{One Family Health (OFH) is a US incorporated entity, registered in Rwanda as a private company, One Family Health (OFH) Rwanda as a low profit organization in a Public Private Partnership with the government of Rwanda through the Ministry of Health, working with ECOBANK Rwanda with loan funding from GlaxoSmithKline (GSK). The COUNTRY DIRECTOR, MAGGIE CHIRWA, explains how OFH is working to improve access to essential medicines and quality health care at the grassroots using a sustainable business model via a network of franchised Health Posts. The New Times’ THOMAS KAGERA writes: }
Owing to limited access by the rural poor to medical services, yet they carry the highest burden of diseases, OFH created a healthcare business model that supports health care providers to work and stay in remote and difficult-to-reach areas, reducing the strain on Government funds and resources in terms of salaries, accommodation and other health-based infrastructures.
OFH Rwanda therefore aims at increasing access to healthcare, essential drugs, basic healthcare and prevention services for children and families in Rwanda using a sustainable franchising business model that maintains standards, scales geometrically, and achieves economies of scale.
This objective in turn contributes to the intermediate outcome of “Increased prevention, diagnosis and treatment of the primary causes of mortality”. For the above mentioned outcome to be achieved, the community must be willing to use OFH HPs and Community Based Health Insurance (CBHI) subscription.
To date, OFH has supported establishment of health posts in; Gasabo, Kayonza, Gicumbi, Gatsibo, Nyagatare, Musanze, Rubavu, Nyabihu, Kamonyi and Burera and targeting Ngorero, Rulindo and Gisagara by the end of 2015.
Market entry and operations
OFH signed a Private Public Partnership with the Ministry of Health first PPP in 2010 and in 2012 during the post-pilot phase, having been successfully piloted in Gasabo district. Piloting in Gasabo met with such challenges as having a better off population that did not reflect targeted rural poor, with a high ratio of medical personnel –populace. Rwanda was chosen in the region to pioneer the programme because of the already established systems and apparent availability of access to internet infrastructures.
OFH, since its inception in Rwanda, has supported nurses to access bank loans to establish their own health posts and, once established, are trained in managing them professionally for the provision of quality health services but also as business entities.
The government targets to have a total of 2000 health posts with at least one in each cell. OFH has committed to supporting the establishment of at least 300 of them by the year ………
Since April 2012, OFH Rwanda, GSK, EcoBank, on one hand and the Rwandan Ministry of Health and by extension the local authorities on the other, started setting up Health Posts at cell level (Entry level health care) in Rwanda in line with the policy framework of the government.
The program was first rolled out in the Eastern Province where the incidences of malaria were high and local leaders were ready to embrace and support its implementation. MoUs were signed with district mayors for mutual support of the implementation mechanisms.
{{How it works}}
OFH working with the Ministry of Health and local leaders identify the nurse to be supported to establish a health post in the locale; where it will be located—where services are most needed, balancing with where it makes economic sense to the nurse involved. Preference is given to local nurses that are used to the operational environs and committed to their communities.
The accommodation unit once identified is accustomed to a health post design, upgraded and branded as an OFH-supported facility. The HP is then equipped with medicine and supporting facilities and infrastructures.
Sometimes, however, local communities contribute to the rehabilitation of structures and construction of such facilities as toilets during Umuganda (collective works). Local leaders also get involved in mobilizing people to subscribe for CBHI (about 95% of OFH patients are CBHI subscribers), report for and access medical services during the launch. It has been observed that during the launch of posts, the numbers of people that queue for medical services are overwhelming.
Nurses running the health posts are connected with Ecobank so they can access loans to finance their day-to-day activities including stock and operations.
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Key performance indicators}}
• The HP has to have stock all the time
• Immediately call for help as and when the need arises
• Reduce distance walked by a patient from home to medical facility to about 15 minutes
• Monitor/audit the quality of care given at all times
• An electronic health management system that ensures nurses play by the rules and monitored in real time
{{Use of IT for services delivery}}
OFH has harnessed internet technology to provide access to care and essential medicines and quality business management services. The company uses a licensed software—Life Qube—which is a mobile application developed by Life Sense. It is used in gathering information on patients, control and managing stock, quality service control, proper prescription, billing and claims.
The software captures patients’ bio-data, generates a unique identification number which is used throughout the franchise; so even when a patient is transferred to another health post, their records can still be accessed through automatic sharing.
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Capacities, Economic Performance Model
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OFH and partners have so far supported the establishment of 94 health posts of which 89 are operational. In mid 2015, three more health posts will be added. In Gasabo, some facilities had to be closed because of some challenges. Usually non-performing facilities are relocated to where services are needed.
When a nurse becomes the owner, he/she reduces the government burden of a salary, provides employment to both professional and casual staff.
The proprietors are then trained in two major areas: One; Managing a Small Franchise Business (finance, stock management and operating systems, clients’ expectations etc) with articulate proprietary manuals elaborated and provided, and two; Managing a Health Unit, which involves following the protocols developed by the government for treatment, among others.
OFH settles the monthly loan account with Ecobank Rwanda after collecting money claimed from CBHI—deducts monthly loan repayment, and drugs costs from income of those franchisees, pays the franchisees the balance due to them and franchisees are actively involved in claims follow up and answering CBHI queries.
The OFH HPs are audited by insurance companies to ensure compliance and spreading of benefits to the stakeholders involved.
{{On the path to Sustainability }}
OFH is on path to sustainability, at both the clinic and franchise levels, saving the government money in nurse salaries and benefits. Hardworking and dedicated Franchisees are now starting to yield results from their businesses.
At a clinic level, performance is monitored daily. Special attention is given to clinics not breaking even, through meetings with the Franchisee and District Officials to understand and address cause of low performance. Ultimately, clinics not breaking even are re-located to more densely populated areas.
At a franchise level, reimbursement payment collection rates have increased from 50% of verified claims in 2013/14 to 98% in the financial year to date. The key to OFH’s success is to secure reimbursement from the CBHI/ MoH and cost based prices for treatments rendered.
{{Challenges and way forward}}
A major challenge has been delays in CBHI reimbursement and non cost based pricing of drugs and consumables. OFH Rwanda remains confident that these will be overcome with the move to RSSB as the systems will be better managed.
OFH future activities shall involve improving collections and reduce costs through simplified processes possible such as e-claiming; time spent travelling shall then invested in quality control. Other actions will be improving pricing policies (market/cost based) and increased services package including aligning with market demand and increasing volumes and reduce time spent travelling.
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