Stre@mline Ubuntu

According to the World Health Organisation (WHO) Universal Health Coverage Report (2019), 15 million Africans are pushed into extreme poverty each year due to catastrophic out-of-pocket expenditures. 

In Uganda, 98% of the population has no health insurance which exposes people to catastrophic out-of-pocket expenditures. There is no national health scheme plan for Uganda at the moment. Uganda has a population of 44 million people, (70%) of whom live in rural areas. These problems affect the rural people more severely, especially the women and children. 

According to the WHO report, 30% of the households in Africa borrow money to pay for healthcare. 15 million people are pushed into extreme poverty every single year due to out-of-pocket health expenditures and an estimated 1.6 million people die due to lack of access to affordable health services. 

Community-based health insurance schemes/ health cooperatives have been adopted as a way to enable rural underserved communities to access health coverage. The majority of the people in rural communities belong to at least 1 affinity group eg. women, savings, investments, burial, work associations, teachers, farmers, etc. Leveraging this social solidarity, people pool money together to access healthcare from hospitals in their proximity. 

Community-based health insurance schemes/heath cooperatives have been shown as a proven model to enable rural communities to access affordable health care in Rwanda, Ethiopia, and Brazil. 

However, these schemes usually have inadequate capacity for management, strategic planning, and finance management. Fraud and lack of transparency and efficiency undermine their growth and scale. 

Stre@mline is a digital platform powered by artificial intelligence that facilitates community health insurance by enabling rural groups to pool resources together while providing hospitals with the technology and tools to provide affordable health coverage to the groups in their communities. 

Stre@mline Ubuntu digital platform has 4 components:

1. An Electronic Medical Records (EMR) system that cover all aspects of the patient journey while delivering key patient safety prompts to clinicians. The EMR provides data that powers our business intelligence platform.

2. Scheme administration platform used by hospitals to manage all scheme operations including member registration, identification using barcodes and fingerprint scanners to avoid fraud, claims management, reporting, etc.

3. An Unstructured Supplementary Service Data (USSD) enabled mobile application that enables community groups/individuals to enroll, save money, and pay premiums with mobile money in flexible installments.

4. A business intelligence analytics platform powered by artificial intelligence that is key for keeping costs manageable and for health promotion. Artificial intelligence supports pattern analysis, uncovering useful epidemiology trends to target health promotion and minimizing costs, forecasting usage of resources eg. medicines, and staff; key for planning and identifying potential cost savings opportunities and fraud detection.

Our solutions target rural not-for-profit healthcare facilities and the communities they serve.

There are 1,008 not-for-profit healthcare facilities in Uganda whose mission is to provide care at a low cost to vulnerable people. These not-for-profit hospitals usually find themselves in debt as they receive so many patients who are not able to pay for the subsidized healthcare they offer. When a non-for-profit healthcare facility runs a community scheme, it increases its source of funding and reduces its debt. 

There has been published studies that show how hospitals are more sustainable because of community health schemes. “Kisiizi Hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme."- Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage:  Sebastian Olikira Baine; Alex Kakama and Moses Mugume

Our solution targets rural underserved communities that are usually left out of insurance programs because they do not have formal employment or salaries to access traditional insurance. The daily average wage for families in the rural locations of Uganda is $2. 

An independent report done by the Economist magazine showed that the insured are healthier and their finances, too. Reference: The Economist magazine.

Members of a community health scheme save and pool resources together, hence get health coverage that enables them to access affordable healthcare. This prevents catastrophic health expenditures in case of a health emergency. Otherwise, families would sell their assets especially land which pushes them into the vicious cycle of poverty.

Independent studies have been done by researchers at the University of Bonn in Germany. These were the results:

a)    In children under 5 years of age, 1 year of a household’s participation in community-based health insurance was associated with a 4.3 percentage point less probability of childhood stunting.

b)    Enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%

c)     A hospital’s involvement in the scheme increased the source of funding and reduced the debt burden.

