Good Governance

Good Governance

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Guideline code
GG
Old code
COLL02
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Risk management and implementation of a decision-support system for medical controls

The objectives of the National Health Insurance Fund (Caisse nationale d'assurance sociale (CNAM)) are expenditure control and improving the quality of care. Electronic transmission requirements and medical control prerogatives have made it necessary for the CNAM to invest in the automated processing of medical claim forms.

The main objective is the establishment of a decision-support system with a medical knowledge base which would take into account the specificities of each medical claim form.

Contractual arrangements with partners

Since its reorganisation in 1996, the Pension Fund of Morocco (Caisse marocaine des retraites (CMR)) has managed civil service pension schemes and services on behalf of third parties. The CMR follows a multi-annual strategic planning process, characterized by a multidimensional, balanced distribution of its objectives into five areas of focus: governance, finance, process, resources and clients.

Institutionalization of a performance management system - The "Navigator"

Improving performance management has been identified as core to achieving the strategic objectives of an entity. In 2008, the Fund implemented a performance management system (PMS) to plan, monitor and evaluate performance. Though well crafted, this plan failed and Fund performance continued to be at sub-optimal levels.
 
In order to improve our services and maintain our strong financial position we had to implement a robust PMS. We developed a PMS that was customized from the balanced score card framework and named it the 1cNavigator 1d.

Biometric identification

Biometric identification is a method of identifying socially insured persons using their fingerprints and a photograph. The insured person is given a card after the identification process has taken place. The card holds all the information about the career of the insured person.

Financial performance certification of scheme reserve funds

Financial performance certification is a commitment by the Pension Fund of Morocco (Caisse marocaine des retraites (CMR)) since 2009 concerning its governing bodies. This practice is part of the management reserve fund's modernization (FDR: fonds de réserve) scheme.

In fact, the CMR opted, without regulatory constraint, for the performance certification of the various pension plan portfolios it manages. It is an annual total portfolio and asset class financial performance audit by an independent expert.

Modernizing the information system to improve service quality and combat fraud

In July 2013, the National Social Security Fund (Caisse nationale de sécurité sociale (CNSS)) launched a programme to improve its information system by integrating the use of biometric cards and e-declarations in its operation. With the biometric card, insured individuals will be able to verify the payment of their contributions, obtain all career and status information, simulate the conditions of their upcoming retirement and collect benefit payments at a kiosk.

SOLI: Short Message Service (SMS) reimbursement through a pharmacy network

Using new information and communication technologies (ICT) to implement a project of great social intensity: reimbursing health services by SMS and 3G in the pharmacy network under the supervision of a leading bank. Social benefit reimbursement is fundamental to the State because it relies on respecting the national commitments made to the population. It is not a theoretical question but a practical reality. When a person on a low income is entitled to a reimbursement of health services, the reality of having to manage a household budget on a daily basis becomes apparent.

Planning and performance

The National Sickness Insurance Fund (Caisse nationale d'assurance maladie (CNAM)) which has implemented new and innovative information and communication technologies (ICT) in social benefit management, has developed since 2010 a new strategy to improve performance at all levels of management.

Drawing on Kaplan and Norton's Balanced Score Card (BSC) work, the method aims to share out all the projects and action plans among the managers to maximize results and thus cultivate a culture of excellence based on project progress accountability reporting.

Proximity through a mobile office

In order to be closer to its policyholders, the National Social Insurance Fund (Caisse nationale de prévoyance sociale (CNPS)) of Madagascar has increased its number of agencies at a regional level. However, the isolation of some areas limits its efforts to improve service quality and the effectiveness of social protection. A special proximity policy was adopted to remedy this situation. A mobile office was set up to get closer to the target population and insured people in particular, and to adapt the services offered to the needs of people living in less accessible areas.

Paperless social benefits

The paperless benefit documents project consists of eliminating paper (prescriptions, medical treatment forms, etc.), and replacing it with Web application screens starting with doctors and then other healthcare providers (laboratories, pharmacies).

The three main advantages for patients are: