No to touch the hard currency

Healthcare financing helps the expansion of healthcare services coverage and meets the SDG’s goal of universal health coverage. Sharing the cost of healthcare services among society is also another benefit of healthcare financing.

To achieve the goal of attaining Universal Health Coverage (UHC), the government of Ethiopia introduced two types of health insurance schemes; the Social Health Insurance (SHI) scheme and the Community-based Health Insurance (CBHI) scheme. The CBHI scheme is currently implemented in over 870 Woredas with over 40 million of people and over 8 million households are enrolled in the scheme. Health insurance financing in Ethiopia faces has many challenges.

Poor quality data with poor analysis led to poor decision. This idea could be explained inability to well-forecast healthcare expenditures; ineffective the redistributive capacity of collected available funds. Undigitized with poor management of information will end up with, inaccuracy –high risks of errors and missing data, unstandardized workflows, Poor evidence-based decisions, Low transparency, ineffectiveness and inefficacy and with low testability of the program.  

The current practical challenges of data management in Ethiopia among other LMDC countries to implement health insurance are : 

• Community or village representative collect the plenty of money from community in cash in hand
• To deposit the money in health insurance’s bank account, premium collectors must move long distance with transport cost, time consuming, risk of losing
• Collectors are not depositing the money on time
• It is tough to know money at the hand of collector, unless community let know the district, usually when they need health service.
• Collecting money in cash is high risk to be exposed to fraud (there is an experience that the collectors use the money for their own business)
• Beneficiaries are not getting health care, due to high delay to deposit the money (they are not illegible till deposited)  
• Since delay to deposit schemes are would face shortage to pay for health care provider for service given
• Health provider and scheme will be in difficulty to identify beneficiaries entitled to use service
• Working in manual will burden the scheme, beneficiaries, providers for claim processing, identification with high administrative coast 

To overcome these challenges, a well-responsive and comprehensive management information system is vital. One of the solution and need digitalizing is banking  system. 

The solution  digitalizing to link banking system with health provider in a way : 

1. Community open independent blocked bank account in which they deposit throughout the year head of premium collection period.

2.  Contractual agreement will be signed between the of the three (Health insurance scheme, beneficiaries and the bank)

3. As per agreement and responsibility given, the bank will transfer money to Health insurance account by default at the time of premium collection 

4.  Health facilities, scheme and bank are linked to the system  to exchange information   

5. At the time of money transfer beneficiaries are notified the amount and to which account it transferred, by massage  

6. Health facilities are linked to the system will check eligibility of beneficiaries and provide service  

The target population for the solution are  health insurance beneficiaries, health insurance premium collectors, professions working at health providers and at schemes. currently, they are underserved in the following ways 

• Community or village representative collect the plenty of money from community in cash in hand
• To deposit the money in health insurance’s bank account, premium collectors must move long distance with transport cost, time consuming, risk of losing
• Beneficiaries are not getting health care, due to high delay to deposit the money (they are not illegible till deposited)  
• Since delay to deposit schemes are would face shortage to pay for health care provider for service given
• Working in manual will burden the scheme, beneficiaries, providers for claim processing, identification with high administrative coast 

In General the solution will

• Easy for community to deposit their premium throughout the year and minimize cost burden as they are ready a head 
• Avoid house to house movement to collect premium. So that will minimize burden of collectors 
• Minimize coast of administrative like printing coast of receipt voucher, expense for rounding home to home, the solution saved about 32 million birr yet. 
• Improve saving culture of the community 
• Improve Efficiency of the program 

while working on health insurance program Me and my team passionate to solve challenge community, the scheme and health providers are facing in information management. We engaged the health insurance scheme (major stockholder), health care giver, community and bank as of designing, inception and through out the journey. throughout the journey all stockholder impute is valued and amendment to the system would be made if reasonable. To collect inputs there is brain storming platform, community discussions, supportive supervision, follow-ups and feedbacks system.

The current challenge to expand the solution is financial barrier only. I hope challenge will help us to by complementing in straggling to overcome financial barrier. Not only financial may support us in technical skills 

We never heard/see such program in our country or Glob. Besides the solution highly accepted by consumer as it benefit in reduction of job burden, easy, save resource among plenty of benefits. As we tried to explain its benefit and high acceptance from users, we  surly expect it to change the market or enable broader positive impacts from others

Next year, pilot will be finalized the initiation of expansion will happen. For next five year the expansion will cover through the country. To achieve our goal robust promotion, communication and marketing will be conducted by supporting with demonstration. For promotion tick tank group will be established     

We will measure and evaluate based on goal set

• How the solution saved resources (how time, finance, energy are saved)
• How fraud is reduced
• How much quality of data produced?
• How information management system strengthened
• How efficiency the system is
• How is the acceptance of the solution in community, organization?  Are few among others 

The current massage and software pilot solution will end up AI system. To arrive it long goal different strategies will be developed, continues discussion, brain storming, feedback and linkage with stockholder will be priority. Every lesson will be documented in away for feature leaning. Input, output, out-come and impact level indicators will be designed and evaluated continuously. Based on our indicators corrective measure will be taken. Our moto is “our mistake is our university”.   

Our solution uses SMS technology, software which is easily applicable, feasible and accessible. We envisioned to upgrade to AI system 

Collection of data is linked with existing system but it may need some input like man power, computers, Internet consumption, capacity building 

Yet the solution is at infant age which will expand and consider to assure diversity, equity, inclusiveness. The solution will have guidance document to insure the team members whether consisted gender mixing, cultural, locality and diversity in discipline, geography, among money criteria. 

Our source of financial uses social enterprise business models. Since there are no shareholders as it is non-profit organization, yet financial source is from Health insurance scheme. Based on lesson from the pilot going forward we will decide the model. As of today’s lesson, the modal might be Mix of Revenue Sources as a Model. Our model may include small and major donors, foundations, corporate support, and government grants, among many options.

Though yet we couldn’t narrate in concrete, as our model is “social enterprise business models” we will use all possible opportunities, methods and acting on lesson from pilot. Our model may include small and major donors, foundations, corporate support, and government grants, among many options. From experience so far, the solution is acceptable at scheme, bank, community and health facilities. So that the solution will be promoted to any potential source of fund

So far health insurance scheme covers all the financial expenses, as we provided the solution free of any cost