Table 5 Identified problems and solutions, December 2003
Problem | Discussed solutions | Implementation |
|---|---|---|
Ineffective procedures for premium collection: | Comprehensive revision of procedures for premium collection: | |
- Monthly collection | - Annual collection - Close follow-up of due renewals | - Option from 2008 onwards - No close follow-up |
- Transport to be paid by volunteers | - Monthly tour of all zones by the manager | - Successfully executed during several months, then interrupted |
- Many delegates are discouraged by demanding tasks | - Replacement of inactive delegates - Transfer of tasks from volunteers to the paid manager | - No replacements - No explicit transfer of tasks; in practice some tasks were taken on by the manager |
- Mismanagement of funds by some delegates | - Enactment of sanctions as stipulated in the Statutes | - No sanctions; individual discussions by the President of the MHO |
Complicated procedures for proving entitlement when seeking care | Abolishment of the ‘guarantee letter’ proving entitlement and timely distribution of lists of active beneficiaries to care providers | - Abolished in 2007 - Timely distribution of lists from 2008 onwards |
Poor understanding of multiple and complicated rules and regulation | - Better information of leaders, delegates and members about procedures, rights and obligations - Simplification of procedures where possible | - Several training sessions for scheme leaders and delegates - Regular information campaigns |
Disinformation by recruiters with the aim to register high numbers | New information campaign; open exchange with members about the initial disinformation by some | Dynamic and candid information campaign in 2004 |
Distrust of members resulting of insufficient information, disinformation and mismanagement of funds | New information campaign; transparency; better communication; promotion of participation and ownership | Several information campaigns; no change in communication style, participation and feeling of belonging and ownership |
No perception of belonging and ownership by members | Regular meetings with members in each zone to discuss health subjects of general interest | - Done during several months - Successfully done in the zone of Zaatar |
Poor performance of delegates in positions of responsibility, who had expected personal rewards | - Replacement of inactive delegates by motivated candidates - Abolishment of bureaux de zone | - No replacement of delegates - No explicit changes in the role of the bureaux de zone |
Exclusion of the poorest and large households; disinterest of wealthier households | - Creation of an equity fund - Redefinition of ‘the household’ - Discounts for large households - Targeted information campaigns - Advocacy with municipal administration to integrate the MHO among other public services | - Done in 2005 - Spontaneous evolution towards the nuclear family - No discount for large households - No campaigns to attract the wealthier - No rapprochement with municipal administration |
Inaction of scheme leaders when faced with unexpected problems | - Responsive management aiming at problem solving and members’ satisfaction - Continuing education | - Leaders tried to improve implementation of initial strategies; no change in management style - Frequent training workshops until 2008 |