How openIMIS improved health insurance coverage in Tanzania

health-insurance-coverage

 

openimis

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openIMIS is an open-source software that supports healthcare institutions and facilities in administering data and managing health protection operations. The system has been proved helpful in a variety of functions, including health insurance schemes, voucher schemes and cash transfer schemes, successfully improving health insurance coverage around the world. The following case study is focused on openIMIS implementation in the mainland Tanzania, which was the first country to ever use this system.

Healthcare System in Tanzania

In 1972 Tanzania began a long and challenging process of the government’s decentralization. Its purpose is to devolve more power to the local authorities who are closer to people’s problems and needs, and can act more effectively than a centralized government. There is also an effort being made to strengthen the communication between local and national authorities, and establish effective national healthcare structures that would increase the quality of life in Tanzania.

The Challenge

The Tanzanian government needed a tool that would support their healthcare related goals in terms of national voluntary health insurance program management (Community Health Fund). The mission was, and still is, to improve quality, access to and utilization of health resources and services, and to have these services delivered by an effective and well-governed system.

The system in question was required to support the following functionalities:

  • Beneficiary Management,
  • Claims Management,
  • Claims Review,
  • Reports.

IMIS Implementation in Tanzania

The Insurance Management Information System (IMIS) was originally developed by the Swiss Tropical and Public Health Institute (Swiss TPH) as part of the Health Promotion and System Strengthening (HPSS) project, with financial assistance of the Swiss Agency for Development and Cooperation, as a solution to some of the challenges faced by Tanzanian authorities.

The system was first implemented in 2012. At the very beginning, the project was focused on three regions of the country. Since then it has expanded to 26 regions, covering the whole mainland area of Tanzania.

All regions in Tanzania have been asked to implement the new iCHF (Improved Community Health Funds) model in the country, using CHF IMIS as the IT backbone for running CHF operations. All components of openIMIS (online, offline and android applications) are being used in the implementation. The country continues to develop the system based on stakeholder needs and is working to integrate openIMIS into its IT landscape. 

The server is installed and maintained by the President’s Office, Regional Administration and Local Government Tanzania (PORALG), an institution focused on increasing the quality and accessibility of both public and local health services in Tanzania. 

The HPSS project team supports the government’s roll-out and implementation activities. Each region operates its own CHF scheme through openIMIS. Enrollments and renewals are handled by village-based enrollment officers. Each health facility undertakes verification and claims submissions for the patients they treat. Regional-level teams then manage payment to each facility.

Now, in 2022, Swiss Tropical and Public Health Institute continues to manage the whole openIMIS project in Tanzania. It includes, among others, software and infrastructure updates, enhancements development, performance management, bug fixing and adding new integrations with other systems e.g. MUSE, GoT-HoMIS.

Scheme Design Details

The implementation scheme was designed to manage the Improved Community Health Fund (iCHF), which is a community-based and government-run health insurance program. The scheme design has the following characteristics:

  • Providing services from 6,173 health facilities,
  • Contribution: 30,000 TZS for a family of 6,
  • Benefit Package: All services offered at government health facilities (dispensaries, health centers and hospitals),
  • No co-payment required,
  • Cashless system for beneficiaries.

 

The Impact

Swiss TPH has successfully implemented openIMIS in the whole Tanzania mainland area, covering over 96% of the entire population. 

The impact is visible in numbers. As of September 2022 there were:

  • Beneficiaries: 4,020,750 (with 4,071,457 individuals registered in CHF-IMIS)
  • Households covered: 851,571 (4.9 is the national average household size, and in iCHF families up to 6 members are enrolled for the set contribution amount)
  • Families registered: 857,086
  • Household contribution: 30,000 TZS per household (150,000 TZS in Dar es Salaam)
  • Users: 43,623 (including medical staff and health facilities personnel)
  • Health facilities registered and connected with openIMIS: 7,166

openIMIS has significantly helped in improving Tanzanian insurance system, scheme efficiency and data quality. It has also enhanced fund management and simplified the decision-making process.

Integration and Interoperability

The system is currently being integrated with other government systems, including:

  • SMS gateway solution to notify enrollment, renewals and payment confirmations to clients.
  • GEPG (Government e-Payment Gateway) solution for contribution payment through mobile and bank payments, thus reducing the risk of frauds.
  • USSD gateway for mobile requests (enquiring, renewal, request control numbers for mobile or bank payments).
  • GoTHOMIS (Government of Tanzania Hospital Management Information System) and AfyaCare hospital management systems allow an efficient flow of information between health facilities, IMIS, and the CHF accounting system.

Currently, national accounting system (MUSE) integration is under development to secure the health facilities reimbursement and enrollment officers commissions payments. Swiss TPH will develop further integrations depending on the priorities defined by the Tanzanian government.

SolDevelo’s Involvement

Engagement of our SolDevelo development team is divided into three objectives:

  • Development,
  • 3rd level user support,
  • Software maintenance,
  • Release management.

Besides developing our own fixes and features according to the release cycle, we have been regularly integrating separate code developments, coming from local organizations in countries that have already implemented openIMIS, to the core system. As part of our work, we are guided by the international development principles:

SolDevelo’s openIMIS team is using the following programming languages and frameworks: Python, Django, Django Rest Framework, GraphQL, Javascript, React Redux, MS SQL Server, Docker, GIT + GitHub Actions CI, VB.NET, C# Rest API.

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Learn more about SolDevelo’s involvement in various projects in our Case Study section.