Community Health Financing (CHF)

What we do to protect families from catastrophic health expenditures

1. We educate families about health-related risks, disease prevention and how to manage cases of illness. This is done through health education.
2. We educate families about health insurance and functioning of CHI schemes.
3. We support communities to create and sustainably run community health insurance schemes. The schemes help families to reduce out-of-pocket payments at the point of accessing the services. This is also done through social marketing campaigns and members’ capacity building for active participation in managing the health insurance schemes.
4. We link families to partner Micro-Finance Institutions to access low-interest loans to start, boost their income generating projects and also pay their premiums.

How CHF schemes protect families from catastrophic expenditure

Families pay premiums to the scheme and form a single pool at a regional level. The scheme leadership with support from Save for Health Uganda contracts health care provider to offer medical care to members. Families are issued ID cards that enable them to access medical care at the contracted health care providers with out being made to pay. The scheme leaders verify and pay medical bills presented by the contracted health care providers based on the service contracts. Members of the scheme use the pooled funds to access medical care depending on need irrespective of the amount contributed by the family. This promotes equity in accessing services and cross subsidization hence protecting vulnerable families from incurring catastrophic healthcare expenditures.

Our strategies to sustain the CHF schemes and benefits

We support all sub-schemes in each region to federate and work together under one technical network called a SCHEME. Every scheme has a team of technical staff at its secretariat who perform the technical roles of schemes including oversight, financial management, purchasing health care services and capacity building of scheme leaders. Schemes progressively contribute towards their operations to wean them from donor dependence to become locally sustainable institutions.

Currently, there are five schemes:

1. Munno mu Bulwadde Union of Schemes Organisation (MBUSO) which brings together all schemes in Luwero, Nakaseke and Nakasongola districts.
2. Western Ankole Tweragurize Schemes Association (WATSA) which brings together all schemes in Bushenyi, Sheema and Mitooma districts.
3. Munno Mu Bulwadde Schemes Cooperation Mechanism (MSCOM) which brings together all schemes in Mityana and Kassanda districts.
4. Central Regional Urban Munno Mu Bulwadde Schemes-Luwero (CRUMBS-L) for corporate and organised groups in Luwero, Nakaseke, Nakasongola and Masaka districts.
5. Busoga Region Association of Tweidandhabe Schemes (BURATS) which brings together schemes in Iganga, Bugweri and Mayuge districts in Eastern Uganda.

What we do to simplify premium payments into schemes for families

1. 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.
2. We give financial literacy 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 three months in which to pay the premiums and not feel the burden of paying a lump sum amount.

What we do to improve access to quality healthcare facilities and services

1. We organize communities into formal groups operating at parish level known as CHI sub-schemes. Each sub-scheme sets up structures and elects leaders to run it. Through this structure, families meet regularly to discuss issues related to their disease burden, health care needs and availability of quality services.
2. We facilitate negotiations between contracted health care service providers and sub-scheme members. New communication channels are established through which both parties participate in the others’ activities. Through this channel, communities give feedback to healthcare 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, updates to the communities on the services available and also to give answers to complaints raised by patients who leave dissatisfied.
3. We prepare and facilitate the formalization of partnerships between selected health care service providers and the schemes done by signing service contracts.
   1. We follow up the implementation of service contracts by both healthcare providers and the schemes. We participate in follow up meetings to support the growth of the partnership and respect of the service contracts.
   2. We provide technical support services by doing medical audits and satisfaction surveys. The findings of these surveys are used as feedback to each party to act in areas where weaknesses are identified.
   3. We lobby for establishment of client relations desks aimed at improving reception of clients and addressing clients’ complaints regarding quality of services offered at the contracted Health Care Providers.
   4. We conduct patient-centered care trainings, patient rights and responsibilities 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.

Advocacy for a universal National Health Insurance Scheme in Uganda

We support the process of enacting a fair National Health Insurance Scheme 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 organizations, media programs, and holding meetings with policy makers at different levels. We hold meetings with different stakeholders to harmonize 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. With support from Save for Health Uganda, Luwero district council passed a resolution to establish a district wide health insurance scheme. This resolution will help the district authorities to implement the schemes in the district which will work as a pilot for government to roll out the National Health Insurance Scheme.