Using Rapid Assessment in

Ugandan Communities to

Gauge Perceived Economic

Benefits of Community-Based

Health Insurance

Christina Blanchard-Horan, PhD,

Consultant, Global Health Liaisons

Under contract with Matre Group Inc.

Value of Perception Evaluations

for

Community Based Organizations

Contributes to the design of more

robust program messages

Improves diffusion of innovations

Community-based health

insurance (CBHI) in developing

countries

Protects members from economic downfall

in the event of a catastrophic health

incident

Helps members get healthcare when

needed

Assists with health planning

Disseminates disease prevention

messages reducing preventable diseases

Improves health systems by providing

solid payment systems

CBHI Challenges in Ishaka

Enrolling large percentage (60%) into

group participation as risk mitigation

tactic - slow uptake

Retention of dynamic leadership

Misperception about CBHI because of

donor funding at start-up

Departure of donor funding = changes

at CBHI and need for diversification

Purpose of Perceptions

Evaluation

Understand CBHI contribution to well-

being

Determine members' perceived

economic benefit and beliefs about CBHI

Improve messages for sensitization

Realize other apparent benefits of CBHI

participation

Methods

◦Rapid assessment

Survey interviews – open and closed-ended questions

Pretested on Ugandans from community

Ugandan-tested amenities scale

◦n=30 heads of households

◦Examined patterns among

responses

Limitations

Generalisability

Retrospective Questionnaire

dependent upon long-term memory of

CBHI members = one year

Point to determine perceptions not

actual occurrences

16

10

3

0 5 10 15 20

6 h

ad

bee

n o

n th

epla

n s

ince incep

tio

n,

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in

the

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st

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6 h

ad

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ith t

he

pla

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ince incep

tio

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99

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Ne

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r D

roppe

dD

rop

ped

and

retu

rne

dD

rop

ped

and

ne

ve

rre

turn

ed

Dropping the Plan

n=30

Number of

HH Size, Education & Vocation

HH

Siz

e (M

ean

&

Me

dia

n)

Edu

cati

on

No

Sch

oo

ling

Farm

ing

inco

me

624 = P3 to S3

(27% =P7)6

(20%)22

(73%)

Interviewee

Demographics Women, 8

Men, 12

Women Single HH, 9

Women

Men

Single WomenHH

Interviewee Gender and

Single Head Households

Single

Men HH

Single Men HH,

1

Perceived Experiences with

CBHI Sustainability - land and livestock ownership

“I would have to go back to selling land.”

Work – Ability to work“IHP has improved my life. I added some years because of IHP and increased working. Because, if sickness comes, I cannot work.”

“I go sooner to the doctor when feeling sick, so I can go back to work sooner.”

Education– Ability to pay school costs = 43% (12)“The money we use to bring to the hospital can pay school fees”.

Psychological - reducing household financial stressors from cost of unplanned healthcare ◦ 20 mentioned financial difficulty would have had medical bills to pay

if not for IHP

Healthcare Access – quality care when needed ◦ 4 said they would die without CBHI

Results in Practice

Social Marketing - 63% (19)

◦ better financial and health conditions

since joining the Health Plan

Identified new CBHI models

◦ Chronic illness models = 30% (10)

◦ Targeting Schools

Potential CBHI Benefits

Requiring further investigation -

Contribution to the financial health of

the larger community as well

Reduction of infectious disease

transmission

Impact on the local economy of rural

communities

Implementation of Resuts

The health plan responded by

Updating policies

Increasing rates to improve services

Implementing a recognition program

Integrated findings into media strategy

More Information

Ishaka Health Plan www.ishakahealthplan.com

◦ Community-based Health Plan (CBHI)

Matré Group Inc. www.matregroup.org

◦ Health Services

◦ Solar Light

◦ OVC in schools

Tuchwemu Project www.tuchwemu.com

◦ Savings Cooperatives

◦ Economic Development Initiatives