STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA)

Transcription

1 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 DRAFT Plot 898, Ssekabaka Kintu Road, Rubaga-Wakaliga, Kampala Uganda. P.O Box 830 Kampala, Uganda E mail: ucbhfa@infocucbhfa.org Tel: Fax:

2 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

3 Table of Contents 1.0. INTRODUCTION THE COUNTRY CONTEXT The Economy The Political and Administrative Environment Human Development Uganda s Health System Health Financing In Uganda Community Based Health Financing in Uganda Community Based Health Financing Schemes in Uganda Uganda Community Based Health Financing Association UCBHA SWOT ANALYSIS Internal Assessmentof the Association Association Weaknesses External Assessment of the Association Associations Threats UCBHFA STRATEGIC DIRECTION Our Vision Our Mission Our Core Values Goal Program Areas Strategic Objectives and Key Result Areasper theme Program Area 1:...20 Coordination and enhancement of capacity for Community Health Initiatives...20 Key Result Areas (KRA) Program Area 3: Knowledge Management:...21 Key Result Areas (KRA) Program Area 4: Institutional Strengthening and Development: STAKEHOLDER ANALYSIS Monitoring And Evaluation of the Strategic Plan(M&E) SUSTAINABILITY Political Sustainability Financial Sustainability STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

4 Abbreviations & Acronyms 1.0. INTRODUCTION THE COUNTRY CONTEXT The Economy The Political and Administrative Environment Human Development Uganda s Health System Health Financing In Uganda Community Based Health Financing in Uganda Community Based Health Financing Schemes in Uganda Uganda Community Based Health Financing Association UCBHA SWOT ANALYSIS Internal Assessmentof the Association Association Weaknesses External Assessment of the Association Associations Threats UCBHFA STRATEGIC DIRECTION Our Vision Our Mission Our Core Values Goal Program Areas Strategic Objectives and Key Result Areasper theme Program Area 1: 20 Coordination and enhancement of capacity for Community Health Initiatives 20 Key Result Areas (KRA) Program Area 3:Knowledge Management: 21 Key Result Areas (KRA) Program Area 4: Institutional Strengthening and Development: STAKEHOLDER ANALYSIS Monitoring And Evaluation of the Strategic Plan (M&E) SUSTAINABILITY Political Sustainability Financial Sustainability 28 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 2

5 Chairperson s Foreword Achieving equitable access to quality health care remains a distant yet critical pre-requisite to attaining an improved quality of life for people in Uganda and other African countries. No doubt good health or the absence of it is a critical factor in poverty reduction, improvement of human productivity and general quality of life irrespective of the social, economic and political status. Since its inception in 1998 and through a series of unfavorable policy and institutional changes, UCBHFA has stayed on the course of searching for possible solutions to ensure establishment and growth of CHF initiatives to guarantee access to quality health care especially for the low-income population in Uganda. Despite all the known challenges ranging from policy migration, inadequate funding and capacity limitations, a number of CHF initiatives have been established and coordinated in the different parts of Uganda. Over 24 schemes benefiting more than 100,000 people are in existence to-date. With the current level of resources, UCBHFA has delivered a series of trainings to CHF scheme managers, coordinated many experience visits, engaged in policy advocacy activities, held various knowledge & experience sharing events etc.,. This strategic plan therefore is designed to build on the current growth of UCBHFA through a more innovative and evidence based approach. In this framework, more focus will be given to enhancing CHF management competences, advancing information & knowledge generation & management mechanisms, re-engineering policy advocacy processes, strengthening the delivery structure as well as introduction of CHF to different parts of the country. We will also ensure to work collaboratively with other relevant persons and organizations to make equitable health care access a reality. Our Board of Directors and the secretariat are very keen to this plan and are more than ready to engage all those with a stake to deliver the long awaited change. We will exploit all opportunities and take advantage of all possible synergies. It s envisaged that at the end of the five years, there will be a better policy environment for CHF growth. CHF will also be known in many parts of the country and there will be notable growth of a competent CHF human resource base. UCBHFA will also be characterized with quality knowledge and management information (resulting from research & established MIS) as well as better governance and operational management systems. Certainly once the above conditions materialize, many more people will be protected by the increasing and growing CHF schemes. Conclusively, we hope and pray that all key stakeholders particularly government, development partners, UCBHFA members and the medical bureaus do not despair but rather put in more effort and energies to accompany this plan. No doubt the success of this plan depends highly on the collective blessing of the stakeholders mentioned above. Mr. Fredrick Makaire Chairperson UCBHFA Board of Directors 3 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

