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OpenClinic GA Open Source HIS enabled Universal Health Coverage Monitoring
and Evaluation in Burundian Hospitals
Presentation · August 2017
DOI: 10.13140/RG.2.2.27249.58720
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Vrije Universiteit Brussel Vrije Universiteit Brussel
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 OpenClinic GA Open Source Hospital
Information System enabled Universal Health
Coverage Monitoring and Evaluation in
Burundian Hospitals

Gustave Karara, Frank Verbeke, Evelyne Ndabaniwe,

Etienne Mugisho, Marc Nyssen

1
 Introduction

“UHC means that everyone receives essential health services needed,

in quality and without being exposed to financial hardship” (WHO)

Monitoring of UHC is based on 2 major components: Health services
coverage and financial protection coverage.

Under UHC, people in developing countries should not spend 25% or
more of their total health expenditure or 180USD per capita per year as
OOP.

4 types for HI plans are observed in Burundi:
– CAM (Carte d’assurance maladie) is integrated in CBHI scheme => 23%
– MFP (Mutuelle de la Fonction publique) is a SHI plan => 3%
– Private health insurance (PHI) plans => 2%
– Free health service insurance for children <5year and pregnant women

Establishing monitoring indicators on UHC still remains a challenge in HF
(DHS & Weakness of HMIS): using appropriate ICT-HMIS could lead to the
2 quality of data and improve the UHC tracking at the level of HF.
 Objectives

General objective
Demonstrate that UHC can be adequately evaluated in Burundian hospitals by
using an Open Source HMIS based on standardized patient administrative
and financial data (real time data gathering). .

Specific objectives:
– Definition of set of health service metrics for UHC monitoring in HF
– Configuration & standardization in OpenClinic GA -HMIS software to
collect needed information in UHC indicators
– Implementation of OpenClinic GA in Burundian hospitas
– Evaluation of the UHC in studied health facilities

3 Openclinic GA implementation process

 Materials and Methods

OpenClinic GA Software
specifications
(https://sourceforge.net/projects/
open-clinic/)
– # users unlimited, # patients
unlimited, # bed unlimited
– User centric, patient
oriented, Very customizable
to local needs
– Opensource, webbased
application, high standard
proven technologies (Java
programming language,
Tomcat web application
server, compatibility with
different db servers, OS
4 and browsers)
 Materials and Methods (2)

Global health barometer (http://www.globalhealthbarometer.net)

– centralization of activity and productivity indicators
– centralization of health and coverage indicators

5
 Materials and Methods (3)

Period of research: 1/1/2013-30/06/2016 (~4 years)

8 Burundian hospitals:
– 4 National reference hospitals (NRH):

HMK (Military hospital of Kamenge)

CHURK (University hospital of Kamenge)

CPLR (Prince Louis Rwagasore Clinique)

HPRC (Prince Regent Charles Hospital)
– 3 District hospitals (DH):

NGORH (Ngozi Regional Hospital)

MUDH (Muramvya District Hospital)

KIDH (Kirundo District Hospital)
– 1 Private hospital (PH):
6
CMCK (Medical Chirurgical Center of Kinindo)
 Materials and Methods (4)

Monitoring of UHC metrics:

– Health coverage

Patient health insurance coverage (PHIC): % encounters using
a type of a HI

Patient health services coverage (PHSC): Insured (POOP<=25%) &
Uninsured (POOP>=75%)
– Financial protection coverage

Patient health services payments rate (PHSP): threshold to
25% of health service costs

Patient out-of-pocket payment (POOP): threshold to 180USD
as POOP per patient per year

7
 Results (1):
Distribution of patients and encounters

Distribution of patients and encounters (2013-2016)

Children
Out- In- Out-patient In-patient
Hospitals Men Women <5y
patients patients encounters encounters
HMK 586 905 48 487 734 260 48 581 52.10% 13.23% 11.24%
CPLR 113 146 18 043 215 196 19 139 3.57% 95.08% 0.08%
NRH
CHURK 126 042 25 939 208 717 45 789 27.05% 72.88% 13.23%
HPRC 50 395 12 287 77 969 77 969 41.11% 58.23% 20.70%
NGORH 27 454 13 452 51 471 18 700 41.00% 58.47% 27.22%
DH MUDH 10 164 2 691 14 311 3 095 42.25% 56.70% 24.54%
KIDH 9 778 5 469 16 197 6 053 43.30% 55.69% 31.48%
PH CMCK 82 228 2 619 90 807 2 619 29.90% 48.65% 9.22%
Total 1 006 112 128 987 1 408 928 221 945 33.63% 62.32% 17.94%

⇒ More than 1million electronic patient records have been created and
updated during the 3 years’ study in the 8 Burundian hospitals
8 ⇒ Women and children <5years more encountered Burundian hospitals
 Results (2):
Patient health insurance coverage (PHIC)

Health insurance schemes for outpatient encounters in 8 Burundian HF

- FREE (19%-32%) and

SHI (~MFP plan)
(34%-69%) are mostly
used in all public
hospitals.
- CBHI scheme mostly
used in DH (7%-16%)
- PHI scheme (28%)
and Patient direct
payment use (65%)
were dominant at the
CMCK, a private
hospital.
⇒ Important role of FREE and SHI schemes in PHIC
9 ⇒ Direct POOP payment (patient no covered) remains used in all hospitals
 Results (3):
Patient health services coverage (PHSC)

