Nations across the globe are strengthening social health protection systems to realize the vision of universal healthcare coverage and comprehensive social protection In an effort to improve people’s access to affordable healthcare services and other mechanisms of social protection.
Developing and managing digital systems poses financial and other resource challenges to various health program administrators. While healthcare financing models vary from country to country, one challenge is universal: managing the complex workflows and large amounts of data associated with administering such systems. Managing the core processes digitally can contribute to large scale efficiency including the enrollment of beneficiaries, renewal of policies, submission and processing of claims, and disbursement of payments.
To address this need, the German Federal Ministry for Economic Cooperation and Development (BMZ), and the Swiss Agency for Development and Cooperation (SDC) joined forces to create an innovative software solution designed to enhance the management of social protection and health financing known as openIMIS.
openIMIS is a DPG Alliance certified Digital Public Good (DPG) that can be freely downloaded, adapted and used by people anywhere in the world for the administration of health financing and social protection programs. It is available for all countries at no cost, and has already reached over 25.5 million beneficiaries in more than 13 countries through the efficient management of social protection programs, such as health insurance, employment injury insurance, and cash transfer and voucher schemes. It was designed to be interoperable with other information systems, contributing to the advancement of digital public infrastructure across the world, and can be configured to support workflows across the social protection delivery chain in support of advancing the Sustainable Development Goals (SGDs).
OpenIMIS is available in the IDB’s open-source software catalog, Code for Development, and was the focus of an implementation workshop in 2024 that was part of a series aiming to support open-source solution implementations across Latin America and the Caribbean. You can watch the recording here to learn more about openIMIS and how it is being used.
The importance of a global good for social protection and health
Developing and maintaining software to manage complex social protection processes is a resource-intensive endeavor for individual organizations. When countries and institutions work together globally to develop a product that follows international standards while still being customizable to meet an individual organization’s needs, it saves human and technical resources.
Building such a global product also helps to foster a community around the tool and topic—one that can jointly develop common core business processes in social and health protection, share experiences, and exchange new developments. The openIMIS community of practice brings together users, developers, and implementers from across countries and organizations, enabling peer learning, joint problem-solving, and shared ownership of the tool’s evolution. By aligning with the Digital Public Goods Standard from the Digital Public Goods Alliance, as well as sector-specific standards like HL7 FHIR for health and the Social Protection Digital Convergence Initiative (SPD-CI) for social protection, openIMIS strengthens this community and provides meaningful support to countries progressing toward universal health coverage and universal social protection.
openIMIS use case: impact on the Nepali social healthcare system
openIMIS has played a key role in strengthening Nepal’s Social Health Insurance (SHI) scheme by making it more accessible, efficient, and inclusive. Through mobile apps, it has simplified the enrolment process, allowing for door-to-door registration, while a web-based system has streamlined how claims are processed. Its integration with digital health records has made claims submission faster and less reliant on paperwork. Today, the system supports over 65% of the country’s districts, reaching 1.5 million people across 268 health facilities. It also includes informal sector workers and provides real-time data to guide better health policy decisions.
The open-source solution was customized for Nepal’s specific needs and is now deployed through a combination of Android-based mobile apps and web interfaces. These tools support key functions such as enrolment, contribution management, medical claims generation and processing, and data analysis.
The mobile apps allow registered assistants to go door to door to register households into the scheme, while the web interfaces enable health facilities to submit medical claims digitally to the Health Insurance Board, significantly reducing paperwork and improving accuracy. Although the initial customization was carried out by international teams, ongoing development and the addition of new features—such as support for the Nepali calendar—are now primarily managed by local teams. The customization required was relatively minimal given the complexity of the software. All households enrolled—estimated at around 3 million individuals, based on Nepal’s average household size of 4.8—have been brought into the scheme using this locally managed system. openIMIS also enables the Health Insurance Board to perform automated medical reviews of submitted claims, helping to clear backlogs and ensure timely reimbursement to health facilities.
A key advancement of openIMIS in Nepal is its integration with Electronic Medical Record (EMR) systems, enabling hospitals to submit claims electronically via standard APIs. This has replaced the time-consuming process of manually preparing, printing, and submitting paper claims. By removing these routine administrative steps, hospitals can redirect staff time and operational resources toward improving patient care and service delivery.
Watch this short film on YouTube to find out more about the use of openIMIS in Nepal.
Visit the wiki page to learn how to set-up and configure the tool for your context too!
Interested in using this tool? Share your ideas in the comments section below.
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