Under the Community Health Financing (CHF) program, we promote community health insurance (CHI), organise communities to actively participate in running the formed CHI schemes, and advocate for the inclusion of CHI schemes in local and national-level systems to enable families enjoy quality health care services without facing financial hardships. Our focus is in two areas:
- Improving access to quality health care facilities and services
- Protecting families from catastrophic health expenditures
There are 93 running CHF schemes formed by SHU at parish level in the districts of operation.
1. What we do to improve access to quality health care facilities and services
- We organize communities into formal groups operating at parish level known as CHI schemes. Each group sets up structures and elects leaders to run the new structure. Through this structure, families meet to discuss issues related to their disease burden, health care services availability, organization and quality.
- We facilitate negotiations between health care service providers (of quality) and organized communities. New communication channels are established through which both parties participate in the others’ activities. Through this channel, communities give feedback to service providers on the quality of services they offer, as well as on their felt needs that the service providers should make available and accessible. The service providers use the channel to provide information and updates to the communities on the services available. The providers use the channel to give answers to complaints by patients who leave dissatisfied.
- We prepare and facilitate the formalization of relationships between interested health care service providers and interested communities done by signing partnership and service contracts.
- We follow up and accompany the collaboration of service providers and organized communities. We participate in follow up meetings to support the growth of the partnership and respect of the contracts.
- We provide technical support services by doing medical audits and satisfaction surveys. The findings are used as feedback to each party to act in areas where weaknesses are identified.
- We sensitize communities about saving for health care.
- We conduct patient-centred awareness trainings to health care service provider staff and to community members. We do this to address bad reception which is the commonest reason for low utilization of health care.
The types of community health financing schemes we are promoting
We promote two types of CHF schemes:
a) Member-managed: The schemes are managed by members themselves through the democratically elected leaders and technical persons in the networks of schemes.
b) SHU-managed: The schemes are managed directly by SHU on behalf of the members after a formal agreement is signed stipulating the terms and conditions of collaboration. The members are actively involved in the governance of the scheme.
What we do to simplify premium payments into schemes for families
- We partner with local micro-lending institutions to extend low interest loans to families in the schemes for income generating projects and charge a scheme premium that is transferred to the scheme once recovered.
- We support communities to create and run Village Health Savings and Loans Associations (VHSLAs) and link them to existing CHF schemes. Through the VHLSAs, members are able to pay premiums on a weekly basis alongside their other savings. Because of this arrangement, families are given identification cards prior to full payment of the premiums and are able to access health care throughout the year.
- We give financial education to the target communities and encourage them to save individually or with the scheme. When the premium payment window is opened, families are given up to a period of 3 months in which to pay the premiums and not feel the burden of paying a lumpsum amount.
2. What we do to protect families from catastrophic health expenditures
- We educate families about health related risks, diseases, and how to manage cases of illness. This we do through health education.
- We educate families about health insurance principles and schemes.
- We support communities to create and run community health insurance schemes. Through the schemes, families reduce payments out-of-pocket at the point of service. For this, we do social marketing campaigns and capacity building for active participation in managing the insurance schemes.
- We mobilize and avail subsidies to poor families. This enables the majority of the families to enrol into the Insurance schemes.
How CHF schemes protect families from catastrophic expenditure
By design, the protection of families is at two levels:
- Scheme level: At this level, the scheme covers a patient up to an agreed amount (ceiling) per episode of illness.
- Union of schemes (network) level: At this level, the union covers a patient for the bill amount above the scheme ceiling up to an agreed amount (ceiling) per episode. This is only applicable if the bill exceeds the amount covered at scheme level.
The models of community health financing schemes we are promoting
We promote three models of community health financing schemes:
- Pure Insurance Schemes: a member contributes a copayment to receive services. The rest of the bill is paid by the scheme up to an agreed ceiling.
- Pure Credit Schemes: a member receives healthcare services from a contracted provider on credit. The scheme pays the bill and money is later recovered from the member.
- Mixed Insurance and Credit Schemes: a health care bill is paid partly under insurance and partly under credit.
- Family savings for health care: A family is required to save and maintain a minimum amount earmarked for health care. Once withdrawn, the family is required to replenish the account. The scheme in this arrangement does not require a family to pool with others but instead, it keeps the savings and clears the medical bills on behalf of the family.
Our strategies to sustain the CHF schemes and benefits
We support all schemes in each region to federate and work together under one technical network called a union. Every union has a team of staff at its secretariat who perform the technical roles of schemes including oversight in financial management, purchasing health care services and capacity building of scheme leaders. Schemes progressively contribute towards the operations of the unions to wean them from donor dependence to locally sustainable institutions. Currently, there are three unions of schemes:
- Munno mu Bulwadde Union of Schemes Organisation (MBUSO) which brings together all schemes in Luwero, Nakaseke and Nakasongola districts.
- Western Ankore Tweragurize Schemes Association (WATSA) which brings together all schemes in Bushenyi, Sheema and Mitooma districts.
- Mubende Schemes Cooperation Mechanism (MSCOM) which brings together all schemes in Kassanda and Bukuya sub-counties in Mubende district.
Advocacy for a universal National Health Insurance Scheme in Uganda
We support the process of enacting a fair health insurance law to create an enabling environment for all people living in Uganda to equitably access quality health care services as per their needs, and without facing financial hardships. This we do through developing position papers in partnership with other civil society organisations, media programs, and holding meetings with policy makers at different levels. We hold meetings with different stakeholders to harmonise positions on the proposed National Health Insurance Scheme (NHIS).
At the local government level, we engage district leaders on supporting CHF schemes and advocating for introduction of a national health insurance scheme. All our advocacy activities are guided by an advocacy strategy.