Quality improvement program
The Health Insurance Fund continuously work to improve the quality of the healthcare service provided under its programs. At the start of each program, PharmAccess performs a ‘medical due diligence’ of the relevant health facilities to determine the suitability of the providers and to establish a baseline for the quality improvement program, which is laid down in a so called upgrading plan.' for inclusion into the program.
Upgrading plans
The next step is the design and implementation of upgrading plans for each of the selected providers. This process will be repeated periodically. The upgrading plans are designed by the insurer (HMO, insurance company) and the providers and are endorsed by PharmAccess.
As the program progresses, the scope of quality improvement will generally expand from improving the availability of the required assets (buildings, equipment etc.) to improving the skills and organizational processes. Assets are upgraded by providing or replacing equipment and improving facilities. Skills are improved through training of medical and administrative staff, organized by the insurer and PharmAccess. Improvement of processes is accomplished by designing and implementing protocols and guidelines.
Monitoring and evaluation tool
In order to monitor this continuous upgrading process, PharmAccess has developed a monitoring and evaluation (M&E) tool, called 'On Track' consisting of a number of function-related modules. This tool is based on PharmAccess’ existing quality assessment tools, complemented with essential elements from American and South African quality management standards (Joint Commission International and COHSASA, the Council for Health Service Accreditation of Southern Africa).
Each module contains a list of assets, processes and skills, each of which will be scored on a 1-5 rating scale. The scores express quality levels ranging from ‘complete absence or great shortage’ (1) to ‘according to European quality standards’ (5).
Required quality standard
Eventually, all providers must perform according to at least level 4 (‘above the average observed level of care in the country’). PharmAccess will undertake biannual monitoring and evaluation visits to the clinics to measure the status and effects of the upgrading activities and to define the priorities for the next upgrading plans.
Investment Fund for Health in Africa (IFHA)
Parallel to the Health Insurance Fund, an Investment Fund for Health in Africa (IFHA)is being established to attract private equity capital in order to build and support local infrastructure related.
Medical Credit Fund (MCF)
The Medical Credit Fund (MCF) provides complementary financial support through loans to medical providers with an appropriate and affordable financing mechanism. This support strengthens and improves the healthcare delivery of hospitals, pharmacies and pharmaceutical distributors. In turn this will also result in an increased sustainability of healthcare in Africa.