NIGERIA

HYGEIA COMMUNITY HEALTH PLAN

The performance of community health insurance schemes can be improved through health information systems Laoye Folashade, Ndili Njide, Adenusi Peju, Sule Abayomi
INTRODUCTION
In 2007, Hygeia Nigeria Limited, PharmAccess Foundation and the Dutch Health Insurance Fund partnered with two State governments in Nigeria to implement donor subsidized community health insurance schemes for identified low income groups. The scheme which is implemented by Hygeia Community Health Plan (HCHP), an HMO, is modeled around a managed care platform which integrates the financing, management and delivery of defined health care services to the target population through a network of 13 contracted private and public providers. Cardinal to achieving the objectives of the community health insurance scheme was the development and implementation of a health information system for the ongoing monitoring and evaluation of the programme through the collection and analysis of utilization (patient visit) data from all participating healthcare centres. This led to the development and deployment of an electronic health information system consisting of an electronic utilization (coding) application and a wide area network of VSATs and wireless broadband connected computers in each of the 13 participating primary healthcare providers. The coding application utilized codes derived from the ICD 10 coding system.
Figure 1: VSAT equipment installed to provide internet access to a remote healthcare center

IMPACT
The health information system has enabled the collection and analysis of utilization data for over 220,000 patient visits reported from more than 99,000 people who have enrolled on the scheme since February, 2007. Data from the health information system guides several quality improvement initiatives including quarterly provider staff training activities and other capacity building initiatives. The data collected also guides the development and implementation of treatment protocols which standardize treatment for designated conditions across the network of providers and within the hospitals. Improvements in healthcare delivery can be routinely evaluated through the utilization report emanating from the health information system
Figure 2: Healthcare worker entering patient encounter data into health information system

LESSONS LEARNED
1. Keep application/health information system simple 2. Ensure adequate user/stakeholder buy in WIIFM 3. Provide support to integrate health information system into routine hospital practice 4. Provide trainings and ongoing technical support 5. Provide adequate feedback on data to the benefitting communities , participating healthcare providers and government 6. Implement health information system as an integral part of the community health insurance scheme : business process and monitoring and evaluation framework
Figure 3: The patient encounter form

Figure 4: A screen shot of the health information management system

CONCLUSION
Experience gained from implementing the scheme highlights the importance of health information systems to the benefitting communities, healthcare providers, the insurer, donor and the government. The community health insurance scheme has benefitted immensely from the development of the health information management system. It has significantly improved the quality of decision making and achievement of programme objectives by all stakeholders involved in the implementation of the community health insurance scheme.
Figure 5: Use of the health information system in quality improvement

CONTACT PERSON: Folashade Laoye

Email: folalaoye@hygeiagroup.com