Collaborating, Learning and Adapting for Sustainability in Ugandan Health Cooperatives

Ugandans face high out of pocket costs to access health care. To remove the cost barrier to care, HealthPartners trains local stakeholders to manage their own health insurance cooperatives, so members prepay for basic health care and access it when needed. Initially, all health care providers made surpluses. The challenge arose years later when monitoring data showed care providers losing money. Positive provider cost recovery is a linchpin in the health cooperative development model, so the issue needed a systematic review best guided by the CLA approach.  HealthPartners engaged external and internal stakeholders to share the monitoring data, elicit perspectives about the problem and build ownership of potential solutions. The main problem identified was failure of providers to enforce insurance principles. In the midst of the CLA process, HealthPartners noted that it needed to focus its partnership investments on those that shared HealthPartners' objectives and cease investments in those that did not. With its strategic partners, HealthPartners rolled out stakeholder-defined solutions including additional training, exchange site visits and an adjustment of its funding mechanism to incentivize sustainability and improve outcomes. The development outcomes of the CLA approach were improved cost recovery for providers, more accurate data collection, and reduced "free riders" (members who don't pay for services). Organizational outcomes were improved partnerships with and between cooperatives, more focused investment, and a deeper appreciation for the role of learning and adapting in project management.