Areas of performance: |
1. Access to health care services |
2. Contribution to equitable health financing |
3. Impact on service delivery |
4. Protection of household assets |
5. Inclusiveness |
6. Empowerment of members. |
Determinants of performance: |
1. Creation: the objectives formulated by each stakeholder and the process that led to the launching of the CHI scheme. |
2. Environmental profile: background information on socio-economic conditions, the health system, health service delivery and quality of services, and health financing. |
3. Preparedness: readiness of the national administrative, legal and financial system, of the health sector and of the target population to integrate community health insurance. |
4. Resource mobilisation describes design and implementation related to premium, co-payment and subsidies. |
5. Marketing and communication |
6. Financial management: the administrative functions of budgeting and bookkeeping. |
7. Financial viability: financial results and specific indicators measuring financial viability of CHI. |
8. Managing risks: strategies to manage adverse selection, over-consumption, provider’s prescription, and fraud. |
9. Financial protection: risk-spreading between healthy and sick, prepayment to reduce direct payment at the time of illness and measures to reduce the overall bill. |
10. Premium calculation: how were benefits’ package and premium calculated |
11. Benefits: the package of services, conditions for accessing benefits, evolution of the package over time. |
12. Membership: rules and regulations, membership statistics and reasons for affiliation and drop-out. |
13. Social inclusion: strategies and activities for inclusion of vulnerable groups. |
14. Utilisation: utilisation figures of members and non-members; health seeking behaviour. |
15. Provider payment: rules and management practices related to claims’ payment. |
16. Health care provision: health care providers, quality of care, relationship between CHI scheme and health care providers, strategies and action to influence provision of care. |
17. Stewardship: legislation, government involvement. |
18. Governance & decision-making: organisational structure, interactions within the scheme. |
19. Role table: support to get insights in interactions. |
20. Empowerment: ‘empowerment in action’ describes the practices of community participation within the MHO; ‘empowerment as a result’ explores whether the organisational structures of the MHO influence power relationships in matters of health and society. |