Documentation of Requirements Workshop for National Social Health Insurance Organizations including employees in the formal economy

The Digital Convergence Initiative (DCI) is a collaborative effort involving USP2030 members, governments, development partners, civil society organizations, and private companies aimed at creating integrated and interoperable social protection information systems. Launched in 2021 and funded by the European Union, the initiative seeks to establish global technical standards for digital systems that facilitate smooth data exchange between programs integral to social protection delivery.

As social protection policies increasingly rely on technology, DCI partners focus on enhancing the capacities of social security and health protection agencies through digital transformation and interoperable Management Information Systems, particularly by customizing and implementing openIMIS. This open-source software effectively manages complex data flows by integrating beneficiary, provider, and payer data into a single platform.

There is a growing interest among social protection organizations in implementing openIMIS to learn from real-world experiences. Engaging with existing implementations helps organizations tailor the customization and deployment of openIMIS to their needs. The openIMIS community believes that despite unique implementations, common business processes can be identified. To promote this understanding, exchanges among scheme operators in a workshop setting are necessary to agree on commonalities and differences, guiding future developments for openIMIS to better encompass requirements of national social health insurance systems covering employees in the formal economy.

From January 20 to 24, 2024, a global event was held in Kathmandu, Nepal, with delegations from Ethiopia, Zambia, and Senegal to observe openIMIS in action for managing social health protection under the Health Insurance Board and the Social Security Fund. This visit was followed by a workshop to establish common business process requirements for registration management, contribution management, and claims management.

The complete documentation from the workshop is presented below:

Description	Downloads

Description	Downloads
Determining common requirements and documenting business processes for social security systems. Full Report	Open
Business Process - Registration Management	Open
Business Process - Contribution Management	Open
Business Process - Claims Management	Open
Gap analysis with openIMIS	Open

A special thank you goes to @Suravi Bhandary and @Dragos Dobre for this documentation and facilitation as well as support in making this workshop a success.