6 Acknowledgement For over 10 years, UCBHFA has struggled to build capacity and that of her member organization so as to achieve improved access to quality health care. A number of people and organizations have participated in the various processes that have enabled UCBHFA to continue coordinating and supporting her member organizations and other stakeholders. This has been possible because of the importance that UCBHFA attaches to planning especially longrange planning. Looking ahead, we have generated a strategic plan that will guide all our engagements and actions for the next five years. A rich stock of ideas has emerged particularly to enhance the earlier plans. I am very certain that the new focus that emphasizes; policy advocacy, knowledge management, geographical expansion, capacity enhancement both at organizational and membership levels will cause a forward movement for UCBHFA and her members. In respect hereof, and on behalf of the entire UCBHFA family, I would like to take this opportunity to thank all who contributed to the successful development of this plan. I wish to appreciate UCBHFA secretariat for all the input and administrative support, members of the Board of directors, UCBHFA member organizations & schemes, Medical bureaus, representatives from academic institutions and development partners. I particularly thank those who made it and participated in the brainstorming workshop and those who sent their views by mail or otherwise for their valuable time and intellectual input. In the same way I wish to thank the process facilitator (Mr. Godfrey Bwanika) as well the management of St. Augustine institute Nsambya for hosting our brainstorming session. Finally I thank CORDAID our key partner for providing the finances for the process, and for all other activities and programs that UCBHFA implements We are certain that with this plan UCBHFA will be more effective. Joseph Kiggundu National coordinator STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 4

7 1.0. INTRODUCTION This strategic plan covers a period of five years from January 2013 to December It specifies the organization s strategic direction, interventional priorities and implementation strategies. In addition it highlights the country s economic, political, cultural, NGO and CSO sectors. This defines the context in which Uganda Community Based Health Financing Association (UCBHFA) is operating. Out of the eight development objectives of the Ugandan National Development plan (NDP), this strategic plan directly taps from the one on increasing access to quality social services. This national objective focuses on improving 1 access to quality social services by focusing on literacy levels, sanitation levels, incidence of communicable diseases and HIV/ AIDS, health systems, affordable access to health services, and free access to health.ucbhfa strategic plan also taps from the National Health Sector strategic and Investment plan 2, which defines the long and medium term health agenda and operationalizes Uganda s aspirations as outlined in the NDP and the Public Investment Plan, and the Second National Health Policy with the objective to make a contribution to the well-being of the people that will result in expandedeconomic growth and increased social development. The policy 3 mission is to attain a good standard of healthfor all people in Uganda to promote a healthy and productive life. The health sector facilitates theprovision of basic health services that are proportional, equitable, of high quality, affordable,sustainable, and gender-sensitive, Therefore the contribution of this plan to the national health development framework will be demonstrated through improved coordination of community health insurance schemes, strengthening advocacy for CBHF, improved capacity of community based health financing schemes, and rolling out community health insurance nationwide. 2.0 THE COUNTRY CONTEXT 2.1 The Economy Uganda has substantial natural resources, including fertile soils, regular rainfall, small deposits of copper, gold, and other minerals, and recently discovered oil. Agriculture is the most important sector of the economy, employing over 80% of the work force. Coffee accounts for the bulk of export revenues. Since 1986, the government - with the support of foreign countries and international agencies - has acted to rehabilitate and stabilize the economy by undertaking currency reform, raising producer prices on export crops, increasing prices of petroleum products, and improving civil service wages. The policy changes are especially aimed at dampening inflation and boosting production and export earnings. Since 1990 economic reforms ushered in an era of solid economic growth based on continued investment in infrastructure, improved incentives for production and exports, lower inflation, better domestic security, and the return of exiled Indian-Ugandan entrepreneurs. Uganda has received about $2 billion in multilateral and bilateral debt relief. 1 Uganda National Development Plan 2010/ /16 2 Health Sector Strategic and Investment plan 2010/ / STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

8 In 2007 Uganda received $10 million for a Millennium Challenge Account Threshold Program. The global economic downturn has hurt Uganda s exports; however, Uganda s GDP growth is still relatively strong due to past reforms and sound management of the downturn. Oil revenues and taxes will become a larger source of government funding as oil comes on line in the next few years. Instability in southern Sudan is the biggest risk for the Ugandan economy since 2011 because Uganda s main export partner is Sudan, and Uganda is a key destination for Sudanese refugees The Political and Administrative Environment Uganda is divided into districts which are further sub-divided into lower local governments called subcounties. Of late the number of district & lower local governments has increased subsequently increasing the number of administrative units straining delivery of health services. Government decentralised delivery of health services (Constitution, Local Government Act)as amended under the NDP as the overall development framework for GoU for the period 20/ /15 In an attempt to improve health services delivery, the GoU decentralized delivery of services guided by the Constitution of the Republic of Uganda (1995) and the Local Government Act (1997). This policy shift has inadvertently strained the capacity of the supervising institutions, brought about inadequate funding, and weak logistics management. UCBHFA entry is based on the national objective to increase availability and access to quality social services including health services delivery. 2.3 Human Development Progress in social and human development has been very slow. Almost all of Uganda s social indicators remain below the average for sub-saharan Africa. Uganda s population is characterized by high levels of illiteracy (about 62% and higher for women), high morbidity, infant mortality rates and high unemployment and underemployment, leading to low income and poverty amongst the population. The decentralization of the health system and recently introduction of free access to health is hoped to improve access to affordable health. However, much as the impacts are to be realized in the long term, the quality of community health is still poor. One in every 19 Ugandan children dies before the first birthday, and one in every 11 children dies before the fifth birthday, the under-five mortality rate is 90 per 1,000 live births, one-third of women receive postnatal care in the first two days after delivery, forty-five percent of Ugandans have access to an insecticide-treated net;in other words, almost five in ten people could sleep under one if everynet in a household were used by two people 5, 2.4 Uganda s Health System The Uganda s health system, aims to achieve and sustain good health for its people.the Health system has been evolving over the last 3 to 4 decades to handle emerging concerns and challenges to the health situ Uganda Demographic and Health Survey2011 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 6

