27 questions about the eQuality Health Bwindi

schemeBwindi Community Hospital December 2009

Introduction

Bwindi Community Hospital is about to start working together with International Medical Foundation (IMF) to start a health scheme for the people of Kayonza, Mpungu and Kanyantorogo sub-counties of Kanungu District, Uganda

The scheme will benefit an estimated 60,000 people

Bwindi Community Hospital

Located in Kanungu District, Uganda Church of Uganda Hospital. Private-not-for-profit Highly donor-dependent (largely small

donations, with a few larger partners) 120 staff, including 5 doctors 200 village health promoters working with the

Hospital – one in each village Annual Report and more information is online at

www.BwindiHospital.com

Bwindi Community Hospital

Vision: “A healthy and productive community, free

from preventable disease and with excellent health services accessible to all”

Bwindi Community Hospital

Services:Outpatients, dental and eyesAdult inpatients and diagnosticsSurgeryChild HealthCommunity Health & BatwaHIV/AIDS & TBSexual and Reproductive Health

Kanungu District

South West Uganda95% of households are subsistence

farmers10 hours from KampalaHilly terrain with lots of rain and muddy

roads

1. What is the eQuality scheme?

At the moment patients pay a fee for service at Bwindi Community Hospital. So if someone is admitted with pneumonia they pay an admission charge and a charge for drugs

With a health scheme people pay in advance for care. And they pay a flat fee – the same amount for everyone. When they need to come to Hospital they don’t have to pay for drugs or care. They have already paid in advance.

2. What are the advantages of a Health Scheme?

Fee for service Health schemeHow much to pay?

Unpredictable amounts

Fixed annual payment

When to pay? Pay when sick Pay when wellIf you don’t have money?

May go into debt for large amount

No large debt

Responsibility Hospital taking responsibility

Community responsibility

Power Passive recipients of care

Powerful consumer body

2. What are the advantages of a Health Scheme?(2)It provides a sustainable source of income

to the Hospital from the community

3. Who are IMF?

International Medical Foundation is part of International Medical Group, which also runs International Hospital, Kampala

IMG have experience of delivering quality health care, and also own the health insurance organisations IAA and Microcare

This scheme has been given the name eQuality Health Bwindi

eQuality, the Hospital and the Community

Community

Pay annual subscription for all Bataka members to…

eQuality Health Bwindi

Contract with and pay monthly payments to…

Provide services to…

Bwindi Community Hospital

International Medical Foundation

Financial support and performance management

4. eQuality? Why?

‘Quality’ because Bwindi Community Hospital and IMF have entered into a partnership to ensure quality health services

‘Equality’ because all people are given an equal opportunity to join the scheme at a price that is affordable to all

The ‘e’ in eQuality shows that we are using modern electronic technology to collect information and measure the impact of the scheme

5. Who pays who?

The community make payments to eQuality Health Bwindi

Bwindi Community Hospital (BCH) provides services to patients

eQuality Health Bwindi pays BCH according to the delivery of quality standards. Payment is per capita – the Hospital gets a fixed amount per person per year (estimated at UGX 12,000)

6. How much will membership cost families to buy?

Everyone aged 5 or over will pay UGX 6,000 ($3) a year to join the scheme

They will make these payments through their Bataka groups (burial societies) who are used to collecting and saving money

The Bataka has collect money from families and will make the payment to eQuality Health Bwindi for all members at the same time

Children under 5 years will have their premium paid as part of the Child Health Access Project (CHAP), so will not be included in this at the moment

7. CHAP?

This is the project being funded by the Eurochange Charity.

This project was initially for one year, but we are negotiating extending it to three years, and possibly even beyond

It pays the costs of care for about 8000 children under the age of 5 in Kayonza and Mpungu

8. What will membership of the scheme entitle a person to?

Members can able to access most emergency and routine outpatient and inpatient health care at Bwindi Community Hospital including admission to the Hospital, investigations, drugs, eye care, dental services and specialist clinics

Care provided on outreach and at Byumba Health Centre II is covered

Some operations that can be performed in Bwindi (like hernia repair) will be covered

9. Will there be any other charges

Yes, there will be a small charge each time someone uses the service of UGX 1000 (UGX 500 for Batwa and children under 5).

10. Why?To encourage people to only use the

service when they are sick

11. So – antibiotics, multivitamins, x-rays and blood tests for all?

No, it will be very important that the Hospital only gives people medicines that they absolutely need, and keeps investigations to a minimum.

