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1 Welcome to the webinar Introducing openimis an open source solution for Universal Health Coverage organised by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) in partnership with

2 socialprotection.org presents: Introducing openimis an open source solution for Universal Health Coverage Speakers: Alexander Schulze, Federal Department of Foreign Affairs, Swiss Agency for Development and Cooperation Siddharth Srivastava, Health Economics and Financing Group, Swiss Tropical and Public Health Institute (Swiss TPH) Dr. Madan Upadhyay, Health Insurance Board (HIB), Nepal Moderator: Ralf Radermacher, Gesellschaft für Internationale Zusammenarbeit (GIZ)

3 Submit your questions to the panelists Simply type them in the

Introducing openimis an open source solution for Universal Health Coverage Moderator Ralf Radermacher Head of Sector Initiative Social Protection, Gesellschaft für Internationale Zusammenarbeit (GIZ)

4 Introducing openimis an open source solution for Universal Health Coverage Moderator Ralf Radermacher Head of Sector Initiative Social Protection, Gesellschaft für Internationale Zusammenarbeit (GIZ) Ralf Radermacher heads the GIZ Sector Initiative on Social Protection, which advises the German Federal Ministry for Economic Cooperation and Development (BMZ) on all aspects around the topic. Before working at headquarter, Ralf was the team leader of the GIZ Social Protection Programme in Malawi, which supports the Malawian Ministry of Finance, Economic Planning and Development in harmonizing the social protection sector. Prior to joining GIZ, Ralf co-founded a specialized nonprofit consultancy in the pro-poor insurance domain and managed first a team in the New Delhi office and thereafter the international office in Bonn. He also worked at the University of Cologne coordinating an EU funded research and exchange project. Ralf is economist by education holding a degree from the University of Cologne.

Introducing openimis an open source solution for Universal Health Coverage Panellist Alexander Schulze Co-Head Division Global Programme Health, Federal Department of Foreign Affairs, Swiss Agency

5 Introducing openimis an open source solution for Universal Health Coverage Panellist Alexander Schulze Co-Head Division Global Programme Health, Federal Department of Foreign Affairs, Swiss Agency for Development and Cooperation Alexander Schulze, Ph.D., M.A., is a sociologist with a postgraduate Diploma in Development Co-operation. He is Co-Head of the division Global Programme Health at the Swiss Agency for Development and Cooperation (SDC) since July His areas of work include access to health care and medical products, social health protection and health financing as well as health product research and development. He joined SDC as a Senior Advisor for Health Systems Strengthening and Financing in Previously, he held various positions such as Access Program and Research Manager at the Novartis Foundation in Basel. Schulze is currently member of the Advisory Council to the Lancet Global Health Commission on High-Quality Health Systems.

6 Introducing openimis an open source solution for Universal Health Coverage Panellist Siddharth Srivastava Health Financing Specialist, Health Economics and Financing Group, Swiss Tropical and Public Health Institute (Swiss TPH) Siddharth Srivastava, M.Sc. Operational Research, is a health financing specialist in the Health Economics and Financing Group of the Swiss Centre for International Health. He is providing technical support to design and implementation as well as research on health insurance projects in Tanzania, Nepal and Cameroon. He is also leading the Swiss TPH team s effort towards making the Insurance Management Information System (IMIS) open source. Additionally he teaches MSc. and MBA modules on health insurance and health financing topics at the Institute. In the past he has worked extensively on various aspects of design, implementation, research and advocacy for pro poor health insurance systems. His country experience (primarily Asia and Africa) spans across Cambodia, Cameroon, Bangladesh, India, Nepal, Tanzania and Kenya.

Introducing openimis an open source solution for Universal Health Coverage Panellist Dr. Madan Upadhyay Executive Director, Health Insurance Board (HIB), Nepal Dr.

7 Introducing openimis an open source solution for Universal Health Coverage Panellist Dr. Madan Upadhyay Executive Director, Health Insurance Board (HIB), Nepal Dr. Madan Upadhyay is the Executive Director of the Health Insurance Board of Nepal. The Health Insurance Board Manages the national social health insurance program of the Government of Nepal, which has gradually expanded since 2016 to cover close to 1 Million people 36 out of 77 districts of Nepal. Prior to his role as the Executive Director in the Health Insurance Board, Dr. Upadhyay, Joint Secretary in the Ministry of Health and Population, has led multiple large public hospitals in Nepal as their Medical Superintendent. The Health Insurance Board of Nepal has been using openimis to manage its insurance scheme since its launch in openimis supports the management of all processes in national social health insurance scheme, from enrolment to claims management including review, to payment recommendations. Dr. Upadhyay will be presenting on the current use of openimis in Nepal, implementation experience, and his views on the future of the software.