9 ation in the country.the delivery of health services in Uganda is by both public and private sectors with GoU being the owner of most facilities. Over the past decade, Government has focused on expanding its health infrastructure through construction of the health facilities in an effort to bring services closer to the people. The GoU has introduced several Health sector reforms including; Decentralization, Abolition of user fee, Government partnering with Private not for profit organizations, Working with private health care providers, Encourage the autonomy of public Hospitals, Planning and resource allocation system (bottom-up VsTop-down practice), Human resource management Retrenchment, Pay reforms, Transparent remuneration structures, and Decentralized human resource management etc. 2.5 Health Financing In Uganda The goal of health financing for the health sector in Uganda is to raise sufficient financial resources to fund the sector programs while ensuring equity and efficiency in resource mobilization, allocation and utilization. In Uganda the health system is made up of both public and private health care providers. Third party purchasers of health care operate on a very small scale. The public healthcare system provides 60% of all the health care services. The private not for profit subsector provides about 30% while the private health practitioners provide the rest (10%)of the health care services. In Uganda, households constitute a major source of health financing (49%) followed by donors (35%) and then government (15%). NGOs contribute less than 1% 6. User fees were abolished in all government health facilities in March 2001, but at hospital level, a dual system exists. There is a free wing for those who cannot pay and a paying wing for those who can afford. The private sector charges user fees and there is evidence of patients paying under-the counter fees in public institutions 7 The health sector in Uganda has been faced with a challenge of under-funding for a very long time. GoU expenditure on health remained low at around US$5-7 per capita between 2004/05 to 2007/08 8. The projected allocation for health for the period 2010/2011 to 2012/2013 shows no increase in the health sector budget 9. Donor funding through projects amounted to US$10 per capita in 2008/ This is not adequate to deliver a minimum health care package costed at US$40 per capita 11. Gaps in service delivery are evident with only 35% of health facilities having essential medicines throughout the year and only 51% of approved posts filled by trained health workers, 12 only 1 percent of women and less than 2 percent of men are covered by health insurance WHO:World Health statistics. 7 Uganda Bureau of Statistics, National Service Delivery Survey; Uganda Bureau of Statistics, Kampala - Uganda; Ministry of Health, Annual Health Sector Performance Reports for Financial Years 2003/04, 2004/05, 2005/06, 2006/07, 2007/08; Ministry of Health, Kampala, Uganda; 2004, 2005, 2006, 2007, Ministry of Finance Planning and Economic Development; Background to the Budget 2008/09, Ministry of Finance Planning and Economic Development, Kampala, Uganda, Ministry of Health, Annual Health Sector Performance Reports for Financial Years 2003/04, 2004/05, 2005/06, 2006/07, 2007/08; Ministry of Health, Kampala, Uganda; 2004, 2005, 2006, 2007, Ministry of Health, Minimum Service Standards; Ministry of Health, Kampala, Uganda, Ministry of Health, Annual Health Sector Performance Report. Financial year 2007/08 Ministry of Health, Kampala, Uganda October Uganda Demographic andhealth Survey STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

10 Out of pocket expenditure for health continues to increase amidst government provision of free health services. Households are a major source of health financing in Uganda, contributing about 50 per cent 14. Spending includes purchasing drugs and supplies and informal payments at public facilities; user fees are paid at PFP and PNFP facilities. The poor and vulnerable groups accessing essential health care from these health providers are at risk of catastrophic health expenditure. Average cost per utilization, computed as the average cost per person for those who fell ill and sought care, increased from US$7 per utilization in 2003 to US$13 in Nearly 50 per cent of total household health expenditure is incurred on drugs. Twenty eight per cent (28%) of the households in Uganda are experiencing catastrophic payments, that is health expenditures in excess of 10 per cent of total household consumption; with considerable variations by wealth quintile (28.3% among the poorest quintile -24.8% among the richest quintile) and region (23.6% central region to 38.1% western region). Percentage of households incurring catastrophic health expenditure increased from 8% to 28% between 1996 and 2006, despite the elimination of user fees in Two per cent of households (2.3%) were pushed into impoverishment because of medical bills 17. Private health insurance, which is largely subsidized by employers on behalf of employees, is for a few covering only 0.2% of the population 18.Health facilities infrastructure is old. Access to health services for women is further compounded by decision-making processes in families: 40% of the women report that their husbands make decisions about their own healthcare 19. Although 72% of households in Uganda live within five kilometres from a health facility (public or PNFP), utilisation is limited due to poor infrastructure, inadequate medicines and other health supplies, the shortage and low motivation of human resource. The private health system comprises of the Private-Not-for- Profit organisations (PNFPs), Private Health Practitioners (PHPs) and the Traditional and Complementary Medicine Practitioners (TCMPs). Unlike government facilities, the private health facilities charge user fees which limits access to care Community Based Health Financing in Uganda The first CBHF scheme in Uganda was set up in 1996 in Kisiizi hospital, Rukungiridistrict. Following a successful piloting of the scheme at Kisiizi hospital, other schemeswere started at Mutolere, Nyakibale, Ishaka, Comboni and Kitovu hospital amongothers. Majority of these schemes were (until recently) hospital based (facility basedschemes) and were started jointly by the Ministry of Health (MOH) and various donors. In response to community health financing initiatives the GoU through the Health Sector Strategic Plan I (2000/1-2004/5) and II (2005/6-2009/10) highlighted the need for the development of alternative health financing mechanisms among which is Social health insurance (SHI) 21. A feasibility study undertaken in 14 Uganda Health System Assessment, 2011http://health.go.ug/docs/hsa.pdf 15 Ibid 16 Ibid 17 Ibid WHO:World Health statistics. 19 Uganda Bureau of Statistics (2007).Uganda demographic and health survey Kampala: UBOS 20 The Second National Health Policy, July, STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 7

