Download - AEA Perceptions Evaluation IHP web
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,
10
in
the
pa
st
5years
6 h
ad
bee
n w
ith t
he
pla
n s
ince incep
tio
n(1
99
9)
Ne
ve
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