Cordaid-IICD Health Programme Uganda:Health Management Information Systems as a Tool for Organisational Development\ud

A Health Management Information System (HMIS) can be a powerful tool to make health care delivery more effective and far more efficient. This paper describes how an HMIS can also be used for organisational development and reports on the experiences of the HMIS programme of the Uganda Catholic Medical Bureau (UCMB) in Uganda. The programme forms part of a larger programme on ICTs for health in Uganda, Tanzania and Zambia and is supported jointly by the International Institute for Communication and Development (IICD) and the Catholic Organisation for Relief and Development Aid (Cordaid). The goal of the paper is to evaluate the project against a background of organisational development and to draw practical lessons from the project that may provide guidance to new HMIS projects in the development context.\u

A matter of trust:clients' perspective on health and health insurance services in Ghana

Dit participatieve actie onderzoek (PAA) betreft percepties en ervaringen van zorgklanten van het National Health Insurance Scheme (NHIS) in Ghana (2011-2014). Het beantwoordt de onderzoeksvraag: Wat drijft zorgklanten gebruik te maken van de gezondheidszorg en het NHIS? De onderzoeker voert individuele en groepsgesprekken onder 223 zorgklanten en gebruikt een gestructureerde vragenlijst onder 1903 huishoudens in hun eigen context in Greater Accra en Western Regios. De data toont verschillen in de betekenis en waarde (Explanatory Models) die de zorgklant, de zorgverlener en het NHIS toekennen aan ‘ziekte’ ‘behoefte aan zorg’, ‘kwaliteit van zorg’ en ‘de rollen van ieder in de zorg’. Het negeren van deze verschillen in EMs kan leiden tot assymmetrie in communicatie, onbegrip en verminderd vertrouwen. Daarnaast toont het onderzoek dat sociaal kapitaal* in een gemeenschap een positieve werking heeft op deelname aan het NHIS. Echter, sociaal kapitaal is niet statisch en varieert per gemeente door ontwikkelingen in de samenleving en ervaren kwaliteitsverschillen in de zorg. Vertrouwen is onlosmakend verbonden met EMs en sociaal kapitaal en fundamenteel in keuzes die zorgklanten maken. Het gemeenschappelijk ontwikkelen en testen van de interventie MyCare demonstreert dat klanten een belangrijke aktieve rol kunnen spelen in de beoordeling en verbetering van zorg. Resultaten tonen tevens dat communicatie en onderling vertrouwen tussen zorgverleners, NHIS en klanten hierdoor verbeteren. De PAA blijkt essentieel bij het verkrijgen van inzicht in besluitvormingsprocessen en interactie van mensen in de complexe context van gezondheidzorg. Ook draagt het bij aan het genereren van draagvlak voor verandering onder belanghebbenden. *Note: Horizontaal sociaal kapitaal is gebaseerd op sociale cohesie, dat vertrouwen faciliteert en aanzet tot actie. Vertikaal sociaal kapitaal is gebaseerd op relaties met formele instituties (i.e. zorginstelling en verzekering

Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana

Aging in Sub-Saharan Africa causes major challenges for policy makers in social protection. Our study focuses on Ghana, one of the few Sub-Saharan African countries that passed a National Policy on Aging in 2010. Ghana is also one of the first Sub-Saharan African countries that launched a National Health Insurance Scheme (NHIS; NHIS Act 650, 2003) with the aim to improve access to quality health care for all citizens, and as such can be considered as a means of poverty reduction. Our study assesses whether premium exemption policy under the NHIS that grants non-payments of annual health insurance premiums for older people increases access to health care. We assessed differences in enrollment coverage among four different age groups (18-49, 50-59, 60-69, and 70+). We found higher enrollment for the 70+ and 60-69 age groups. The likelihood of enrollment was 2.7 and 1.7 times higher for the 70+ and 60-69 age groups, respectively. Our results suggest the NHIS exemption policy increases insurance coverage of the aged and their utilization of health care services

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana:Results from a randomized experiment

Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured

Core health-components, contextual factors and program elements of community-based interventions in Southeast Asia:a realist synthesis regarding hypertension and diabetes

Abstract Background In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia. Methods A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements. Results We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice. Conclusions We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context