11 2001 recommended that Uganda pursues a strategy of starting up SHI gradually, by initially covering only civil servants and their families located in large cities plus workers and their families employed by large companies such as those employing 250 workers or more. The study recommended that step-by-step, the scheme could be expanded to include all workers and their families in the formal sector, and the informal sector as well 22. In 2006, the Government of Uganda asked the MoH to design a Health insurance (HI) scheme through a cabinet minute No. 63 (CT 2006) to the Ministry of health (MoH). The Minister of Health established a national task force on health insurance, with representation from all relevant stakeholders to spearhead drafting of the Bill and design issues. Stakeholders includedmoh, Ministry of Finance, Ministry of labour and gender, Ministry of public service, trade Unions, Federation of Uganda employers, and the Uganda Community Based Health Financing Association. The purpose of the Bill is to diversify and strengthen health care financing, stimulate providers to provide good quality services at affordable prices and increase welfare gain in health care through financial risk protection. The bill has been developed and ready for discussion and approval by cabinet before onward transmission to parliament. 2.7 Community Based Health Financing Schemes in Uganda Apparently there are over 30 known CBHF initiatives in Uganda, of which 25 are members of UCBHFA and cover over 100,000 people in total. A number of initiatives are yet to meet the accreditation criterion and formal UCBHFA membership registration. The majority of existing initiatives are located in the Western part of Uganda, with a few of them in the central region. The East, North and North Western parts of Uganda hardly have any known formidable schemes in operation. These existing initiatives have through time and experience evolved into unique management and operational models. Many schemes are initiated and managed by local health service provider facilities, playing the role of provider as well as that of fund manager. 11 Schemes can be identified under this arrangement to date. There is also a community based model where an organised community establishes a health fund and contracts a service provider of their own choice. In this case the roles are very distinct and clearly stipulated in the service agreements. Apparently 14 CBHF initiatives14 fall under this category. The nature of fund management also varies, with the insurance category being the main one. Other categories include Credit funds where beneficiaries medical bills are paid by the credit fund and then the respective persons pay back to the fund in a specified period of time. There are also hybrid models with a mixed insurance and credit fund. In terms of mobilization, there are several approaches. The facility based schemes are mobilised within the provider catchment area by the facilities themselves. In other cases communities are mobilized, sensitized and prepared by promoter organizations whose focus is to empower the communities to manage CBHF schemes on their own STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

12 The CBHF schemes and entire movement in Uganda are highly regarded by the main faith based health service provider networks namely the Uganda Catholic Medical Bureau (UCMB) and the Uganda Protestant medical Bureau (UPMB). Right from the inception of the first scheme in Kisiizi in 1998, the medical bureaus have worked very closely with the schemes with a belief and hope that these initiatives can grow and become a solution to limited health care access. The ministry of health on the other hand has maintained community health Insurance on government agenda and continued to provide guidance and hope for a policy that will create a better operating environment for CBHF growth. It s against this background that the CBHF movement is represented on the task force of the National Health Insurance scheme, although its realization is still far from reach. 2.8 Uganda Community Based Health Financing Association Uganda Community Based Health-Financing Association (UCBHFA) is a Non-Government Organization (NGO) established in 1998 to coordinate and promote Community Based Healthcare Financing (CBHF) initiatives in Uganda. The Association was registered as a non-governmental organization (NGO) in the year The Association currently has 25 members as shown in the table below. SCHEME LOCATION REGION Bushenyi Medical centre (BMC) Bushenyi area Western Kibirizi Kabale Diocese Kinanira Kitanga Mutolere Nyakibare Nyamwegabira South West Kisiizi Hospital Hospital area South West Ishaka Health plan Bushenyi Western Comboni Hospital Bushenyi Western Save for Health Uganda Bushenyi Sheema Western Luwero Munno mumbulwadde Union of Schemes Nakasongola Nakaseke Central Kitovu hospital Masaka Katimba Sembabule Central Nkoni Rwengo Central STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 9

