Mise en place d’IMIS (Insurance Management Information System) pour les mutuelles de santé au Sud-Kivu, RDC

About the project

The implementation of the IMIS pilot in the Democratic Republic of Congo (DRC) is part of Phase III of the Health System Support Programme, PASS South Kivu funded by the Swiss Cooperation (SDC). Swiss TPH and GIZ were commissioned to implement the project with similar roles, but in different areas. Towards the end of Phase III, it was decided to allocate part of the budget to strengthen community health insurance through a project to revitalise health insurance. Thus, the establishment of an information system has been identified as the priority to strengthen the development of health insurance in South Kivu, by:

strengthening improvement of operational procedures management
making data more reliable for risk monitoring for better knowledge and adaptation of the insurance product
providing more transparency regarding the management of affiliation, contribution and reimbursement data by each promoter.

In April 2017, a team of three consultants from Swiss TPH was commissioned to set up IMIS in six healthcare zones in South Kivu, with a limited pilot focusing on the configuration of systems, the test of affiliation registration and the encoding and validation of repayments. Implementation of the pilot began in April with eight insurance mutuals, with a first mission in June 2017 to set up the system and train the users. It will be finished by the end of December 2018. The PASS project is entering its final phase. For the moment, investment continuity for the implementation of IMIS remains uncertain while local partners are interested in continuing development and extending the pilot to insurance mutuals in their network. Thus, financial and technical assistance is needed to maintain continuity in the development of this project.

The initiative addresses issues related to the quality of data collection, the transparency of financial transactions and weakness in fraud control encountered by insurance systems that still operate with “paper-based procedures”.

Few benefits of IMIS:

It’s a comprehensive system for managing a health insurance scheme (enrolment, renewal, claims management, feedback, reporting)
It provides a way to standardize operations of a health insurance scheme while starting up as well as for scaling up across multiple sites
It uses easily accessible technology (android mobile phones) – easy to implement, scale and further innovate
IMIS targets specifically the challenges of informal sector schemes, both urban and rural
it takes processing closer to clients (cuts down transaction time), applies a cost effective mechanism for establishing identity and eligibility, and supports an ‘active’ enrolment structure
IMIS is able to operate multiple products, multiple insurance models, multiple structures, and multiple business rules, with the possibility to implement verification mechanisms, etc.
On line and offline (both computer and mobile phone) capability to adjust to available infrastructure
The system is managed through a central server which can allow for gradual roll out (geographically or feature wise) in a modular way; and for centralized or decentralized management of schemes
The system allows “portability” for clients (e.g. clients from district A can utilize the membership card also in District B, and claims are charged to the “home” district)
The license is open source.