ICT-Enabled Universal Health Coverage Monitoring and Evaluation in Sub-Saharan Health Facilities: Study in 8 Reference Hospitals of Rwanda, Burundi, the Democratic Republic of Congo and Mali

UHC (Universal Health Coverage) is at the center of the Sustainable Development Agenda. In this study, the authors made an evaluation of the indicators allowing quantification of the impact of health coverage schemes on patients, applied in 4 sub-Saharan Africa countries: Rwanda, Burundi, the DRC (Democratic Republic of Congo) and Mali. After an analysis of potential health coverage indicators, the most relevant ones were calculated on the basis of patient administrative and health insurance data, collected via OpenClinic GA, an HIMS (health information management system) used in 8 sub-Saharan hospitals during the period 2010-2016. The results show that the PHSC (patient health services coverage) rate is highest (81.5%-92.7%) in the 2 hospitals of Rwanda and in 2 hospitals of Burundi (37.7%-77.7%). The PHSP (patient health service payment) rate as the proportion of costs paid by the patient versus total health service costs is below the 25% threshold recommended by WHO only for the 2 hospitals in Rwanda. The POOP (patient out-of-pocket) payment is below the threshold of 180USD per patient per year for all hospitals. The HIEXs (health insurance expenditures) are funded by the university private insurance (86% of expenses covered) in 2 university teaching hospitals in DRC, by CBHI (community based health insurance) (69%) in 2 hospitals in Rwanda, by the free care policy (77%) in 2 hospitals in Burundi and by the SHI (social health insurance) (100%) in the 2 hospitals in Mali. PHSC in the 8 reference hospitals reflects the national trend towards UHC in each country. With this study, we demonstrate the possibility to assess the degree of UHC in developing countries, by a methodology based on indicators calculated via information extraction from routine data in electronic health records.