13 Happy health insurance Ntungamo Western Nyakasiiro HC III Bushenyi Western Intergrated Commuinty Based Initiative (ICOBI) Sheema, Bushenyi Western BUREDO HC III Buhweju Western Mitooma central clinic and nursing home Mitooma Western Kabohwe Clinical Research centre (KCRC) Sheema Western Shine Africa Ministries Soroti Area Eastern Uganda Health Coperatives Bushenyi Areas Western Health Partners, Uganda Bushenyi Areas Western The table below shows UCBHFA Partners Partners Organization CORDAID Uganda Catholic Medical Bureau Uganda Protestant Medical Bureau Ministry of Health Community Health Financing Association for Eastern Africa Uganda Martyrs University - Nkozi International Health Sciences University Relationship Donor Partner Promoters Promoters Policy guidance Promoter at regional level Technical Partner Technical partner UCBHFA s previous and current activities Since its creation, UCBHFA has coordinated its members. The association in partnership with the MOH, ILO, and CHeFA-EA has done some researches and a catalogue of schemes in the country. Support to CHF schemes and scheme promoters have been done through support visits to schemes, resource mobilisation for schemes, trainings of scheme managers and data managers, etc. The secretariat has always been functioning even if with financial difficulties during the last four years. Also, several Governance meetings (executive committee meetings and General assembly s) have been held UCBHFA Challenges UCBHFA is yet to surmount a number of challenges to be able to serve its constituents effectively and to cause a change both at policy and cultural level. It requires greater amounts of investment of resources, technical knowledge, innovativeness, commitment and probably political will. Some of the challenges that UCBHFA needs to surmount include; 10 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

14 Inadequate management capacity especially at scheme level Limited resources which slows the implementation of programs Absence of a technical desk to offer continuous technical guidance for establishment, manage- ment and appraisal of CBHF initiatives Limited geographical coverage schemes are yet to be initiated it the Eastern and Northern part of the country Limited innovations leaving many schemes focused on one product instead of developing complementary products to make CBHF more appealing. Absence of a standard Management Information System which has limited the generation and effective processing of information for planning and advocacy purposes. Inadequate growth of schemes Existence of a national free health care policy that seems to contradict alternative mechanisms Inadequate advocacy skills causing limited engagement at various levels. 2.9 UCBHA SWOT ANALYSIS During the strategic planning workshop, an environmental analysis of the association was carried out using the Strengths, Weaknesses, Opportunities and Threats (SWOT) tool in order to build a firm foundation upon which the next five years will be based. The partnering of the different elements and the extensive data collected as a result of the analysis served as a spark for roundtable discussions and generation of new strategies. The tool was complemented by the problem tree which helped identify the core problem of the association, and the stakeholder s analysis. The SWOT results are presented in tables 1, 2, 3, 4 for strengths, weaknesses, opportunities, and threats respectively Internal Assessmentof the Association An internal analysis of the associationby the stakeholders was conducted to describe the resources and the skills that the organisation has acquired and to identify what to do for improvement. Table: 1 Strengths Sn Issue Strategies/actions 1 Growing membership (25 in total). 2 Strong governance and.management structures Tool to advocacy. This shows a sign of commitment. It is a tool to strengthen funding. Helps in sharing of experience. Helps in delivery of.services Enhances operational delivery such as coordination, planning, direction, supervision, controlling. STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 11

15 Available material resources.(office equipment s, vehicles, rented accommodation, physical address) An organization rich in data and information on Community Based Health Financing in Uganda. Committed and Competent board with diversified skills Represented at the national health insurance task force Facilitates work Facilitates research, advocacy and planning Resource for generating good strategies in resource management, foresight, sustainability etc. For advocacy To come up with simple policy beliefs Association Weaknesses Table: 2Weaknesses Sn Issues Strategy/actions 1 2 Inadequate sustainability strategies for the organization Reducing relevancy of UCBHFA to members i.e. some old members are not interested in UCBHFA anymore. 3 Inadequate capacity of secretariat 4 No permanent home for UCBHFA 5 Limited financial resources 6 Poor information management 7 No program to promote IGA 8 Informal partnership framework 9 Inadequate development and integration of the research and training elements within the operations of UCBHFA Develop a strategic plan and project proposal Collaborate and partner with local and international research in CHI Review the membership criterion, Clarify roles of UCBHFA and her members so that expectations of each party are made clear Train the secretariat and solicit for technical assistance and other capacity needs from partners Identify strategic partners to provide a home Develop proposals Write proposals and Strengthen membership recruitment drive Develop standard software Sell information. Start regular publications Collaborate with institutions that promote IGAs MOUs with partners. Accreditation criteria for members. Mainstream research in UCBHFA operations Partner with likeminded academic institutions Agree on research priorities and periodically update the same 10 Inadequate publicity Make an elaborate Advocacy strategy 12 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

16 2.9.3 External Assessment of the Association. To determine the association s long term direction an external analysis was conducted focusing on the opportunities and threats. Below are the results Table 3: Opportunities Sn Issues Strategies/actions 1 2 Presence of CHI in the NHIs policy and the health sector strategic and investment plan Interest by local and international research institutions in CHI Support representatives from the association in the NHIs task force Advocate for inclusion of CHI in the draft legislation Training program at UMU and IHSU i.e. collaborate and partner (MOU). 3 Recognition of UCBHFA as a key actor in the NHIS. Advocate for policy influence 4 International donor funds which supports enrolment in CHIs Develop Strategic plan and project proposal. 5 presence of members with long standing membership Membership relationships & expectations be made clear to all 6 High cost care in the private sector Strengthen negotiation skills Develop a clear framework for health insurance 7 Poor quality and functioning of free public care systems An initiative for people to join the schemes Articulate CHI solution 8 Global movement toward universal health coverage. Identify international alliances 9 UCBHFA as the only national coordinating board of CHFS. Develop clear coordination frameworks STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 13

