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Session I: Celebrating a Decade of Impact and Extracting Lessons for the Future (Panel Discussion)

Session I: Celebrating a Decade of Impact and Extracting Lessons for the Future (Panel Discussion)

Digitalization of insurance processes to Intelligent systems: The Future of openIMIS in Nepal

Type of contribution: 60 min panel discussion in the plenary

Facilitator:

  • Ms. Pratima Rai, Advisor - Social Health Protection, GIZ Health Program, Nepal

Panelists:

  • Dr. Pawan Sah, Chief Claims Section and PPMD, Health Insurance Board (HIB), Nepal

  • Dr. Roshan Koju, Director - Information Management Division, Social Security Fund (SSF), Nepal

  • Er. Suraj Prakash Aryal, Standards and Interoperbility, SIL Lab, Director- IT, Ministry of Health and Food Safety (MoHFS), Nepal

  • Ms. Anna Koziel, Health Specialist , The World Bank, Nepal

Note-Taker (Documentation):

  • Aditi Manandhar, Trainee, GIZ Health Program, Nepal

  • Volunteer

 

Description:

Digital health technologies have become a central pillar in strengthening health systems and advancing Universal Health Coverage (UHC). In many low- and middle-income countries (LMICs), digital solutions are increasingly used to manage health financing functions such as enrolment, claim processing, provider payments, and monitoring of service utilization (World Health Organization, 2021). The openIMIS platform- an open-source health insurance management information system- has emerged as a globally recognized digital public good designed to support health financing and social protection schemes (openIMIS Initiative, 2023).

Nepal is among the early implementors of openIMIS and has established itself as the backbone of the Nepal’s Health Insurance Programme (HIP) administered by the Health Insurance Board (HIB). Since its introduction nearly a decade ago, openIMIS has played a critical role in digitizing key operational processes including beneficiary management, claims submission and verification, provider payment management, and program monitoring. Over time, the system has evolved from a primarily administrative claims-processing tool into a broader platform enabling data-driven decision-making in health financing.

However, as HIP coverage expands nationwide and operational complexity grows, there is increasing recognition that digital systems must evolve beyond basic transactional functions. Emerging technologies- including data analytics, artificial intelligence (AI), machine learning, and interoperability with other national digital systems- offer opportunities to transform platforms like openIMIS into more intelligent systems capable of supporting fraud detection, predictive analytics, strategic purchasing, and evidence-informed policymaking (OECD, 2022; WHO, 2021).

At the same time, digital transformation must also be aligned with broader principles of Gender Equality, Disability and Social Inclusion (GEDSI) to ensure that digital systems contribute to equitable access, inclusive service delivery, and responsive governance in health insurance programs.

Marking ten years of openIMIS implementation in Nepal, the openIMIS Community Meeting provides a timely opportunity to reflect on Nepal’s experience, celebrate key milestones, and explore future directions. This plenary panel discussion aims to bring together policymakers, implementers, and technical experts to reflect on Nepal’s journey and collectively explore the next generation of digital innovations for health insurance program.

 

Objectives

 To reflect on the current analytical and functional capabilities of openIMIS in Nepal

  1. To explore opportunities for integrating advanced analytics and intelligent features into HIP operations

  2. To discuss how digital innovations can strengthen equity and inclusion, including examining risks related to data bias, exclusion, and ethical governance

  3. To identify practical pathways for strengthening digital health insurance system

 

Related inputs during the Community Meeting:

 

Background:

 

Agenda:

 

 

 

Summary & documentation