Improving Health Insurance Management


Many low- and middle-income countries are working to build up health insurance schemes – both public and community based – to protect their populations in case of sudden illness. To professionalise these schemes in a sustainable manner, Swiss TPH has created an Insurance Management Information System (IMIS). IMIS was first developed in English with national partners in Tanzania, in the context of the Health Promotion and System Strengthening (HPSS) project of the Swiss Agency for Development and Cooperation (SDC). IMIS now exists in other languages and is being rolled out in different countries, including in the Democratic Republic of Congo.

Sharing experiences on health insurance management between South Kivu and Tanzania on 12-14 December 2017 in Morogoro, Tanzania.

To share experiences and learn from their Tanzanian counterparts, nine Congolese delegates are visiting Morogoro, Tanzania, through support from the SDC's Programme d'Appui au Systeme 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." 

The visitors from the Democratic Republic of Congo include representatives from the Réseaux des mutuelles de santé communautaires de l'Archidiocèse de Bukavu (REMUSACO), from a non-confessional independent mutuelle, as well as from the South Kivu health and social welfare authorities. They are hosted by Tanzanian colleagues from HPSS and government partners in the Morogoro Region. Both projects - HPSS and PASS - are funded by SDC and implemented by Swiss TPH.

Technology to professionalise insurance management

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. Given the positive experience in Tanzania and other countries, IMIS is currently being scaled up as an open source release in the frame of the openIMIS initiative, supported by SDC and the Federal Ministry for Economic Cooperation and Development in Germany (BMZ) under the coordination of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). This also falls within Switzerland and Germany's contribution to the Providing for Health (P4H) Initiative.

Towards Universal Health Coverage

The majority of people in low- and middle-income countries still do not have health insurance. In case of illness, they are often faced with high healthcare costs which can lead to impoverishment. In many countries, public and community-based health insurance schemes are being established to protect the population from such catastrophic payments. Health insurance is regarded as a key element in the drive towards Universal Health Coverage.