A study tour to exchange on improving Health Insurance Management

In-country activities​

A study tour to exchange on improving Health Insurance Management

Xuân-Mai Kempf, Swiss TPH Swiss Center for International Health, Basel Switzerland

Eustache Ndokabilya Dunia, DFAE Direction du développement et de la coopération DDC Bureau de programme Bukavu, DRC

An estimated 97 million individuals are impoverished in any given year because of the costs of health care¹. In many countries, public and community-based health insurance schemes are being established to protect the population from such catastrophic payments.   Indeed, Health insurance is regarded as a key element in the drive towards Universal Health Coverage and is today in the centre of the agenda of Ministry of Health in DRC. Mutuelle de santé (MUSA) have been identified as one of the insurance mechanism solution and membership will be progressively be mandatory for all informal sector non covered by the National Health Insurance Agency. However, penetration rates of MUSA remains very low in South Kivu and MUSA are experiencing financial and sustainability issues.

Managing insurances schemes is a complex field requiring specific tools and expertise for professionalized operations as well as raising new challenges for the stewardship and regulation of health systems. To professionalise these schemes in a sustainable manner, Swiss TPH developed an Insurance Management Information System (IMIS), in the context of the SDC-funded Health Promotion and System Strengthening (HPSS) project in Tanzania.  IMIS aims to improve insurance management through more efficient processes, better data quality, greater transparency with regards to financial transactions (including claims and premium collection) and increased fraud control. Initially developed in English, IMIS now exists in other languages and is being rolled out in different countries, including in the Democratic Republic of Congo.

In December 2017, to share experiences and learn from their Tanzanian counterparts, nine Congolese delegates visited Morogoro, Tanzania, through support from the SDC-funded Programme d'Appui au Système de Santé (PASS) in South Kivu. While IMIS in Tanzania today manages 1.47 million individuals, the database in South Kivu stands at around 15,000 insured people. "Currently our first priority is to operationalize basic features of IMIS. There are a lot of challenges such as enrolment follow-up, claim follow-up, fraud, enrolment management, collaboration between health facilities and mutuelles de santé, as well as collaboration with regulators to share information at all levels," says Bienfait Aganze, IMIS Adminstrator from REMUSACO, South Kivu. "I hope IMIS can help us to improve all these aspects for a better management of our mutuelles."