Healthpartners Enhanced Collaborations Project Semi-Annual Report July-December 2014 OAA-A-11-00010
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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.