High-level delegations from three African countries visit Nepal to observe openIMIS in operation: South-south cooperation at its best

The aim of the study tour was to observe and understand how openIMIS supports the management of health financing and social protection programmes at different levels of Nepal’s health system.

We travelled to Nepal because we are considering replacing our costly commercial information management system with openIMIS. What we learned here has been tremendous: openIMIS can be used to register clients, collect contributions, pay providers, and more. We have been struggling with these things for some time.
 

So says Michael Njapao, Director General of the National Health Insurance Management Authority (NHIMA) of Zambia. Mr Njapao was part of a high-level group of delegates from health insurance agencies in Ethiopia, Senegal and Zambia, who visited Nepal from 20 – 25 January 2025. The aim of the study tour was to observe and understand how openIMIS supports the management of health financing and social protection programmes at different levels of Nepal’s health system. Delegates were formally welcomed by Nepal’s Ministry of Health and Population, followed by an inspiring week of meetings, field visits and workshops.

The week-long study tour was organised by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, the International Labour Organization (ILO) and Expertise France, with additional support from the Digital Convergence Initiative (DCI) and the European Commission (EC).

Observing openIMIS from the policy to the community level

The tour kicked off with meetings at the headquarters of Nepal’s Health Insurance Board and Social Security Fund, followed by a visit to one of Nepal’s largest hospitals – Dhulikhel hospital – to see openIMIS in action. From here, the group continued to the district offices of the Health Insurance Board to understand how local stakeholders use and interact with the programme, while a short trip to a nearby village provided an opportunity to observe how openIMIS facilitates the enrolment of new households into the social health insurance scheme.

A visit to Kathmandu University's School of Engineering rounded off the first half of the week, where faculty at the Department of Health Informatics described how they use openIMIS to teach master’s degree students about issues of health system efficiency and accessibility. The university visit also took in the Health Informatics Lab and discussions on the interoperability of openIMIS with other open source digital public goods, such as DHIS2 and OpenMRS.

The second half of the week was devoted to a workshop where delegates discussed openIMIS requirements for business processes that are common to different formal sector employment schemes. (More about this workshop will be shared in an up-coming article.)

Show-casing Nepal’s digital leap forward

Despite its size and challenging terrain, Nepal has made remarkable progress in strengthening its health and social protection systems, thanks in no small measure to the Government’s vision of a ‘Digital Nepal’. Over the last decade, the country has prioritised investment in digital technologies with the aim of enhancing efficiencies and extending access to services, and is now well on the way to creating an interoperable digital health ecosystem.

Nepal is unique in using openIMIS to manage a nationwide social health insurance scheme. As of March 2025, more than a third of all households - representing nine million individuals - were enrolled in social health insurance across 76 of Nepal’s 77 districts, providing much-needed health protection. And in the formal sector, a further eight million individuals benefit from the Social Security Fund’s employment injury scheme, which uses openIMIS for the management and review of claims. These are impressive feats, which the delegates from Ethiopia, Senegal and Zambia were keen to see first-hand.

Bernd Appelt, Head of Health Programmes for GIZ in Nepal, describes the impact of the tour for Nepal,

This study tour has made our partner institutions in Nepal rightly proud. Nepal is a small country sandwiched between giants, and it was highly motivating that three large African countries came to see and to learn from what is happening here.

South-south cooperation – the way of future development cooperation

While south to south cooperation is not new, the advantages of using more ‘horizontal development coordination mechanisms’ to strengthen the delivery of public health services are increasingly well-recognised in today’s post-colonial world of diminishing aid budgets.

South to south cooperation aims to increase aid effectiveness and sustainability, placing development partners in the role of enabling and facilitating change rather than direct implementation. When executed well, south to south cooperation provides critical opportunities to gain first-hand knowledge of approaches that work in similar health and development contexts. 

‘South to south cooperation is a very good tool for us to facilitate knowledge sharing both across the development space and across borders,’ explains Bernd Appelt. ‘For GIZ as a supporting agency, this tour was an important lesson on what development cooperation might look like in the future. It works better than us sending technical assistance to other countries.’

Building the openIMIS global community

By bringing together potential openIMIS implementers with experienced practitioners, study tours such as this one both extend and consolidate the global openIMIS community. Over time, this widens the pool of expertise and experience that members of the community can draw from when, for example, planning a new openIMIS use case or customising the software for a health financing or social protection scheme in a new country or programme.

Mrs Perpetual Halindi Kalobwe, Director Health Insurance Services at NHMIA in Zambia and a colleague of Mr Njapao, sums up the benefits of the tour well, saying,

This visit helped us to see what openIMIS can do, not only for Zambia, but for our sister countries. I salute our cooperation partners for bringing us together to build alliances both with the technical experts from our partner agencies and with other country teams. Now we have people we can call to help us implement our own social health insurance.

For more information, please check our documentation in the openIMIS wiki.

Other recommended reading in this context: Building bridges between social protection and health sectors (SDC / Health Network blog, March 2025)