Digitalisation of health insurance services in Ethiopia

Overall project value

The project contributes greatly to the digitalisation of the Ethiopian Health Insurance Services (EHIS) through the development of digital solutions, training, and support for various players in the health insurance landscape (managers, enrollers, claim managers, etc.), as well as capacity building for the EHIS IT Department.

Specifically, the project aims to:

• Enhance efficiency and reliability in the enrolment and claim processing for the Ethiopian Health Insurance Services which would provide information for use and exchange.
• Build capacity of the Ethiopian Health Insurance Services (EHIS), Community Based Health Insurance (CBHI), and Health Financing for the staff in handling and sustaining Health Insurance Information System (HIIS).
• Develop prototype system for the Social Health Insurance (SHI) registration, premium collection and claim management.

At the end of the project, the current IT solution suite for the Community Based Health Insurance schemes that was just piloted in one location will be scaled up to include the entire capital city (Addis Ababa) as well as several more woredas (districts) in the country. In addition, a new platform will be developed to support the forthcoming Social Health Insurance scheme.

Project description

The overarching goal of the current intervention is to strengthen the information system of the various components of the health insurance system and the capacities of the most crucial stakeholders. Moreover, it seeks to achieve strategic alignment between the information systems of the CBHI schemes and the forthcoming SHI scheme. The project’s distinctive mix includes bolstering the software development for CBHI and SHI schemes, training the end-users of the system and enhancing the capabilities of EHIS’s Information Technology Division (ITD) through training, coaching, and mentoring.

Scope of Work

In-depth assessment of the application suite currently developed by the Clinton Health Access Initiative (CHAI),

• Detailed assessment of 3 android apps and web apps that are part of the CBHI solution suite,
• Overview of the best practices in HIIS development in Germany, Croatia, and Estonia,
• Strengthen the solution architecture and improve robustness, security, and agility of the existing CBHI solution,
• Continuously refine and enhance CBHI solution suite,
• Collect and document the SHI HIIS requirements,
• Develop a solution prototype to support the SHI activity,
• Pilot testing of SHI prototype,
• Capacity building and certification training (training over 2000 claim managers and enrollers in 20 districts of the country reaching to the population of approx. 500,000 households).

Results

Optimised and customised digital CBHI enrolment and claim management.

Enhanced capacity of EHIS for development, optimisation, support and maintenance of the claim management and enrolment process.

Trainings and certifications of over 2000 claim managers and enrollers in 20 districts of the country, EHI, CBHI and HF will lead to skilled staff in handling IT system.

Training of Trainers with the selected EHIS employees and internal trainers