ICT-enabled monitoring and evaluation methods of health coverage for sub-Saharan health facilities: A field study in Rwanda, Burundi, DRC, Tanzania, Mali and Senegal.

Universal Health Coverage (UHC) is at the center of the Sustainable Development Agenda 2030. During the period 2010–2016, the PhD researcher made an evaluation of the indicators allowing quantification of the impact of health coverage schemes on patients, applied in 6 sub-Saharan countries: Rwanda, Burundi, DRC, Tanzania, Mali and Senegal. After an analysis of potential health coverage indicators, the most relevant ones were calculated on the basis of patient health records collected via OpenClinic GA, a health management information system (HMIS) used in several sub-Saharan health facilities (HF). Results of this research show that DRC and Malian health facilities (HF) have a level of patient coverage lower than those in Rwanda and Burundi, where the patient is covered by more solidarity-based health insurance schemes. This research also managed to estimate the average costs of health insurance expenditure per patient and pathology related financial burdens in the studied sub-Saharan HF. More efforts are needed to achieve a good financial protection of patients in sub-Saharan HF. Only Rwandan HF had reached the indicators recommended by WHO thanks to the high reimbursement rates of CBHI (Mutuelles de santé). The research contributed to establish relevant parameters for assessing the level of health coverage in sub-Saharan HF using ICT-HMIS patient routine data. Additional broader studies involving more HF are needed in order to draw further conclusions on the role of health insurance schemes in health coverage in sub-Saharan countries. The same methods could also be applied to all health facilities in developing countries through implementation of an adequate ICT infrastructure for health information management.