SmartClaims: The context motivating the use of mobile phones to improve output-based aid in Uganda

Background: Providing effective healthcare in poor countries is an essential component to economic development and population wellbeing; however, efficiently financing it is difficult. In Uganda, the Ministry of Health is running a pilot of the output-based aid (OBA) healthcare finance model, linking payment of healthcare providers to services rendered. While this model has benefits over traditional models, the program management is information intensive, necessitating much paperwork to track and reimburse claims. We propose to deploy smartphones (mobile phones with advanced features) for use in the Uganda OBA project, to reduce claims processing time and improve communication between the health care providers and the management agency. Purpose: Based on recent work in Uganda we have identified some of the constraints and realities of the context in which these devices could improve the quality and speed of payment claims. Methods: Our findings are based upon a qualitative survey administered to 12 participating service providers, followed by in-person qualitative interviews and the use of participant observation to understand the existing paper-based claims process. Results: While very few providers had computer training (4/12), mobile phones are ubiquitous (12/12). Primary problems expressed include delayed payment processing (10/12), lack of feedback on processing status (3/12). Follow-up interviews highlighted the need for additional training as well as management agency concerns with fraud. Discussion/Conclusions: We discuss different means of integrating mobile phones into the claims process in the context of these findings. A web-based system is infeasible because most providers do not have access to the web. Trained mobile clerks may help close the feedback loop; however, the cost of travel to each participating clinic may make this solution infeasible. While a completely phone-based system seems the most efficient, a hybrid model integrating phone-based form submission with paper-based authentication may better address potential fraud.