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Digital Health Interoperability in Cameroon

Connecting openIMIS with National Health Systems

February 17th, 2026

Maxime NGOE, Y-Note

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openIMIS UHC Cameroon key figures

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  • Started 2023�
  • Merge between 2 different instances on 2 programs already using openIMIS (HIV / Cheque Santé - Maternal healthcare)�
  • Managing now 5 programs :

HIV

TB

Children Consultation below 5

Cheque Santé (Maternal Healthcare)

Hemodialysis

1

2

3

5

4

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openIMIS UHC Cameroon key figures

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Millions �Insurees�(17% of population)

Health Facilities�(20% of HF)

Millions�Claims

5.2

1.100

2.3

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Cameroon Digital Ecosystem overview

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Dama

CHC

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Current Interoperability Architecture

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CHC

Dama

Insurees

Insurees

Claims

Services�Items�Diagnosys�HF

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Current Interoperability Architecture - CHC

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CHC

Patient

Enrolment

Policy Attribution

Contribution

Claims

Enrolment Online / Offline

Deduplication / Validation Process

Patient Creation

Policy attribution

Claim Management

Insuree

Auto-creates family groups

(no family mgmt in Cameroon)

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Current Interoperability Architecture - Dama

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Challenge: Protect HIV patient identity while ensuring coverage

  • Solution: Anonymous enrollment with minimal data
    • Unique HIV patient identifier
    • Birthday, gender, location only

Two enrollment pathways:

  1. Manual creation: Mobile app + web interface (dedicated fields)
  2. DAMA integration: EMR-initiated enrollment at point of service

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Current Interoperability Architecture - Dama

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Patient

Enrolment�Care

Policy Attribution

Contribution

Claims

Enrolment HIV Patient

Care

Claim Creation

HIV Insuree Creation

Services / Items

HIV Insuree

Dama

Claim

Diagnosys

Activity / Medication

ICD 10

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Implementation Challenges - Part 1

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�

Master data inconsistency:

    • Locations differ across systems
    • Services, items, diagnostics not aligned
    • Root cause: Siloed development (openIMIS team vs MoH teams)
    • Impact: Cannot accurately map new insuree locations

Rapid Deployment (6-9 months) = Technical Debt

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Implementation Challenges - Part 2

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Legacy data migration: 3M insurees took extensive time with FHIR

  • Solution: Switched to bulk import/export process

Uncontrolled data volume:

  • No rate limiting on CHC → openIMIS FHIR calls
  • Can receive 30+ insurees/minute continuously
  • Works at small scale, breaks at millions with concurrent processes

Performance & Scalability Issues

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Next Evolution - Digital Voucher

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Risks of Expanded CHC Integration. �Designed as an MPI now planned as a Policy Manager��Expanded scope: CHC now manages:

​

CHC

z

CHC enrolls beneficiaries and creates their digital identity in the Master Patient Index

1. Insuree Creation (Current)

CHC tracks and manages payment status and financial contributions for each policy.

3. Contribution Management (New)

CHC assigns health insurance coverage and activates policies for enrolled beneficiaries

2. Policy Attribution (New)

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Next Evolution - Digital Voucher

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CHC Takes Ownership of Policy Management : ��New Challenges Introduced:

  1. Reduced openIMIS control over core insurance functions
  2. Fraud risk increase - external system managing policies
  3. Claim-policy timing mismatch - claims may arrive before policy sync
  4. Data protection concerns - CHC gains access to sensitive policy data

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Next Evolution - Future Architecture

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GIZ-led Central Interoperability Platform

Components:

  • openHIM: Central interoperability layer
  • Connected registries:
    • MPL/MTL (Master Product/Terminology Lists)
    • MFL (Master Facility List)
    • CHC (MPI)
    • Bahmni (EMR - 10% coverage in pilot region)

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Next Evolution - Future Architecture

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Governance & Compliance Gaps��Critical Missing Elements:

❌ Governance: No MoH-level interoperability oversight�❌ Security: Security protocols not integrated �❌ Legal compliance: Health data sharing regulations not addressed

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Next Evolution - Future Architecture

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Expected Benefits of openHIM Migration

Transformation Advantages:

✅ Performance improvement: Pull-based architecture (openIMIS controls load)

✅ Data harmonization: Standardized master data across systems

✅ Standards compliance: FHIR + openHIE standards

✅ Better monitoring: Centralized audit logs and interoperability tracking

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Digital Health Interoperability in Cameroon

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