8 An open source solution for Universal Health Coverage and Universal Social Protection Alexander Schulze, Swiss Agency for Development and Cooperation

9 9 The issue at hand 100 million people pushed into extreme poverty due to out-of-pocket payments 400 million people without access to complete set of essential health services SDG3, target 3.8 Agenda 2030! SDG1, target 1.3 Individual poverty and societal welfare losses Ill-health Alexander Schulze SDC

10 10 Universal Health Coverage a SDG 3 target and systemic approach to health Quality of health services Systems thinking! Equity! Access to health services UHC Social protection against health risks Range of health services Alexander Schulze SDC

11 11 Why openimis? Focus on operational core of scheme management Social (health) protection and financing schemes Complex business processes linking beneficiary, provider and payer data (e.g. beneficiary enrolment, claims processing and provider reimbursement) openimis Expanding schemes to hitherto excluded populations Alexander Schulze SDC

12 12 openimis a global good advancing the Agenda 2030 and SDGs Open source solution Free download, changes to the code, feed new developments back to the Community Sustainable approach Continously improved solution driven by Open source Software Community Capacity development and technical assistance Management Information System for social (health) protection schemes Interoperable system Compatible formats and interfaces for data exchange (international standard protocols and codes) Adaptable and modular design Customizable to different scheme types, organizational and country needs Alexander Schulze SDC

13 13 The evolution from IMIS to openimis 2012 IMIS designed by Swiss TPH, Micro Insurance Academy and Exact Software for Tanzania CHF 2014 IMIS Customized for Nepal 2017 openimis Master Version (TZ+CMR+NPL) completed 2013 IMIS Customized for Cameroon 2016 openimis initiative 2018 openimis Community

14 14 openimis COMMUNITY - Home of the openimis Initiative openimis wiki - Read more about openimis - DOWNLOAD SOFTWARE/SOURCE CODE NOW! openimis Demo: demo.openimis.org - use the demo now! openimis Service Desk- report issues, bugs, or feature requests!

15 System Description & Open Source Resources

16 16 Overview of presentation Software description Communication within openimis Construction of a scheme Transactions (by key processes) Enrolment Claims Renewal and Feedback Reporting Available open source resources

17 17 Communication within openimis central server Internet Internet physical transport Internet on-line mobile off-line

18 18 Construction of a scheme I (Building blocks)

19 19 Construction of a scheme - II (Product Configuration)

20 20 Construction of a scheme - III (Product Configuration)

21 21 Enrolment I (Standard Process) Collect contribution

22 22 Enrolment II (Enrolled unit: Household/Group)

23 23 Claims I (Client verification) 1. insuree s ID number read by phone through QR code 3. retrieving photo and information on coverage 2. send it to the central server

24 Claims II (Claims submission process) server mobile network

Internal claims processing in IMIS Automated Checking (client

) Review by a Medical Advisor Automated final claim calculations

24 24 Claims II (Claims submission process) server mobile network health facility Internet network mobile client on-line client Internal claims processing in IMIS Automated Checking (client status, price lists, etc.) Review by a Medical Advisor Automated final claim calculations (remaining limits, etc.) Generating consolidated claims report CHF office on-line client off-line client paper forms

25 25 Claims III (Mobile phone claims submission) 1. insuree s ID number read by phone through QR code 2. claim details entered 3. send it to the central server

26 26 Renewal and Feedback I (Standard Process) Feedback trigger server mobile Network - sms Renewal trigger mobile Network data transfer CHF office Print out of generated Renewal list OR offline file to be uploaded to mobile phone

27 27 Renewal and Feedback II (Mobile phone supported) server

28 28 Reporting I (Standard reports) 28

1'048 Mkonze 199 Grand Total 1'757 mobile network IMIS Data Warehouse ETL Operational database

29 29 Reporting II (Analytical Reporting component) Front-end (Excel) Row Labels Number of out-patient visits Dodoma 1'757 Health Centre 1'757 Hombolo 387 Kikombo 123 server Makole Urban 1'048 Mkonze 199 Grand Total 1'757 mobile network IMIS Data Warehouse ETL Operational database of IMIS mobile phone clients AR-IMIS External data sources (eg. DHIS) on-line clients off-line clients

