Cameroon openIMIS CS-CSU - Improvements to openIMIS for the Chèque Santé and alignment with phase 1 of the UHC
Project Abstract
1. Background
In response to the problem of maternal and infant mortality in certain regions of the country, the Cameroonian State has been implementing a health system support program since 2009, the main objective of which is to improve the health of vulnerable populations, and more particularly pregnant women and children. This project named the “Joint Program MINSATNE/AFD/KFW” is financed by the French Development Agency (AFD) and the German Development Bank (KfW) intervenes in the Far North, North and Adamaoua regions at three main levels:
- Support the decentralisation and governance
- Support healthcare delivery through the rehabilitation of equipment of the health facilities
- Stimulate demand though the implementation of the Health Voucher program (Chèque Santé)
The Chèque Santé is a mechanism to support the demand for care to reduce financial barriers to access obstetric and neonatal care and improve the quality of care through a subsidized purchasing system.
Swiss TPH has acted as sub-contractor of GIZ International Services (GIZ InS) since 05.07.2021 within the framework of the mandate entrusted to it by AFD. This subcontracting, which ended on 31.12.2022 aimed to support the deployment of the IT solution openIMIS for the voucher scheme as part of a pilot with 11 health facilities. openIMIS is an open source health insurance information system used in low resource settings to support various health financing schemes. It had been used in Cameroon since 2013 for a community-based health insurance (BEPHA) and then since 2018 for the HIV User Fee Elimination program.
Given the results obtained and the improvements noted with the use of openIMIS during the initial pilot, the Ministry of Health expressed the need to extend the Chèque Santé program to other regions and align it to the newly announced Universal Health Coverage phase 1 program. This also means adapting the existing openIMIS tool to create an integrated version, to be used by all UHC programs.
2. Objectives and Aims
In order to improve the use of openIMIS for the Chèque Santé as well as create the new integrated version of openIMIS for the UHC programs, KfW contracted Swiss TPH for a mandate of five months (extended to 7 months). As part of the mandate, the aim was to define the alignment processes between the voucher scheme and the UHC phase 1 program and establish the needs in terms of functionalities to be added based on the experiences of the pilot, and proceed with the IT developments.
The specific objectives of the mandate were formulated as follows:
- Evaluate the Chèque Santé pilot and define the new functionalities to be added
- Develop the RFCs (request for change) for the development of the functionalities to be transferred from the old Chèque Santé to the new UHC integrated version and the new functionalities to be added
- Complete the developments defined in the RFCs
- Test and configure the new instance
- Adapt training material according to new functionalities
- Train new and old health facilities and administrators on the new developed instance
- Regularly monitor the deployment of the software
- User support within the established technical support framework
3. Methods / Approaches
The activities were divided into 4 work packages:
a. Monitoring and evaluation
b. Customization of openIMIS
c. Training
d. Support and maintenance
Swiss TPH entrusted a part of the work, notably the on-site trainings to Build-Out-Initiative for Development Association (BID) and IT developments and maintenance to Y-Note.
4. Results
Evaluation of the pilot
An evaluation of the pilot was carried out in two stages by Swiss TPH in close collaboration with the implementing actors:
- Initial evaluation, which began in the first months of the mandate, aimed at taking stock of the implementation of openIMIS for the Chèque Santé (until august 2023) and proposing recommendations for the future (including some recommendations which could be taken up during the current mandate)
- Final evaluation, which took place at the end of the mandate and aimed to take stock of the results achieved and propose an activity plan for the continuation of support for openIMIS for the UCH program.
Supervision and follow-up of the deployment of openIMIS
Regular meetings were held with GIZ and the different departments of the Ministry of Health to coordinate efforts in the implementation of openIMIS. Overall, it was observed that there was a progressive increase in the uptake of the solution, at central and regional level and at the health facilities. The GIZ team set up a data analytics tool with dashboards (MetaBase), to which Swiss TPH has access. This has helped the team track usage a claiming in the different regions.
Elaboration of the RFCs
The description of the openIMIS improvement needs was recorded in two ad hoc documents (request for change) with the aim of guiding developments:
- Those aimed at transferring the functionalities of the initial openIMIS Chèque Santé instance into the new UHC openIMIS instance
- Those aimed at improving the functionality of openIMIS for the new UHC instance, as identified during the pilot evaluation.
In total, 21 requests were taken into account and developed.
IT developments
These developments, divided into two distinct phases allowed better integration of the issues specific to the voucher scheme and notable improvements of the openIMIS UCH instance. In addition, these improvements took into account the various feedback from the field, which helped appropriation of the tool by end users.
Based on the RFCs, different developers were able to advance both on Backend (server) developments and Frontend (user interface) developments. These were also transferred to the mobile applications, essential to being able to offer offline use in areas with low internet connectivity.
Configuration
In order to use openIMIS in production, a number of primary data sets need to be entered in he platform. These also need to be updated in case of changes.
To put in place the UHC openIMIS version, the information for each programmes were configured, and the elements from the Chèque Santé program where transferred from the old version.
In terms of documents a “configuration protocol” was developed to frame the elements to be configured and to guide the future system administrators who will need to maintain the configuration.
Tests
Various testing of the software was done, focusing on the new developments, to ensure it worked well or suggest adaptations. A testing protocol was also developed, which defined specific test cases and described the testing process. This document was used also during the administrators training to sensitise the participants to this process and use the test cases as practical exercises.
Training
Training is a key step in the openIMIS implementation process and was essential for the success of this mandate where the end goal was the utilisation of the established tool. A training plan was developed as well as different training materials such as slides, user guides and practical exercises in a testing guide format. Different types of trainings were undertaken, namely onsite trainings for health facilities and regional staff, administrator training at central level and online trainings with videos, individual coachings and group zoom demonstrations. In total, 274 health facilities were trained.
Support and maintenance
A support structure was set in place to help the users and provide them with a framework for issue tracking in case of difficulties. The project helped each actor part of the support structure to take on his/her role. This was challenging as many actors do not dispose of the time required to fill these roles regarding openIMIS as they have other duties (mostly at the Ministry of Health). However, the project sees this as a work in progress and with each step gets closer to a situation where the local actors can take full ownership of the tool and the support set-up.
5. Target Groups
The main beneficiary of the project is the Ministry of Health as the UHC scheme operator and owner of the openIMIS tool.
6. Further lines of action / next steps
The Ministry of Health will use the final evaluation report as a basis for the formulation of the TORs for the next support project to the digitalisation of the UHC programme.
