Program Management

Requirements

The general idea behind the new functionality is to add the new "concept" to the openIMIS data structure, which is entitled "program".
openIMIS data structure called "program". In other words, in the openIMIS administration administration module, there will be a new "programs" tab where the administrator can define the various programs to include. Then, as he continues with the configuration, the products, health facilities and users. Users and insurance policies will be defined not only by location, but also by program.

At the time of enrolment, the data entry operator will therefore have the choice of adding all the policies of the programs to which the health facility has access. Programs to which the facility has access. For example, if the health facility is located in a region where only the Chèque is currently active, the operator will only be able to add a Chèque Santé policy to the beneficiary.

When entering benefits into openIMIS, the principle is the same. The operator enters the beneficiary's CSU number, and can choose to which program the invoice should be sent. The choices will appear according to depending on the beneficiary's policies. For example, if the beneficiary has a Chèque Santé policy and a Malaria, only these two options will appear.

For invoice review, one or more medical officers may have access to the benefits of a given
program. This depends on the user's access rights.

Impact on overall architecture

The solution's implementation architecture remains unchanged from the existing one.

However, because of the expected load on the system, one or more servers with more capacity than capacity than that already provided for current implementations in Cameroon. With the addition of the "program" mechanism, a third level of access to information and functionalities will be functionalities will be available:

• Authorization by user role (set of access rights to openIMIS functionalities)

• Authorization by location (access rights based on geographic data)

• Authorization by program (new access rights to be created here)

Although the impact may not seem significant, the addition of programs affects all existing openIMIS functionalities existing openIMIS functionalities, and its development could prove consequential (changes in SQL scripts, adjustment of various queries, modification of forms for filtering, etc.).

Impact on database structure

A new table for program registration will be added. As all other information will be linked to programs, links between other tables and programs will have to be made. (Example: Link between user roles and programs , link between claims and programs, etc.)

Impact on the administration module

In the openIMIS administration module (web application only), there will be a new "programs" tab where the administrator can define the various programs to be included where the administrator can define the various programs to be included.

A "program" entity includes the following elements:

• Its name

• Its location,

• Its validity date

The other entities in the administration module that will be impacted by programs are :

Products: a product will have to be associated with a specific program to indicate to which program the beneficiary belongs to during enrolment. A program can have several products (as for the Chèque Santé, we have the quarter 1, 2 and 3 policy). When a product is
a product, we add a "programs" tab with a choice of all the programs that have been configured. Only one can be selected.
Health facilities: when configuring health facilities, there will also be a tab to select programs. This will indicate whether the facility has been accredited by this program. In this In this case, several programs can be selected.
Users: when creating users, one or more programs must be associated with them. In the case of a data entry operator at a health facility who has been accredited by several programs, these same programs must be associated with him/her. In the case of a medical officer, for example

Impact on the membership module

Open

It is planned to integrate the new CamerHealth and openIMIS software to manage beneficiaries and their enrolment.
beneficiaries and their enrolment. We make a distinction here between "registration" and "enrolment".
Registration refers to the first step of registering the beneficiary in the CamerHealth software. At this stage, the person is not covered by a benefit package from one of the programs, he or she is simply registered in the database and given a CSU number. This information is then sent to the openIMIS database, where the "enrolment" procedure can be carried out, i.e., attaching a policy from one of the programs.

Policies are already categorized by programs.
For the Chèque santé, one change to be made is to the Chèque number. As the policyholder number, currently configured as the Cheque number, will be replaced by the CSU NUMBER. The Cheque number will then be used as the policy invoice number. Verification of the
number will be verified as usual, but at the policy level, not at the beneficiary level.

The question of enrolling beneficiaries in the HIV program is still present, as they must remain anonymous.
This issue is being addressed as part of the openIMIS migration and integration project for the HIV user fees program.

HIV user fees program, where discussions are underway to determine whether to leave HIV patient registration
HIV patients separately in DAMA, or whether a solution can be found to integrate it into this procedure.

The diagram below describes the registration and enrolment procedure with the integration of
CamerHealth and openIMIS. It should be noted here that the totally off-line version can pose a problem, as instantaneous
instantaneous data synchronization between the two software packages is required for this approach.

However, there is a workaround to this problem. In fact, the online enrolment process poses no major problems (all elements being synchronous in real time), but the offline the offline enrolment process would at some stage require the assignment of a policy to a beneficiary in the beneficiary in the offline openIMIS version without being able to retrieve all the corresponding
information.

In order to avoid having to re-enter the beneficiary's full enrolment information (which is already entered in the CamerHealth application), it would seem feasible on the mobile (offline) version to authorize beneficiary enrolment based solely on the CSU id generated by the CamerHealth application.

In offline mode, registration would be carried out via the CamerHealth application (which would record all the detailed
information on the beneficiary's identity, marital status info, photo, etc.) and in order to enroll this beneficiary on a specific
beneficiary on a specific policy, the data entry agent could simply create a new beneficiary by specifying the CSU id already generated by the other application. The policy will then be linked to this CSU id.

When openIMIS synchronizes with the server on return of the Internet connection, a specific process to retrieve all the beneficiary's registration details from the CamerHealth application CamerHealth application (via its API) and finalize the enrolment process naturally.

Impact on the claim module

Entering claim

To enter claims, the data entry operator will have just one change to his interface: a new tab where he must indicate which program the invoice is to be submitted to for verification. For example, if it's a CPN1, he chooses "Chèque Santé". Obviously, the tabs that appear will be in accordance with the user's access rights, as well as those of the health facility.

As usual, the data entry operator enters patient information (CSU number, diagnosis, date of visit, etc.) and enters the service with the quantity of inputs and procedures.
A question arises about pre-submission verification by a district manager (DM), as is done for the Chèque Santé. It has not yet been decided whether this step should be carried out for all programs.