1. Using Rapid Assessment in
Ugandan Communities to
Gauge Perceived Economic
Benefits of Community-Based
Health Insurance
Christina Blanchard-Horan, PhD,
Consultant, Global Health Liaisons
Under contract with Matre Group Inc.

2. Value of Perception Evaluations
for
Community Based Organizations
 Contributes to the design of more
robust program messages
 Improves diffusion of innovations

3. Community-based health
insurance (CBHI) in developing
countries
 Protects members from economic downfall
in the event of a catastrophic health
incident
 Helps members get healthcare when
needed
 Assists with health planning
 Disseminates disease prevention
messages reducing preventable diseases
 Improves health systems by providing

4. CBHI Challenges in Ishaka
 Enrolling large percentage (60%) into
group participation as risk mitigation
tactic - slow uptake
 Retention of dynamic leadership
 Misperception about CBHI because of
donor funding at start-up
 Departure of donor funding = changes
at CBHI and need for diversification

5. Purpose of Perceptions
Evaluation
 Understand CBHI contribution to well-
being
 Determine members' perceived
economic benefit and beliefs about CBHI
 Improve messages for sensitization
 Realize other apparent benefits of CBHI
participation

6. Methods
◦ Rapid assessment
 Survey interviews –
 open and closed-ended questions
 Pretested on Ugandans from community
 Ugandan-tested amenities scale
◦ n=30 heads of households
◦ Examined patterns among
responses

7. Limitations
 Generalisability
 Retrospective Questionnaire
dependent upon long-term memory of
CBHI members = one year
 Point to determine perceptions not
actual occurrences

8. 16
10
3
0 5 10 15 20
6hadbeenonthe
plansinceinception,
10inthepast5
years
6hadbeenwiththe
plansinceinception
(1999)
NeverDropped
Droppedand
returned
Droppedandnever
returned
Dropping the Plan
n=30
Number of
HH Size, Education & Vocation
HHSize(Mean&
Median)
Education
NoSchooling
Farmingincome
6
24 = P3 to S3
(27% =P7)
6
(20%)
22
(73%)
Interviewee
Demographics Women, 8
Men, 12
Women
Single HH, 9
Women
Men
Single
Women
HH
Interviewee Gender and
Single Head Households
Single
Men HH
Single Men HH,
1

9. Perceived Experiences with
CBHI
 Sustainability - land and livestock ownership
“I would have to go back to selling land.”
 Work – Ability to work
“IHP has improved my life. I added some years because of IHP
and increased working. Because, if sickness comes, I cannot
work.”
“I go sooner to the doctor when feeling sick, so I can go back to
work sooner.”
 Education– Ability to pay school costs = 43%
(12)
“The money we use to bring to the hospital can pay school fees”.
 Psychological - reducing household financial
stressors from cost of unplanned healthcare
◦ 20 mentioned financial difficulty would have had medical bills to pay
if not for IHP
 Healthcare Access – quality care when
needed

10. Results in Practice
 Social Marketing - 63% (19)
◦ better financial and health conditions
since joining the Health Plan
 Identified new CBHI models
◦ Chronic illness models = 30% (10)
◦ Targeting Schools

11. Potential CBHI Benefits
Requiring further investigation -
 Contribution to the financial health of
the larger community as well
 Reduction of infectious disease
transmission
 Impact on the local economy of rural
communities

12. Implementation of Resuts
The health plan responded by
 Updating policies
 Increasing rates to improve services
 Implementing a recognition program
 Integrated findings into media strategy

13. More Information
Ishaka Health Plan
www.ishakahealthplan.com
◦ Community-based Health Plan (CBHI)
Matré Group Inc. www.matregroup.org
◦ Health Services
◦ Solar Light
◦ OVC in schools
Tuchwemu Project www.tuchwemu.com
◦ Savings Cooperatives
◦ Economic Development Initiatives