30 Implementation Experiences from Nepal Dr. Madan Kumar Upadhyaya Executive Director Health Insurance Board, Nepal

31 31 Presentation Outline Social Health Insurance in Nepal Initial customization process of openimis for Nepal Technical Setup / Extent of implementation Experiences using openimis Looking forward

32 32 Social Health Insurance in Nepal Health Insurance Policy 2014 Contribution based SHI scheme with subsidies for the ultrapoor, poor, and marginalized Family scheme Contribution: Rs (USD 25) for family of 5 Benefit ceiling: Rs. 50,000 (USD 500) [for all 5 members] Services available through empaneled facilities (public and private) Cash-less system envisioned National level pooling; Single payer - HIB Managed fully by Government of Nepal s Health Insurance Board

33 33 Social Health Insurance in Nepal Initial implementation: 3 districts (out of 77) Voluntary only (no provision for poor at that point of time) Services available mostly through public facilities First enrolment started April, 2016 Services started May, 2016 Rapid expansion to 30+ districts in 2017/18 National Health Insurance Act 2017 Social Health Insurance mandatory for all Nepali citizens Currently, over 870,000 active members Expansion to over 42 districts planned till end of 2018

34 34 Customization of openimis for Nepal Scheme design in 2013 openimis (then IMIS) customization started in mid-2013 Requirements collection Resource requirement calculations 2014: Final customization (modifications to code) Functions of Tanzania Functions of Cameroon *New* functions of Nepal Technical assistance from GIZ

35 35 Customization of openimis for Nepal Major feature requirements of Nepal Version Cyclic enrolment Enrolment possible only 4 times a year (to reduce admin. Burden) Defining First Service Point (for promoting primary health care system, and reducing crowds at larger facilities) GPS location of Enrolment Assistants (door to door agents) Inclusion of Nepali Calendar Nepal s official calendar is a lunar calendar, without pre-defined patterns as in the Gregorian Calendar (read more about it here: ) Difficult to program into computer logic Custom Reports

36 36 Implementation: Technical Setup Single server setup Server in Kathmandu Hosted in Government of Nepal s Datacenter Microsoft Windows Server Database backup both on-site and off-site Immediate upgrade plans: Mirrored server at Disaster Recovery Site Outside of Kathmandu Managed by Government of Nepal Data Security ALL insurance related information stored on server in Nepal No external hosting

37 37 openimis Deployment in Nepal Central Server (Kathmandu) Districts where SHI is active Remaining districts HIB Office - Kathmandu

38 38 What does openimis do for HIB, Nepal? Supports in the management of core insurance processes Enrolment Door-to-door enrolment Mix of paper and digital Verification At health facilities/before service delivery Claims Submission At health facilities/after service delivery Claims Review At HIB Data Analytics (

39 39 openimis: Implementation Numbers 870,000 actively insured members 607,286 claims processed USD 5,182,000 paid out to facilities On June 11, 2018, 6553 total claims received on a single day

40 40 Who uses openimis in Nepal? HIB staff use openimis in various ways throughout Nepal 3256 Enrolment Assistants through Android phones 228 Health Facilities submitting claims through web interface 115 HIB District Staff through web and mobile phones 5 Claim reviewers in HIB, Kathmandu 5 IT Administrators as backstoppers

41 41 Experiences using openimis Stable system Very little down time No major incidents Flexible with product/scheme changes HIB experimenting with changes in product/scheme openimis has been able to support changes Local, code-level developments possible Nepali Calendar User interface changes [Nepali language] User friendly Android apps simple for Enrolment Assistants Claims web interface easy for facilities

42 42 Experiences using openimis Starting to get involved in openimis community Contributing Nepal modifications to master version Feature requests Experience sharing openimis community allows us to get new features without investing directly New android apps New payment modalities eg. capitation

43 43 Looking forward HIB Nepal looks forward to being more involved in the openimis community Sharing of knowledge and experiences from Nepal Having an openimis community gives us more confidence in using openimis! Technical Aspects Better claims fraud detection and prevention Seamless integration with Electronic Health Record systems More robust data analytics

44 Thank You!

45 Submit your questions to

47 Thank you for joining Introducing openimis an open source solution for Universal Health Coverage Make sure to answer our webinar survey, available after the session!

48 Thank you for joining the webinar Introducing openimis an open source solution for Universal Health Coverage

Insurance Management Information System (IMIS)

Swiss Centre for International Health Health Economics and Financing Group Insurance Management Information System (IMIS) Fact Sheet 8 th December 2015 Contacts Siddharth Srivastava M.Sc. Operational Research