The scheme will fail if over-prescribing and over-investigation happen.

One of the quality standards of the scheme is to reduce unnecessary prescribing

Sometimes people will come to the Hospital and will leave with no medicines, if medicines are not deemed necessary

12. Is there anything not included?

Yes, there are some exemptions: Maternity care and HIV care are provided for

under other schemes within the Hospital, so are not covered under this one

Operations not provided in Bwindi and referral costs are not covered

Expensive drugs like rabies vaccination are not covered

Cosmetic dental work is not covered

13. How do I join? Individuals and families cannot join – you can

only join as part of a group. More than 95% of people in the area are

members of Bataka groups. When the Bataka pays the annual payment for all of its members they can all join

The Bataka head will bring payment to the eQuality office in Bwindi

We should already have your details including your fingerprint. We will just stamp your green book to confirm that you are a member

14. Can someone pay in instalments?Groups can decide for themselves how to

collect payments

15. If a person is not covered will they still get care?

They will still get health care, but their bill is likely to be very large. Our bills will be for the actual cost of care

For example, the average admission to adult ward including drugs and the cost of staff actually costs the Hospital about UGX 150,000 We will charge all of this to uninsured people

Except in the case of life-threatening emergencies, payment will be before seeing a doctor or clinical officer for un-covered people

16. Will staff of BCH have to buy membership for their families?

Staff and their family members who are not part of a Bataka group will have to form a group for payment, as will other people who work in the Bwindi area

We think that staff who are already part of a Bataka group should show leadership and make payments through their Bataka, otherwise it may seem unfair.

Staff will be able to get a refund from the Hospital for the payments that they make for themselves and their immediate families

17. If I pay and don’t use the Hospital, will I get a refund?No. Some people will incur costs of more

than UGX 200,000 and some people will not incur any costs.

This is known as ‘pooling risk’ – the risk of payment is shared among the whole community

18. Will UGX 10,000 per person per year cover all of the costs?

No. Even if 30,000 people join the scheme then they will contribute

30,000 x 6,000 = 180 million per year

The OPD, Surgery and Adult wards in the Hospital will cost more than UGX 500 million to run this year, and we expect them to cost more next year

19. So where will the rest of the money come from?

GrantsGovernmentDonations

20. Who will run eQuality in Bwindi?There will be an eQuality office at the

Hospital with one employeeThis person will collect money on behalf of

the scheme, and will make payments to the Hospital.

This person will also monitor the quality of the Hospital

21. Quality of the Hospital?

Availability of doctors and clinical officersAvailability of drugsPatient satisfactionAccess to care for the poorestWaiting times for operations

All of these things and others will be measured, and the Hospital will only be paid if it is providing high quality care

22. How will the data be captured?

Bwindi Community Hospital already has a population database containing demographic and health information about every person and family in the area

When people join the scheme their membership will be reflected on this system

Fingerprint recognition will be used to confirm identity

22. How will the data be captured? (2)

Every someone uses the Hospital their disease and their treatment will be recorded

GPS coordinates will be used to monitor uptake of the scheme and use of the Hospital

Poverty measurements including income, water and sanitation and food security have already been made

Household data will be updated through an annual household survey

23. Will International Hospital be making a lot of profit from this?No, this will cost them money at the start

(they will make a loss that they will have to raise money for).

The aim is that in the long-term this scheme breaks even (neither make a profit or a loss)

24. So why are International Medical Foundation making an effort to work with Bwindi?

Because they share our vision of:A healthy and productive community, free from preventable disease, and with excellent health services accessible to all

Because they want to learn from this scheme and try to replicate it elsewhere

25. When does all this start?

By the end of December all people in 4 parishes of Kayonza will be registered onto the population database

Children under 5 are already using the scheme

Bataka groups can start paying premiums in January 2010 and using the scheme in February 2010

26. What else needs to happen? The Hospital needs to continue the

computerisation project in OPD and other areas to record usage of the services

James Twebaze is leading a sensitisation programme, starting with local leaders

The Hospital will change its billing system – and increase prices for people who choose not to join the scheme

Prices will remain low for Parishes that we have not yet registered onto the database and until one month after they have registered

27. And the community?

Bataka leaders need to learn all about this scheme and share information

The CAO, LC V and LC III leaders are supporters of this scheme

Groups, not individuals, will make payments to the eQuality scheme. And the groups will be responsible for collection of money

We will begin marketing with posters and leaflets in December

Any more questions?