Out- and In-PHSC in 8 Burundian hospitals during the period of study

Outpatient Inpatient
- PHSC globally is
Statistical
Hospitals Insured Un-insured
Insured Un-insured significance higher for in-
(difference) (difference)
(POOP<=25%) (POOP>=75%) (Chi² test) patients (70.8%)
69.2% 23.6% P<0.001 than for outpatients
HMK 77.7% 17.0% (-8.5%) (+6.6%)
76.2% 18.3% P<0.001 (46.0%)
RF CPRL 39.7% 39.9% (+36.5%) (-21.6%) - Less health service
70.1% 20.2% P<0.001
CHURK 37.7% 43.0% (+32.4%) (-22.8%) coverage in the
HPRC 39.7% 47.0%
73.5%
(+33.8%)
18.2%
(-28.7%)
P<0.001 private hospital
69.5% 19.9% P<0.001 - High coverage for in
NGORH 54.7% 34.8% (+14.7%) (-14.9%)
DH 86.5% 10.7% P<0.001
patients encountered
MUDH 60.7% 22.0% (+25.8%) (-11.3%) public hospital
77.5% 13.2% P<0.001
KIDH 29.6% 48.4% (+47.9%) (-35.2%)
(FREE & SHI)
PH
43.8% 54.1% P<0.001 ⇒ Important role of HI
CMCK 28.2% 70.3% (+15.7%) (-16.2%)
70.8% 22.3% P<0.001 coverage for
10 Mean 46.0% 40.3% (+24.8%) (-18.0%) inpatient
Statistical significance (ANOVA test) p=0.005 p=0.032 encounters.
 Results (4):
Patient health services payments rate (PHSP)

PHSP in 8 Burundian hospitals during the period of study

Hospitals Out-patients In-patients Difference - PHSP for consumed
health services averages
NRH CHURK 40.5% 33.2% -7.3% 43% for outpatients and
HPRC 41.2% 29.5% -11.7% 30% for in patients
CPLR 46.3% 11.5% -34.8% - In the framework of UHC,
HMK 48.1% 56.7% 8.6% it must not exceed 25%
DH MUDH 25.2% 13.2% -12.0% - High level of PHSP at
NGODH 36.8% 29.5% -7.3% CMCK and HMK (More
KIDH 47.4% 20.9% -26.5% health services are not
PH CMCK 59.3% 47.4% -11.9% covered)
Mean 43.1% 30.2% -12.9%
Statistical significance (ANOVA test) NS
⇒ These difference between in- and outpatient PHSP are explained by the rates
of PHSC: Less health services are covered, more patient participation in
11 his/her health costs is required
 Results (5):
Patient out-of-pocket payment (POOP)

Out and in-POOP in 8 Burundian hospitals during the period of study

HospitalsOut- In-patients Difference - POOP was below the
patients threshold of 180USD per
NRH CHURK 11.54 USD 98.98 USD +758%
patient per year in all public
HPRC 10.47 USD 93.68 USD +795%
hospitals
CPLR 9.39 USD 40.51 USD +332%
HMK 10.84 USD 131.50 USD +1113% - It is higher in NRF and PH
DH MUDH 3.12 USD 2.10 USD -33% than in DH and for
NGODH 6.58 USD 24.71 USD +276% inpatients than outpatients.
KIDH 5.67 USD 12.22 USD +115% - It is excessively high
PH CMCK 13.52 USD 393.42 USD +2809% (393USD) in hospitalization
Mean 8.89 USD 99.64 USD +1021%
at CMCK (private hospital)
Statistical significance (ANOVA test) p=0.064

⇒ Health services are more costed in reference and private hospitals,

and in hospitalization (health services are higher costed are high in that
12 situation)
 Conclusion

Population coverage:
– The population health insurance coverage is less than 23-30%
(DHS, 2014).
– The OOP is 4.39USD/capita/year representing 20.9% of total
health expenditure (WHO,2015)

Patient coverage (our study)
– The PIHC varied between 35% and 75% in studied hospitals
– The PHSC is ranged between 46% and 71% in the studied HF
⇒ Insured patients who more encountered hospitals are
pregnant women & Children<5years (adverse selection)

13
 Conclusion (2)

Finance risk protection

– The POOP varied between 8.89USD and 99.64USD (
PHSP~30%-43%) in studied hospitals
⇒ POOP is high than in general population because
health cost are more expensive in 2nd and 3rd reference
hospitals

The implementation of an ICT-HIMS has enabled the
monitoring and evaluation of UHC in 8 Burundian hospitals
(extraction of routinely collected patient data for secondary)

Additional broader studies involving more HF at all level are
needed in order to draw further conclusions in the use of
ICT-HMIS in the UHC monitoring
14
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Thank you
for
your attention
More information about OpenClinic GA:

http://sourceforge.net/projects/open-clinic
http://www.globalhealthbarometer.net/
http://www.medfloss.org/node/271

gustave.karara@vub.ac.be

15