Roundtable on digital Social Protection in Nepal

Potential links to the global initiative

When: Day 5, 10:00-12:45 Where: GIZ health project office, meeting hall

Background / occasion

• Growing relevance of digital SP esp. in the light of multiple crisis,

• overview on digital SP in Nepal: SSF schemes fully IT-based, preparation of integrated social registry

• openIMIS engagement in Nepal

• announcement on CORE-MIS (WB) & openIMIS merger, visit of BMZ / SDC representatives in Nepal (Funder Field Trip)

Objective … learn about up-coming topics and activities in (digital) SP in Nepal to identify

• Opportunities for bilateral engagement from SDC / BMZ side

• Potential links to the global openIMIS initiative

Facilitator: GIZ Nepal / openIMIS initiative

Participants: BMZ + SDC and the respective colleagues at the German and Swiss Embassy would like to enter dialogue (GIZ facilitation) with representatives from

• WB, ILO, ADB, WHO, UNICEF a.o.

• Overall approx. 12-18 participants

Draft agenda

Time	Agenda		Resources

Time	Agenda		Resources
10:00	Opening & welcome (framing of discussion, 5 min)	Embassy representatives / Chair Social Protection Task Team
10:05	Overview [LKG1]  on agenda and objective of roundtable (3 min)	GIZ
10:10	BMZ (5 min) global digital SP engagement & cooperation / coordination with multilateral partners, (activities in Nepal) SDC (5 min) global SP approach, need for (IMIS path to) DPG in Health (and SP) (interest in expanding portfolio into SP in Nepal)   Q&A (5-10 min)	BMZ, SDC
10:30	Global openIMIS initiative (overview on functionalities and schemes, merger) & engagement in Nepal (7 min) Q&A (10 min)	openIMIS initiative	Open
10:50	Structure for discussion (3 min) & Impulse: Overview on digital Social Protection in Nepal (7 min) (Completing) Mapping of digital SP landscape in Nepal (30 min)	GIZ tba All
11:45	Discussion on current challenges & opportunities in digital Social Protection (45 min)	All
12:30	Wrap-up & next steps (12 min) Closing (3 min)	GIZ & tba
12:45	End
13:00	Optional: Joint lunch

Greeting BMZ – Alexander Schrade

• after bilateral meetings and talks during evening reception the roundtable presents a chance for exchange / donor coordination on digital social (health) protection support to government of Nepal

• German government supports strengthening of national social protect systems in partner countries to make them more resilient against diverse forms of crisis (e.g. COVID-19, Ukraine war, climate change)

• Exchange on activities in support of digitalisation, identify digital solutions and enforce interoperability between them to increase efficiency of SP measures in Nepal

• German and Swiss Development Cooperation supporting openIMIS for management of health and social protection schemes

• Merger with WB CORE-MIS solution will allow further expansion into social protection / social assistance functionalities like cash transfer and public works programmes

Greeting SDC – Olivier Praz

• Swiss Agency for Development and Cooperation on global level active in various programmes in social protection and digitalisation for health (not active in the health sector in Nepal)

• openIMIS was part of a bilateral health programme in 2010 in Tanzania, trying to set up an health insurance for the informal sector; has been developed as a digital tool to manage the health insurance scheme and from there has been taken up and adapted for health financing schemes in other countries

• since 2016 Switzerland and Germany jointly support the openIMIS initiative and implementation of the open source tool in various countries

• in Nepal openIMIS is used for several schemes in the informal (HIB / Social Health Insurance) and formal sector (SSF / Employment Injury Insurance and health insurance), covering overall 6,1 Mio beneficiaries

• grateful for the exchange with international partners present in this workshop

Input on global openIMIS initiative, engagement in Nepal and openIMIS & CORE-MIS merger

• PPT …

• CORE-MIS will be re-programmed and integrated into openIMIS software stack

• Integrating openIMIS and CORE-MIS will create a Digital Public Good that can manage various schemes in the health and social protection domain, spanning from health insurance (formal, informal), employment injury insurance, voucher schemes to cash transfer and functionalities to support public works and other economic inclusion programmes

 Round I: Digital social protection in Nepal

With the objective of improving delivery on social (health) protection …

• (offer) how do you contribute to digitalisation / what digital solution do you offer?

• (expectation) what complimentary contribution would you like to see from other international partners in the sector?

