Managed care is different in Uganda. For starters, it involves trading milk for healthcare services.
In September 1997, the U.S. Agency for International Development, an arm of the State Department, invited our company, HealthPartners, to explore the idea of developing a prepaid, healthcare delivery system. Through the system, Ugandan farmers could convert part of their milk supply into payment for healthcare services.
Uganda had expressed interest in such a system. In fact, USAID and Minneapolis-based dairy company Land O'Lakes already had partnered to establish 50 successful dairy cooperatives in 12 rural Ugandan communities. USAID and Land O'Lakes believed Minneapolis-based HealthPartners -- a not-for-profit healthcare coalition with cooperative roots -- would be well-suited to work with Ugandan consumer groups and tap community resources.
To determine our company's interest in the project, we formed a project team -- made up of the president/chief executive officer, the medical director for contracted care, the deputy medical director at one of HealthPartners' hospitals and me. Then our team members traveled to Uganda. The task seemed overwhelming because of our findings: a lack of infrastructure and resources and significant health problems.
The country is among those with the lowest life expectancies -- an average of 37 years -- of any nation, according to 1995 data. It also has the fewest doctors per capita -- one doctor per 25,000 residents -- of any nation and spends less than $10 per person annually on healthcare, including charity, government and private funds, according to 1990 data.
Infectious diseases like AIDS and malaria cripple and kill large portions of the population. The leading causes of death in 1990 were malaria, AIDS, diarrheal diseases, pneumonia and anemia.
In 1990, 50% of Ugandan children died before age 5: one-third from dysentery, one-third from malaria and almost one-third from AIDS.
Ugandans who can get healthcare services are treated at government hospitals or charity-care facilities. In either case, residents don't have much influence over their care.
Despite the challenges, we decided to accept a five-year funding commitment from USAID to work with Land O'Lakes to develop a proposal for establishing a sustainable prepaid healthcare system.
We believed that by supporting consumer-run systems, we could help Ugandans exert more local control over the quality and availability of their care.
Our team recognized that the best approach was to help Ugandans solve their own healthcare problems. The residents knew what they wanted and had developed goals for preventive and restorative care. They just wanted help to form a working infrastructure.
Our specific strategy was to work with the rural dairy co-ops to decide which healthcare services local residents wanted. Those services would be funded by part of the milk supply and provided by participating hospitals for a predetermined fee. Leaders of the various dairy co-ops expressed interest in the plan and were willing to set aside part of their weekly milk production to generate revenues.
We proposed that for each co-op, a council would determine which healthcare services to cover. Our ongoing role would be to coordinate the efforts of the co-ops, find opportunities for collaboration among them and identify service enhancements.
Although it would have been unrealistic to try to transplant every element of the U.S. healthcare system in Uganda, we believed elements of HealthPartners' preventive program could be incorporated into the co-op system. For example, we launched a program in 1994 to help prevent breast cancer, childhood injuries, dental problems, diabetes and heart disease. Through the program, we look for enrollees at risk for developing any of the targeted diseases, and we work with them to reduce their risk.
To apply that concept in Uganda, public health nurses are paid from dairy co-op revenues to give immunizations, provide prenatal and neonatal care, and educate residents about nutrition. Nurses already have begun immunizing some participants, and the preventive activities eventually will be expanded.
Last February HealthPartners invited three Ugandans with healthcare and hospital administration experience to come to Minneapolis for a two-week session on prepaid health plans. One of those individuals is now a HealthPartners contract employee who will serve as a local consultant to develop the first pilot prepaid plan this year.
The other individuals will develop HealthPartners-linked, hospital-based prepaid plans that will contract directly with local employer groups and other private customers.
Already we have received positive feedback from our involvement in Uganda. And we're gratified to know that we are successfully sharing many of the principles of consumer-governed healthcare with others so far away. The effort also has reinforced our strong commitment to our enrollees at home.