17 2.9.4 Associations Threats Table: 4 Threats Sn Issues Strategies/actions 1 Poor quality services of the health sector Partner with member organizations for improvement measures Existing free service policy in the healthcare. Poor costing & analysis of health cost among schemes. Increased corruption in public offices (bad image to donors) Reduction of funding from the main donor (CORDAID) Economic crisis and relying on one donor Exploit the limitations to our advantage Validate membership Provide audited accounts. Need for a database Work hand in hand with the relevant ministries (MOH) Invite more partners to support Promote more community schemes Local resource mobilization Invite more partners to join and support the association Explore opportunities to be more visible 3.0 UCBHFA STRATEGIC DIRECTION 3.1 Our Vision To be Centre of excellence in promoting community health financing in Uganda 3.2 Our Mission To coordinate and support the establishment and management of sustainable community health financing initiatives in Uganda 14 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

18 3.3 Our Core Values Professionalism: Maintain the highest level of standards in all that we do Integrity: Exhibit honesty and trust in all our operations Teamwork: Foster team spirit within UCBHFA and with all our stakeholders Personal development: Have systems and policies that ensure continuous development of the organization and staff Inclusion: Recognize the view, opinions and aspirations of all stakeholders irrespective of race, gender, age, social status etc 3.4 Goal Improved coordination mechanisms and capacity for promoting community health financing initiatives, to enhance access to quality health care in Uganda 3.5 Program Areas Coordination and enhancement of capacity for Community Health Financing Initiatives Advocacy Knowledge Management Institutional Strengthening and Development CHI Countrywide 3.6 Strategic Objectives and Key Result Areas per theme Program Area 1: Coordination and enhancement of capacity for Community Health Initiatives Under this program, UCBHFA will focus on unifying, integrating, and synchronizing all efforts of the association members so as to provide unity of action in the pursuit of common goal. Through coordination, the theme will further focus on enhancing the capacities of community health financing initiatives. The strategic objective: To strengthen and continuously build competencies and skills in managing Community based health financing initiatives Key Result Areas (KRA) UCBHFA key stakeholders updated and mapped An accreditation system developed and operationalized MOUs developed and functionalised STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 15

19 Support supervision mechanisms strengthened Schemes training needs identified, reviewed and documented Training action plan developed. Code of conduct for members and affiliates developed Program Area 2: Advocacy Strategic objective To advocate for people centred policies and practices that promote sustainable community health financing initiatives. Key Result Areas (KRA) Advocacy issues identified and documented. Advocacy media and network established. Advocacy action plan developed and operationalized. Advocacy outcomes and lessons documented and shared with stakeholders Program Area 3: Knowledge Management: 16 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

20 Strategic objective To establish UCBHFA knowledge management &utilisation system Key Result Areas (KRA) Research themes identified and action plan developed. Management information system developed and operationalized Functional resource centre established Scientific conferences institutionalised Micro health insurance and technical training institutionalised Program Area 4: Institutional Strengthening and Development: The strategic objective To develop and strengthen UCBHFA s capacity to effectively deliver on its mandate Key Result Areas (KRA) UCBHFA policies reviewed, amended and disseminated to members Staff capacity developed to implement quality programmes Resource mobilisation strategy developed and operationalized UCBHFA board capacities strengthened to effectively add value to UCBHFAmanagement A home for UCBHFAsecretariat acquired Equipment s & materials acquired UCBHFA management structure reviewed in line with the plan Program Area 5: CHI Country wide The strategic objective To facilitate, support, and coordinate development of community health financing schemes across the country. Key Result Areas (KRA) Feasibility studies conducted in the northern and Eastern parts of the country. STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 17

21 Scheme establishment proposal developed and shared with partners for funding Awareness of CHI created. Strategic partners identified and engaged for initiation of CHI schemes. 4.0UCBHFA Organisational Structure. UCBHFA consists of the Board of Directors comprised of 7 elected officials and members. The Board of Directors meets once every three months but shall meet more than once, if necessary, for the transaction of its business. The Board is concerned with the implementation of the objectives of the Association and generally with the carrying into effect of the provisions of the Constitution and is responsible for the administration and management of the affairs of the Association. The board will work through three committees of finance and administration, communication and advocacy, and the coordination and technical committees. The association has a secretariat headed by the National Coordinator who represents the secretariat as an ex-official member of the board. The secretariat is responsible for the day to day management of the association s business. 18 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