WB / Jasmine  Rajbhandary (Senior Social Protection Specialist), Ashish Joshi (Consultant), Soyesh Lakhey (Consultant)

• WB support in development of (2 contracts that are about to be approved by Nepal government):

o   integrated Management Information System (iMIS) with Ministry of Labour

o   integrated social registry (InSR)

(expectation)… when consultants on these contracts are hired it would be great to have a presentation on openIMIS for them to consider the software for the implementation

• (offer) in cooperation with SSF (health insurance/social protection schemes for formal sector already running, for informal sector just about to start) – WB efforts could be useful on side of employment and InSR; InSR could help identifying / verification of target group for scheme in informal sector

• *On Integrated Social Registry (ISR) - suggestion to WB to link HIB (openIMIS data) to ISR as HIB has already data 6+ Mio informal sector beneficiaries in their database including some additional data on education and occupation

 ILO / Suravi Bhandary (National Project Coordinator)

• ILO support to SSF in strengthening their systems and schemes (digitalising social protection schemes) – SSF has been using openIMIS for 2 schemes (health and employment injury insurance in formal sector), openIMIS chosen as it enables adaptability and scalability and offers documentation of coding (and community support along with it) which are important for a young institution like SSF and during early phase of implementing new schemes + rolling them out

• ILO is currently supporting implementation of openIMIS beyond the administration of the scheme to basically cover the full cycle (of business processes) from registration / beneficiary management, contribution collection, claim management up to payment – these developments are all new for SSF, but also for Nepal health insurance / social protection… (expectation) there is a need for national Capacity Development to be able to take this forward after the launch – there is an interest by actors involved to learn about what has been the experience in other countries (on working with openIMIS for all these business processes) – training of national staff to facilitate a hand over

ADB / Rakesh Ayer (Health Financing Specialist)

• ADB supporting HIB to improve national health financing as part of regional technical assistance project in Asia and Pacific (also in other countries next to Nepal); recently working with GIZ under this programme and key deliverables

• (contribution) One of the deliverables is digitalisation of the health insurance, this cover the production of a digital transformation roadmap, 5 key areas under this activity

  • Identification of technologies required including functional and technical specifications and sequence of (business processes?) … current challenges for HIB – timely claims settlement, expending number of empanelled health facilities, increasing population coverage of insurance;

  • cost estimate of the technologies which would be required to tackle stated challenges

  • definition of capacity building requirements for each step of the roadmap – defining human resource and skill set needs

  • main product will be the digital transformation roadmap

• (expectation) ADB just started to work in this sector (in Nepal?) – consulting with government on activities under stated programme; government wishes to see ADB support on establishment of citizen service centres which are expected to serve as a one-stop shop (frontdesk) to all digital solutions, based at the local level – in ideal case all social protection schemes can be implemented through those civil service centers, where people go and are provided service on various schemes

• ADB planning for the next phase of technical assistance .. not in details yet, but will look at cross-sectional linking of social protection schemes incl. national health insurance programs

• Finalizing concept note on support to HIB

• One of the outlined deliverables: production of digital transformation roadmap of HIB

WHO / Roshan Karn (National Professional Officer, Health Financing

• Support in digitalisation of health facilities and to the interoperability lab

• Offering leadership in the health sector (on policy level) – promoting digital solutions (importance of MIS) and emphasis on interoperability when implementing them

• Use (policy dialogue) platforms to convey joint messaging from this group – organisations present in the workshop

GIZ / Nirmal Dhakal, Senior Technical Advisor

• (contribution) GIZ working on the interface between health and social protection; support in the digital area has been on the health insurance scheme (working with health facilities and providers on Electronic Medical Record systems, with scheme operators on claims management and enrolment), efforts to ensure there is interoperability between different schemes

• Support to Ministry of Health and Population (MoHP) in digital health and social protection, support on diverse strategies e.g. digital health governance, roadmap and work on integrated health information system, interoperability lap

• Implementation of DHIS2 and EMRs, for health facility link to Civil Registration system of Ministry of Home Affairs so they could give birth notification for health insurance (new beneficiary / household member)

• Implementation / customisation of openIMIS for HIB Social Health Insurance and SSF formal sector schemes

• Interoperability lab within MoHP – team is supporting technical aspects and capacity development of different stakeholders of government, vendors, academia to make their information systems and applications interoperable and complying with international standards; technical team will support connecting systems to exchange data

  • Teaming – team of different stakeholders

  • Defining new tools

  • Testing (provide testing environment / sandbox on API)

  • Training of different stakeholders

• Other stakeholders working on standards: e-government commission and Ministry of Communication and Information

• (expectation) from MoHP for other stakeholders engaging in digital system in health, please check what standards are already defined and get in touch if support is needed to make systems work with each other (linking to health facilities, to medical records, using FHIR data standard ---> even though this focuses on health, it might provide a good example for the social protection sector as well

Q&A

Question: … in connection with WB efforts on social registry – interested to learn on what is the scale of the project to link birth registration system, birth in health facilities (their notifications on birth) with civil registry by now? (to what extend has this been implemented already?)