Find references at: https://streamlinehealth.org/benefits-of-community-health-insurance-schemes/. These results demonstrate universal health coverage in action.  In addition, they demonstrate how Stre@mline increases the resilience of the target households.

We have credible combined experience working in healthcare in resource-poor settings. We are a multi-disciplinary team with medical, finance, technology, insurance, and social science skills. All our team members have experienced first-hand the catastrophes of out-of-pocket health expenditures. 

Samuel Mugisha, the project lead, has spent the last 13 years building and deploying e-health and m-health applications in low-resource settings in East Africa. He holds a master’s degree in advanced computer science from the University of Manchester, UK. Samuel was born and raised in rural Uganda. At the age of 5, he had a near-death experience, when he suffered malaria, fell unconscious, and couldn't access a doctor for 2 days. This near-death experience always awakens his desire to make a difference to many who are in his shoes today. 

Daniel Oporia, the head of Community Mobilisation, has spent the last 6 years working in rural communities with companies including Fenix International and Watu Credit selling solar and finance solutions. He spends most of his time in the communities mobilizing them and understanding their needs. 

Jacqueline Katongole, the monitoring, and evaluation officer has more than 15 years of experience in Monitoring and Evaluation. She previously worked on monitoring of US-funded projects like PEPFAR and M2M. She holds a master’s degree in public health and a postgraduate certificate in monitoring and evaluation.

Moses Mugume, the Hospital onboarding officer,  was the founder of the Kisiizi Community Health Insurance Scheme in 1996 and works as a Senior hospital administrator at COU Kisiizi Hospital. Moses holds an MBA University of Caledonia Glasgow (UK).

Maleen Atugonza holds a bachelor’s degree in accounting and finance and has experience managing local and international funding. 

Angella Mbabazi Arebahona holds a bachelor’s degree in information systems and has experience with stakeholder engagement and product management of more than 3 years.

Our technical team comprising of Douglas Kabuye, Brian Nsubuga, and Ronald Katerrega are full-stack mobile app developers who have spent the last 8 years developing e-health software applications in Uganda.

Our solution is at the growth stage. We started working on this solution in 2018 and did a pilot at 1 hospital. We then did pilots at 2 other hospitals between 2019 and 2022. 

In 2022, Stre@mline Ubuntu was awarded USD 350,000 from the Swiss Re Foundation after winning the 2022 Entrepreneurs for Resilience Award, 2022, a global competition that attracted 264 applications from 81 countries worldwide. 

Today, Stre@mline Electronic Medical Records software is in use in 56 health facilities in Uganda. 6,500+ healthcare workers use the software daily and the software has more than 1.8 million electronic patient visits captured on the system. 

Our scheme administration is in use in 14 hospital schemes all over Uganda. 57,000 community members have accessed health coverage through our solution.

We would like to get more partners who can help advance our solution. 

We would like specialist advisory support to build an organisation and deliver impact at scale in a resource-poor context like ours.  

We would like to be part of a network of like-minded founders. 

We would like to get more media publicity and exposure. 

We would also like to get more support on impact measuring and monitoring. 

We also would like to raise more funds.

8 full time, 3 part time

6 years

Our recruiting policy is based on merit. We advertise on national recruiting platforms where the general public can access the job adverts and apply. Candidates go through several interviews to pick the best fit for the job. Our dedicated Human Resources office works with other team members to ensure that there is no bias in the recruitment.

We have a robust onboarding process that ensures that every member fits in their role well and gets all the support they need to perform at high levels.

We have a warm family-like culture where members care for each other professionally and even personally.

We leverage a Software-as-a-Service business model for our software digital platform. Hospital pay an annual subscription fee to access our software. This ranges from USD 800 to USD 10,000 per year depending on the size of the hospital.

Hospital schemes using our scheme administration platform pay monthly fees depending on the size of the scheme.

We also charge a service fee $1 per year for every member of the community scheme using our digital platforms.

These revenue streams will support our work for sustainability.