Digitalising Ethiopia’s health insurance systems

Commissioned by the Ethiopian Ministry of Finance and financed by the European Commission, m4h has been enhancing the capacities, coverage and software functionalities of Ethiopia’s health insurance systems.

The challenge

Before this project started Ethiopia’s Community-Based Health Insurance (CBHI) only covered few ‘woredas’ (districts) and the functionalities of its software did not fully support crucial work processes, such as enrolment, claims management and payments. In addition, Ethiopia’s government was looking for a software prototype for the Social Health Insurance (SHI) scheme it envisions for its formal sector employees. Thirdly, the Information Technology Division needed capacity building to be able to oversee the digital systems at the core if the Ethiopian health insurance schemes.

The assignment

m4h has been contracted for the following tasks:

• Assess the current software solution in use for Ethiopia’s CBHI
• Develop additional functionalities, including for CBHI enrolment, claims management, disbursement and reporting
• Extend the coverage of the CBHI to further woredas
• Train 2000 CBHI staff in 20 districts in its use
• Collect and document the requirements for a digitalised social health insurance system for formal sector employees
• Develop and pilot a prototype for a digital information and management system for this social health insurance scheme
• Build the capacities of the Information Technology Division

The results

1. The CBHI software now has functional modules for enrolment, claims management, disbursements and reporting.
2. The CBHI coverage has been increased from 2 to 151 woredas (districts).
3. CBHI staff has the capacities to run the enrolment and claim management processes: Over 2000 claim managers and enrollers in 20 woredas (districts) have been trained and certified.
4. A blueprint describing all digital work processes required for the envisioned Social Health Insurance has been completed.
5. A software prototype able to perform these processes, powered by openIMIS, has been developed and piloted.
6. The capacities if the staff of the Information Technology Division are enhanced.

Training of Trainers with the selected EHIS employees and internal trainers