Overview

Date: 13.05.2020

Objective: Align scope and roadmap for Formal Sector Integration

Participants:

• Uwe Wahser

• Purushottam Sapkota

• Maguette T. NDONG

• Fourie, Carl

• Xavier Gillmann (Unlicensed)

• Patrick Delcroix

• Dragos Dobre

• Siddharth Srivastava

• Saurav Bhattarai

• Nirmal Dhakal

• Umesh Prasad Bhusal

• Doreen G. Wamiti

Topic Proposals:

Minutes

scope

• Changing the claim flow (add the admin checks for the claims) was supported by the workflow package that was not accepted by DS

  • workpackage budget for formal sector in Notice D1 does not cover generic workflow engine

• contribution is paid by employer directly

• Nepali Developer / Beneficiary Management System (SOSYS) will remain and needs interoperability

• Beneficiary can claim directly for treatment in hospitals without MoU with SSF - not in scope for this formal sector work package, will be needed with accident insurance, is in issue queue and waiting for other funds

...

• • Reimboursement of cash payment (HF W/O MoU) are important for the Nepali but they are not covered by the RfA answers.

• Beneficiary / employer is responsible to update basic salary.

• Interface standard: FHIR, SOSYS will be able to adapt to that

• The maternity, sick pays are handled by SOSYS, therefore they are not is scope

stakeholders

• invite representatives from Social Security Fund (technical & business staff) for more detailed analysis - focus on specific topics at a later stage, also involving representatives from other scheme operators

• SOSYS Developers ()

further activities

• share SOP document of SOSYS processes (GIZ Nepal)

  • presentation from last weeks call (Formal Sector Beneficiary API in Nepal )

• clearly map out entities (beneficiary, employer etc.) workflows (claiming, enrollment etc) and system components (enrollment system, claiming system, payment system etc..) - SwissTPH & GIZ Nepal

• need detailed view on workflows and needed FHIR APIs: rely on existing openIMIS FHIR ressources and map out gaps (Healthix & SwissTPH)

Challenges

• dependencies: database, FHIR APIs

• product management will not be migrated in time (items, services)

Additional Resources

• Support for formal sector schemes - Incubator page in this wiki

• http://hl7.org/fhir/financial-module.html - FHIR R4 objects (financial Module)