because when the pregnant mother come for the ANC with their Husbands they are also subjected to HIV test when we discover that their HIV positive then we enrol the mother to HIV related programmes that aimed at preventing the mother to child transmission of the HIV virus to the unborn baby "He said In the symposium, Medics advised Government to come up with community based innovations such as community health insurance schemes, Using transport vouchers system to easier the transportation of expecting mother to health Units, Presenting paper on save the mothers project(emergency communication and transport ) Dr Jolly Beyeza senior Gynaecologist said communities need to pool resources together and set up an emergency transport system which they can use in case pregnant lady experiences labor pain .
"One of the challenge most women in the rural areas are facing is the problem of transport most parts are not accessible due to poor infrastructure but if the communities pool out resources in one pool they can sign memorandum of understanding with private transport company or motor cyclists (Boda boda) which will be offering such services to the community instead of relying on Government Ambulances" she suggested.
Beyeza observed that the emergency transport system managed by the community has saved many lives in most parts of the country where it has been implemented especially in the central District of Kiboga (127.03kilometers from Kampala) she said before the introduction of such an initiative the District had the high maternal mortality rate but now the situation has been improved after the Association of Obstetricians and Gynaecologists of Uganda introduced the initiative in the district about five years ago.
According to the information available at the Ugandans population secretariat, Uganda's maternal mortality rate is now 438 mothers per 100,000 live births - higher than the 2006 rate of 435, these send bad signals on the chances for Uganda to achieving Millennium Development Goal 5 (MDG 5) of the United Nations (UN). The MDGs are international development goals set by the UN in 2000; MDG 5 aims to reduce maternal mortality to a quarter of 1990 levels by the target date of 2015. Uganda has a target of 131 deaths per 100,000.
On community health insurance scheme, Reproductive health experts say that if the scheme is implemented this can enable pregnant mothers to Access Quality reproductive health serves from both the private sector and Government Hospitals
Dr Nakiwala Stella Regina of the Health partners Uganda told the East African BusinessWeek that "There many private clinics and hospitals which can offer quality reproductive health services in the country however most of these institutions are expensive the only way to get such services is through women's in the communities forming cooperatives whose members can be insured this can help them to get quality reproductive health services from the private sector" she explained.
Makerere University School of Public Health Maternal and Newborn Health Symposium 2014 Health Cooperatives: Increased Access to Care Dr Nakiwala Regina Stella shared how Health Partners Uganda, a nationally registered cooperative, is helping communities establish health cooperatives in Western Uganda. This, she said, is done by empowering groups and providers to develop partnerships that meet their health needs. Training, tools and technical support are also provided.
Why Cooperatives for Health? They [Coops] empower members to improve their health; offer financial solutions to increase access to care; are 100 percent sustainable by local partners and; do not need reinsurance or subsidies
How do Health Coops work? • Groups sign MOUs with health providers • Members pay premiums and get ID cards • Members pay a small copay when they go for care • There is risk sharing • Not all members fall sick at the same time
Linking MNCH (Maternal Newborn and Child Health) to Cooperatives Between 2008 and 2012 implemented a project of malaria communities program with funding from USAID. The focus was on helping pregnant women and children. The following success was registered. The percentage of pregnant women using •long lasting insecticide treated nets (LLINs) increased from 5.5% to 51.9% The percentage of children under 5 using •LLINs increased from 6.5% to 42% •The percentage of pregnant women seeking antenatal care increased from 16.2% to 31.3% •The percentage of sick children who received malaria treatment within 24 hours of onset of fever increased from 1.1% to 29.5% 1.1% to29.5% Stop Burial Groups, newspaper coverage.