This page is a space to discuss and define the business process and required functionalities to cover formal sector members of a health financing scheme. 

Moved this to Nepali Requirements

requirements

OpenIMIS functional analysis_needs for the future_MS_SB_ND_070918.docx

Problem Statement

openIMIS's current functionality for membership enrolment is geared towards the informal sector with enrollment agents going door to door to collect beneficiary data and contributions from individuals/families. This functional design is not efficient if the scheme operator wishes to expand coverage to employers and a large number of employees and their families need to be enrolled at once. For such scenarios, openIMIS would need functionality to consume large amounts of beneficiary data (ideally with synchronous interoperability with human resource IT systems) at once and assign respective policies to the individual/family, while also keeping track of the contribution requirements and the corresponding incoming payments for those policies.

Informal Sector Definition (JLN)

  • While the concept of an informal sector has existed for decades, in 1993 ILO statisticians drafted the first consensus approach on measuring the sector, using the following definition:

    • The informal sector is composed of entities engaged in the production of goods or services with the main objective of generating employment and income. These entities tend to operate at a low level of organization, with little or no division between labor and capital, and on a small scale. Labor relations are based mostly on casual employment, kinship, or personal and social relations, not on contractual arrangements with formal guarantees. (ILO, 2014)

  • The World Bank offers a narrower, government-perspective definition:

    • The informal economy refers to activities and income that are partially or fully outside government regulation, taxation, and observation. (World Development Report on Jobs, 2013)

  • At a 2013 workshop on expanding access to health services and financial protection for people outside the formal employment sector, Resilient and Responsive Health Systems (RESYST) provided this definition:

    • People who do not receive health coverage through formal employment arrangements including those who work for unregistered or small enterprises, in subsistence agriculture, are unemployed or are not economically active. The definition also includes people who are poor and unable to afford financial contributions to the cost of health care.

  • Women in Informal Employment: Globalizing and Organizing (WIEGO), a nongovernmental organization, uses what may be the broadest definition, which encompasses all employment unprotected by the government:

    • The informal economy is the diversified set of economic activities, enterprises, and workers that are not regulated or protected by the state. Originally applied to self-em-ployment in small unregistered enterprises, the concept of informality has been expanded to also include wage employment in unprotected jobs. (WIEGO Working Paper No. 1, 2012)

  • Individual countries may also use their own definitions. For example, in Malaysia the informal sector is described as follows (Baharudin et al., 2011):

    • 1. All or at least some of the goods or services produced are meant for sale or barter transaction;2. Non-registration of the enterprise with the Companies Commission of Malaysia, Local Authorities, or other professional bodies; and 3. The number of employees are less than 10

Current Standard Operating Procedures

  1. Households are ACTIVELY approached to make them aware of the SHI availability

    The most common ways are:
    - Door to door enrollment
    - Through health facilities (e.g. at a specific day)
    - At various social gatherings

  2. Households are enrolled via an enrollment form and via capturing their picture through smartphone technology.

  3. Forms and membership identity card with QR code are pre-printed and given to the SHI enrollment assistant prior to the enrollment procedure.

Adaptations required

The above-mentioned scenarios usually happen once a month.

Note: For the formal sector enrollment, it’s crucial to understand the difference between initial enrollments (e.g. the Government decides to include formal sector workers as a new target group for SHI) and ongoing enrollments throughout the year.


Pay attention to this!

Where are the family members insured? How can we get information about family members in countries where the postal system is weak and we have limited access in the countryside? Identities for family members who receive free coverage under the person so works in the formal sector need to be checked carefully during enrollment. The names of the family members who get free coverage can’t get changed for a certain period of time (e.g. 1 year) anymore. This is necessary to avoid that “fake family members” will get coverage without having a “paying” household head, working in the formal sector.

Jira ticket

The issues around new functionality regarding the formal sector has been documented in the openIMIS software issue queue: https://openimis.atlassian.net/browse/OSD-28 

Current proposal

The initial proposal by Jiri Nemec, further commented by Michael Stahl: RfC_XX_support_of_formal sector_20180715_SB_MS.docx

Updated with comments from Patrick Delcroix: RfC_XX_support_of_formal sector_20190701_PD.docx


A draft proposed for the formal sector structure:



The source file for this drawing (Formal sector.drawio) can be read and edited on https://www.draw.io/.