22 UCBHFA Organogram General Assembly Coordination & Technical committee Executive Board Finance & Admin committee National Coordinator Communication & Advocacy committee Programme Officer Finance & Admin research & Communications officer support Staff 5.0 STAKEHOLDER ANALYSIS As part of the strategic planning process, a stakeholder s analysis was conducted to identify the key stakeholders for the association and highlight their interests and constraints and even explore the potential support or constraint to the association. The details of this analysis are presented in the matrix below: UCBHFA staff Conducive work environment Carrier development A progressive organization Adequate and appropriate Facilitation Marketing the organization Grow the organization Efficient implementation of activities Mismanagement of resources Staff failure to understand their role (Reason for existence) STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 19

23 Medical Bureaus Effective coordination of Schemes Soliciting for partners in health insurance MOH Ministry of Gender Labour and social Development Coordinate CHF schemes in line with HSS&IP Promote social protection services to CHF members Provide regular policy guidance Financial support Provide regular policy guidance on social protection Financial support Taking over CHF schemes Restrictive policy Local governments Promote initiatives that do not conflict with LG priorities Promote the schemes Policy up-dates Community mobilization Decampaining CHF Healthcare service providers Build capacity of schemes and providers on health financing initiatives Forum for sharing experiences and good practices Provision of quality health care to scheme members Provision of technical support to schemes Charge high cost of services Offer poor quality services Training and research institutions Popularizing health Insurance courses Conducting Scheme s driven courses Failure to run the courses 6.0 Monitoring And Evaluation of the Strategic Plan(M&E) The Board of Directors and Management of UCBHFA will be responsible for the implementation of this Strategic Plan. The Board of Directors will undertake thorough reviews of the Association s operations on an annual basis. Through these annual strategic plan reviews UCBHFA will be able to track the extent, to which the objectives are being realised, the critical factors that are enabling achievement of objectives and challenges. For effective implementation to occur, the Association s strategies will be broken down into individual performance areas of employees that will be measured through a performance management system. This will ensure that effectiveness is measured down to the employee level, which will collectively contribute to the larger vision of the Association. The Strategy will drive the formulation of annual performance goals for individuals and the Association and will also be used for implementing changes in 20 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

24 the Strategic Plan as and when necessary. Some of the key indicators to be monitored at the association level are presented in the table below. There will however be specific indicators for each programme. Thematic Area Coordination and Enhancement of capacity for Community Health initiatives Indicators Availability of stakeholders register No. of MOUs signed Availability of membership accreditation guideline Availability of support supervision reports (quarterly) Availability of a scheme training needs analysis report A training action plan and tools in place Reports of Regional & International experience sharing events attended No of meetings held with various stakeholders No of scheme support visits made Advocacy Approved list of Advocacy issues Approved Advocacy strategy in place Collaborative Advocacy partnership agreements signed No of Advocacy meetings held No of position papers developed and shared with relevant stakeholders Availability of friendly media contact database No. of issues / events covered in mass media Advocacy Impact Reports in Place Knowledge Management Catalogue of research themes in place Collaborative research Partnership agreements signed Detailed research project proposals in place Copy of organizational research policy in place Copies of Research project reports Copy of a CHI training Policy Copy of a training curriculum Copy of annual training calendars Copy of a detailed training project action plan Availability of trainers/facilitators profiles database Copies of proposals for additional trainings Existence of a physical desk & a technical staff available An MIS needs analysis report in place An MIS Development consultancy contract in place Copy of a tailor-made MIS software Copy of an MIS user and management manual Copy of a training report (MIS software application) Report of the user experiences (MIS user experience appraisal meeting) Copy of a policy or guideline for Scientific conferences Copies of profiles of persons to guide the scientific conferences Copy of structure and / or concept for scientific conferences Reports of annual scientific conferences held STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 21

25 Institutional Strengthening & Development Copies of institutional documents reviewed and endorsed List of courses / trainings attended by the secretariat staff Copies of staff salary slips Reports of staff performance appraisals Additional Resource mobilization project proposals in place Copies of new & innovative intervention proposals Amount of additional resources raised No of board meetings & committee meetings held Number and reports of AGMs held No of board trainings held No of board appraisals held Availability of new board members induction reports Availability of a UCBHFA own office building List of equipment and tools used by office CHI Country wide Copies of CHI expansion feasibility study reports in place CHI scaling up project proposals in place Number and reports of meetings held with various stakeholders in new CHI areas Copies I.E.C materials developed for new areas Resources raised for new CHI areas Number and locations of CHIs established Copies of MOUs signed by various stakeholders in new CHI areas General Dimension Annual Strategic plan performance review meetings 7.0 SUSTAINABILITY 7.1 Political Sustainability This refers to recognition of UCBHFA by government and regional institutions as a key partner in promoting community health insurance. In practical terms this will be done through lobbying policy makers at the different levels to advocate for health insurance. Through interaction of the association with members of the social services committee of parliament and other government organs, the association will lobby and advocate for the formulation of policies and laws that support community health insurance. The secretariat will further develop policy briefs that the political leaders will use to advocate for health insurance policies in the country. 7.2 Institutional Sustainability An institution is deemed sustainable if it has the strength to survive and develop to fulfill its functions with decreasing levels of external support. 22 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

