Improving User-fees Collection in Pwani Region

RHMT/RRHMT Ubungo Plaza

10th September 2015

Problem statement • Inadequate Service Provision at Tumbi Designated

Regional Referral Hospital (TDRRH) due to insufficient funds. (Budget, Waivers, RTA casualties)

• User-fee collection amounting to average of TShs 300,000/= per day not sufficient to procure medicines and medical supplies from local suppliers when these items are stock-outs at MSD…eg gauze

• The Facility was not receiving Other Charges or Basket Funds and this created huge debts of internal as well as external clients.

Implementation Strategies 1. Strengthen Control on User-fees collection -

minimizing “Pipeline Leakage”: • Centralization of Collection points to a SINGLE, at

hospital reception. • Strict Control of Exemptions by implementing

criteria for waivers. 2. Implementing Referral System for non-emergency

cases:

• Clients are required to present referral letters except emergency cases

• Clients not wishing to follow referral system are treated as private and pay cost-recovery and not cost-sharing.

FIXED VALUE RECEIPTS

SPOT THE DIFFERENCE

Implementation Strategies 3. Computerization of User-fees collection:

• To generate receipts in order to minimize conventional receipt forgeries

• To generate reports on total costs of health care services (collections & waivers) and 37 more reports on other items

4. Computerization of Pharmacy store stocks and dispensing rooms:

• To control receiving of stocks from suppliers

• To control dispensing to clients

• To facilitate payments against “computer received stocks” print-outs to suppliers.................HOW.......??

Results and Achievements /Impact 1. User-fees collection raised:

• After centralization of user-fees collection to a single point, the amount collected daily raised to an average of TShs 900,000/= per day

• After computerization of user-fees collection, the amount raised to 3,000,000/=

2. Controlled Pharmacy Stocks:

• Computer-generated early notification of RE-ORDER Levels, Stock-outs reduction

• Early warning of approaching expiry dates of Medicines

• Purchase of medical supplies depends on instantly computer-generated stock balance

Name Location

Average Number of

patients attended per

day

Date of Installati

on

Date of commission

Average Daily Cash Collection

before HMIS adoption

Daily Cash Collection after HMIS adoption

Tumbi RRH Kibaha Pwani 500 2012 2012 338,000 3,000,000

Mawenzi RRH Moshi, Kilimanjaro 500 2014 2014 500,000 1,500,000

Morogoro RRH Morogoro 400 2013 2013 800,000 2,000,000

Shinyanga RRH Shinyanga 120 2013 2013 400,000 1,200,000

Sekoutoure RRH Mwanza 408 2013 2013 900,000 2,500,000

Sumbawanga R RH Sumbawanga 120 2014 2014 500,000 900,000

Mtwara RRH Mtwara 2015 2015 300,000/= 1,100,000

Songea RRH Ruvuma 2015 2015 280,000/= 1,350,000/=

Iringa RRH Iringa 2015 2015 1,200,000/= 2,200,000/=

Mkoani Health Center

Pwani 150 2015 2015 70,000 400,000

Rolling-out the Success Story

4PAY Hospital Management System Modules • Patient Registration

• Revenue collection

• Pharmacy Management

• Exemption Management

CHALLENGES of 4PAY System:

• Inadequate capacity of patients information sharing across the health facility

• Weak in capturing intra-referral system

• No storage of other patients information eg Lab/imaging

• The problem of staying with too much cash at Cashier’s

• Lack of compliance with eHealth standards and systems interoperability

These are basic

functions at all levels

of health facility and

was named as 4PAY

Strategy : Upgrading 4PayHMS to GoT HoMIS

Government of Tanzania - Hospital Management Information System (GoT HoMIS)

The GoT HoMIS an Overview • The GoT HoMIS is a comprehensive web and

modular based developed system, which contain >25 hospital management modules.

• The system has 38 different reports concerning Patients Mx and collections (Graphical, Summaries and Details)

• The modules are technically designed to support: patient care services, diagnostic services, and overall hospital administration.

• The GoT HoMIS is a locally designed system with capability to introduce modules (new HoMIS functionalities) and ability to be integrated with other management information systems (MIS) as the source code belong to the PMO-RALG.

GoT HoMIS Modules

Patient Care Services

Diagnostic Services

Hospital Administration

Registration

Patient verification

OPD and IPD

Pharmacy

Billing

Nursing care

Referral System

Laboratory (pathology, microbiology, biochemistry)

Ultrasound

X-ray

Hospital administration

Patient Waiting Counter

MTUHA Reports

Clinical Diagnosis

NHIF and other Health Insurances

CHIF and TIKA Patient management

Exemption Management

MoHSW Reporting tools

Mortality and Morbidity analysis

Implementation Reports

Cost-sharing financial reports

Secret of Success o Prototyping mode of approach for

system development

o Local talent specialists

o Adhering to guidelines and

standards

o Involvement of key stakeholders

o ICT Competency Capacity building

o Proper System Documentation

o Commitment of Top Management

and GoT HoMIS Team work

GoT HoMIS MoHSW

Hospital 1

Hospital 2

Hospital 3

Hospital 4

Hospital 5

Hospital 6

Hospital 7

Importance of Integrated GoT HoMIS • One Medical Record Number (MRN) for One

Patient

• Will enable MoHSW and PMORALG to track financial collections of all public health facilities in real time

• The MoHSW will be able to determine the status of drugs consumption per region and district hence correct estimations for MSD procurement plan

• Improvement of data collection at OPD and IPD for self generating (automated) report for HMIS and others hospital administrative data from the system

• It has support bulk cashless at hospital as money is transferred electronically to the hospital account (use of ePAY)

• It monitors practitioner’s performance as she/he use the system so it increases decentralized governance and transparency

Why choosing GoT HoMIS • Involving local experts in its

generation and therefore easy to re-engineer (RS/LGA IT experts, MU-DICT, PMO-RALG-DICT and KEC-DICT)

• Being overseen in terms of guidelines and policy from EGA which increases synergy in terms of security and compliances as per government directives

• Capable of maintaining the validity, integrity and confidentiality of individual private health information

• Capable of ensuring security through integrated system checks to prevent access and misuse of data

• Owned by PMO-RALG housed at Kibaha Education Centre.

•Very light in such a way it can be installed and operated in a standard desktop computer •Easy to deploy no complex technical skills are needed •Easy to translate to Swahili language which is dominant in primary level facility •Designed to meet different needs of health facilities according to facility size, technical capacity, the presence or absence of specialised health services

ASANTE KUSIKILIZA

For more INFO:

CONTACT

• KIBAHA EDUCATION CENTRE

0754294538