• not started yet, but will take off under the leadership of MoHP with high expectation to be implemented soon; GIZ bilateral programme is supporting the definition of SOPs and implementation in 1 district, afterwards scale-up to more districts planned by ministry

Question: .. on positioning of openIMIS – Is openIMIS the agreed (between International Cooperation agencies) solution in support of the Health Insurance Board in Nepal?

• openIMIS has been used since the establishment of the HIB. As it is open source it has a lot of advantages for the government and it has the great support of a global community

• openIMIS follows (BMZ, SDC, GIZ) global commitment for digital (public) goods, eventually IT systems decision is a decision of the government of Nepal and the HIB – international cooperation agencies can only inform them about pros and cons of the different (proprietory vs. open source) digital solutions

• from perspective of bilateral level programme hope to coordinate to efficiently use limited resources rather than everyone trying to do everything alone

• from perspective of donor (BMZ, SDC) roundtable also shows that coordination is needed to also improve the exchange on activities in digital social protection to not re-invent everything from scratch; wish to see a more interlinked approach between the diverse systems- for this initiative of the interoperability lab can be used;

• stressing importantance of having a governmental entity (coordinating body) that works together with all the line ministries and is trying to develop an integrated approach for the social protection system in Nepal; it is essential that there are various social protection schemes in place, but also to coordinate on what are the priorities, where do we invest, who are the beneficiaries; it is not necessary to have just one social protection scheme to cover all, but the integration and interlinkages are very important and there digital tools, open source software with all their flexibility will be helpful and can bring a push forward to coordinate and interlink the different programmes

• digital public goods, using openIMIS as an example, allow to actually practice donor coordination

Round II: Current challenges and opportunities in digital social Protection

Relate to conclusions in the dimension of …

• How / On what areas should international partners in Nepal cooperate?

• What joint messages can international partners send to counterparts in Nepal? (e.g. using policy platform of WHO) / How can we consolidate messages, and would we address these to?

• How can activities be better linked to Digital Public Goods / openIMIS?

… On joint messaging

• (WB) we have to think about what are our messages that are not just principle, but easy enough to put in practice 

.. on raising awareness of government for open source tools – idea of joint workshop

• Open source as a product is mostly a new concept to government and one needs to inform the ministries; they might know about DHIS2, but not necessarily about open source in an MIS

• best would be if HIB and SSF promote the approach to the government because they have been working with an open source solution – openIMIS - and have seen the benefits of doing so; development partners can help HIB and SSF to make the case towards other government entities (for another implementation)

• challenge, governance of ICT is not seen as an institutional responsibility, but instead often delegated to the IT department –> there is a need to ensure the overall institution is involved in the technical decision, and the decision is not just delegated to IT department

• suggesting a workshop with a similar title ‘roundtable / workshop on digital social protection’ but with participants from government, with inputs on a global and local level experience on solutions and partnerships to start the discussion around efficiency gains through integration of systems

• use existing coordination rounds – e.g. donor social protection group SPTT in Nepal and sub-working groups (add one on digital social protection?) that support coordination of a workshop  

• importance to define the right target group for the workshop – it is not the same whether you talk to IT people or if you talk to senior management explaining them the pros and cons of open source; depending on the target group the invitation could also be sent by the global coalition of BMZ, SDC, WB (following the merger) plus ILO ….

• Suggestion to provide figures and data on efficiency gains - there is a working group that is gathering the actual data and figures to proof the gains comparing cost of scenario to develop your own system vs. scenario of using a digital public good (eg. openIMIS), such presentation would be very useful and convincing for eg. the Ministry of Finance and decision makers

  • Suggestion to use openIMIS total cost of ownership analysis (tool for digital health by USAID) on how much has been already invested in the global good openIMIS

• for the workshop target group – there is a need to work with both levels, starting with policy level and then going over to more practical points to be discussed with the IT, including discussion on the governance side of IT

• in Nepal e-health strategy explicitly mentions open source technology, based on this open source software can be used … existing tools in Nepal are DHIS2, openIMIS, openMRS, …

• Timing rather towards August or later