26 UCBHFA will invest in board development hence enhancing the capacities of the board of directors to steer the organization through both good and ugly time. Regular trainings, appraisals and retreats will be organized for the board of Directors. Management systems will also be enhanced to ensure proper accountability of the organizations resources as well as to ensure effectiveness, smooth management succession and continuity. 7.3 Financial Sustainability UCBHFA will develop a resource mobilisation strategy to guide the association s efforts for local and international resource mobilization. The strategy will involve among other; generation of various complementary projects that make CHI more attractive to the communities, donor partners and other stakeholders in development. UCBHFA will also diversify her fundraising program and invite more donor partners to support community health financing initiatives. Annex 1: Strategic Plan Budget THEME KEY RESULT AREA YEAR OF IMPLEMENTATION YR 1 YR 2 YR 3 YR 4 YR 5 TOTAL (UGX) TOTAL (EURO) COORDINATION AND ENHANCE- MENT OF CAPAC- ITY FOR COM- MUNITY HEALTH INITIATIVES UCBHFA key stakeholders identified and mapped An accreditation system developed and operationalized MOUs with members developed and functionalized Support supervision mechanisms strengthened Code of Conduct for members developed and shared. Regional & International Networks established and functionalized(including participation in all regional and international events) 8,560,000 6,160,000 6,160,000 6,160,000 6,160,000 33,200,000 9,222 3,460,000 2,500,000 2,500,000 2,500,000 2,500,000 13,460,000 3,739 3,460,000 2,500,000 2,500,000 2,500,000 2,500,000 13,460,000 3,739 12,840,000 8,760,000 8,760,000 8,760,000 8,760,000 47,880,000 13, ,000,000 23,000,000 23,000,000 23,000,000 23,000, ,000,000 31,944 Sub total 51,320,000 42,920,000 42,920,000 42,920,000 42,920, ,000,000 61,944 STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18 23

27 Advocacy issues identified and documented. 7,060,000 7,060,000 7,060,000 7,060,000 7,060,000 35,300,000 9,806 ADVOCACY Advocacy action plan developed and operationalized. Advocacy outcomes and lessons documented and shared with stakeholders 29,2000,000 29,2000,000 29,2000,000 29,2000,000 29,2000,000 21,601,800 21,601,800 21,601,800 21,601,800 21,601, ,000,000 40, ,009,000 30,003 Sub total 57,861,800 57,861,800 57,861,800 57,861,800 57,861, ,309,000 80,365 KNOWLEDGE MANAGEMENT INSTITUTIONAL STRENGTHENING AND DEVELOP- MENT Research themes identified, action plan developed and implemented 14,640, ,000, ,000, ,000, ,640, ,000, ,400 Functional resource 97,000,000 centre established 27,000,000 12,500,000 22,500,000 12,500,000 22,500,000 26,944 Micro health insurance technical training institutionalized. 172,500, ,000, ,000, ,000, ,000, ,500, ,472 Management information system developed and operationalized (including MIS needs analysis, product 100,220,800 7,000,000 4,000,000 4,000,000 4,000, ,220,800 33,117 development, trainings, monthly support and product distribution) Scientific conferences institutionalized 30,000,000 30,000,000 30,000,000 30,000,000 30,000, ,000,000 41,667 Sub Total 344,360, ,500, ,500, ,500, ,500,000 1,611,360, ,600 UCBHFA policies reviewed, amended and disseminated to member Staff capacity developed to implement quality programs (Includes staff development and staff salaries) 237,182, ,381, ,941, ,969, ,970,453 1,232,443, ,345 Resource mobilization strategy developed and 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 10,000,000 2,778 operationalized UCBHFA governance capacities strengthened.( Includes board 51,700,000 73,000,000 51,700,000 66,700,000 58,000, ,100,000 75,306 meetings,agms, Trainings) A permanent home for national UCBHFA secretariat - 700,000, ,000, ,444 acquired Equipment s & materials acquired 173,000,000 4,000,000 4,000,000 4,000,000 4,000, ,000,000 51,389 Sub Total 463,882, ,644, ,669, ,970,453 2,398,543, , STRATEGIC PLAN FOR UGANDA COMMUNITY BASED HEALTH FINANCING ASSOCIATION (UCBHFA) 2013/ /18

28 CHI COUNTRY WIDE Feasibility studies conducted in the northern and Eastern parts of the country. 72,900,000-72,000,000-72,000,000 Scheme establishment proposals developed and shared with partners for funding 18,000,000-18,000,000-18,000,000 Awareness of CHI created. 8,720,000 3,500,000-4,000,000 4,500,000 5,000, ,900,000 60,250 54,000,000 15,000 25,720,000 7,144 Strategic partners identified and engaged for 13,000,000 3,611 initiation of CHI schemes. 5,000,000 2,000,000 2,000,000 2,000,000 2,000,000 Sub- total 104,620,000 5,500,000 96,000,000 6,500,000 97,000, ,620,000 86,005 M&E Project Monitoring 50,000,000 50,000,000 50,000,000 50,000,000 50,000, ,000,000 69,444 Evaluations ,000,000 35,000,000 70,000,000 19,444 Totals 50,000,000 50,000,000 85,000,000 50,000,000 85,000, ,000,000 88,889 GRAND TOTAL 916,925, ,450, ,252,253 5,151,833,460 1,431,065

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