Summary

Program goals

This scheme enables people to pay for health care collectively and in advance, instead of waiting until they become sick and fearing the cost of care thus protecting the poor, and enabling them to have some control over their health care.

Key program components

The Bwindi Community Hospital, in partnership with the International Medical Group, designed eQuality Health Bwindi as a sustainable solution to the funding of health services in Bwindi. The program is designed so that 50% the health care cost is met by the community itself, and the other half is met by supporting organizations. This program enables individuals in the remote Bwindi area to pay for their health care before they get sick through an annual payment of US $3 (UGX 6000) for each person ages five and over. This entitles them to use Hospital Outpatient and Inpatient services, including investigations, drugs and even certain surgeries at a cost of UGX 1000 (US $0.50) per visit. The hospital is paid UGX 12,000 (approximately US $4.6) per person per year for providing the covered services. Individuals can join the scheme through their Bataka groups (burrial groups). However, referrals, HIV care, maternal care and care for children under 5 years of age are not included in this scheme because they are covered by other programs. The people in southwest Uganda who are served by eQuality are nearly all impoverished. However, among those most impoverished are the Batwa Pygmies. Although eQuality charges an extremely low rate ($3/year) for healthcare, even this is beyond the means of the Batwa. In response we give Batwa a 50% discount off of the normal eQuality rate. Furthermore, eQuality worked with its sister organization, the Batwa Development Program, to use the proceeds from Batwa basket weaving to cover the remaining 50% of eQuality costs. The scheme costs approximately $126,000, half of which is covered through membership payments. The services are offered to the community members at the Bwindi Community Hospital and the Byumba Health Centre II satellite clinic for those located near the clinic. When the Health Centre is not able to effectively address patient' concerns, they are referred to the Hospital. The scheme also undertakes a number of outreach activities, such as sending dentists to visit the community to assess the members' dental problems. Simple problems are managed within the community and more complicated cases are referred to the hospital. The program works with "Village Health Promoters", Bataka (Burial Society) leaders and Local Council 1 chairpersons in every village to disseminate information about the scheme (e.g., services offered, exceptions), mobilize the groups, register individuals into the hospital database and collect premiums. Clients' income levels and livelihoods are captured at registration and reviewed every month to determine the strength of pro-poor targeting. Quality standards are in place that measure the day to day service quality, including monthly user satisfaction surveys and interviews with a minimum of 10 patients to judge their satisfaction with the services received. This acts as an assurance for the premiums collected from the community members.