Health Insurance for low-income groups in Africa

Health Insurance for low-income groups in Africa

The money we would have spent on hospital bills can now be spent on our children s education and our business. Rufiat Balogun, market shop owner, Lagos Introducing Health Insurance Fund The Health Insurance Fund is a foundation that supports access to affordable and good quality health care through community health insurance. Our mission is to improve the health and wealth of low- and middle-income people in sub-saharan Africa by protecting them from health-related risks. Health Insurance Fund has been supporting health insurance in Africa since 2006, working with local private insurance companies, third-party administrative offices and health care providers. Together with our PharmAccess Group partners and local partnerships with well-established local African companies such as Hygeia, MicroEnsure and AAR, we have established health insurance plans in Nigeria, Kenya, Tanzania, Namibia and Mozambique. 3

Over the past years, our programs have had considerable impact in development cooperation and the improvement of the health care system. Our innovative health care approach gives more people access to better health care. The aim is to scale up health insurance for low-income groups and improve quality by setting up clinical standards. Health Insurance Fund develops health insurance for organized groups in specific areas.programs focus on groups with a strong social structure such as a cooperative of farmers or an organization of market women. Those who choose to participate pay a percentage of the premium and Health Insurance Fund subsidizes the remainder. Health Insurance in Africa Health insurance is almost non-existent in Africa. Of the total health expenditure in Africa, only 4% is covered by health insurance. This means that the vast majority of people have to pay for their health care out-of-pocket. The high costs and loss of income when members of low-income households become ill or injured often lead to even greater poverty. PharmAccess Group The group organizes subsidized health insurance for low income people (Health Insurance Fund), affordable credit for health care providers (Medical Credit Fund), private equity for health care in Africa (Investment Fund for Health in Africa), setting of clinical standards and quality improvement of care (SafeCare), and conducting impact assessments of health care programs (Amsterdam Institute for Global Health and Development). 4 5

Nigeria Kwara State 2007 Farmers in the Kwara region 67,824 Programs and Results Kenya Nandi North District 2011 Tanykina farmers 3,433 Kenya Koisagat 2012 Tea farmers 6,736 Enrollment 130,965 Enrollees in program Premium Financials Average yearly premium e 34,- Average premium co-payment 25% Average subsidy 75% Patients & Care 32,518 51,192 47,256 Payment Method cash/direct debet Frequency monthly/yearly Top 5 reasons for visits (2012) Donors Dutch Ministry of Foreign Affairs World Bank STOP AIDS NOW! Kwara State Government Nigeria International Labour Organization Eno USAID Benefit package Nigeria Lagos 2007 Market women in Lagos 20,323 2009 Small ICT entrepreneurs in Lagos 7,998 Namibia Windhoek 2011 Tanzania Moshi 2011 KNCU coffee farmers 14,846 Mozambique Maputo 2013 Eduardo Mondlane University Health Plan 42% Average percentage of enrollees using care (2012) Medical Quality 78,801 Malaria checks since start program 956,003 Number of visits since start of program 38,274 Number of pregnancies since start of program 1. Malaria 2. Pregnancy 3. Hypertension 4. Upper Respiratory Tract Infections 5. Diabetes Primary Health Care Minor Surgeries HIV / AIDS Maternal & Child Care Chronic Care Mister Sister, mobile health solution Clinic Quality 6 7 SafecCare certificates 9,805 V 0 36 IV 1 51 = 19 14 18 11 Number of III 1 assessments II 0 Total number Public Faith Private Referral with SafeCare I 23 of clinics based hospitals standards (2012) Entry level 6 Visits (2012) average Malaria-related visits with lab test 24% Antenatal care visits per pregnancy 4.7 Number of staff trained (2012) Number of trainings given to clincs 19 Number of staff members trained 779 Data until 30 June 2013

Accomplishments since 2006 Since the establishment of the Health Insurance Fund, access to good quality basic health care for previously uninsured groups in Africa has increased. More than 120,000 people are enrolled in our programs. Leveraging funds Health Insurance Fund has mobilized additional resources from third party donors, local governments, investors, local banks, private clients and member contributions. 8 Quality improvement We have achieved tangible results on the supply side as well as on the demand side. Approximately 50 public and private clinics and hospitals have improved their services and facilities to international standards, and 300 have benefited from our quality improvement program. Learning and evaluation The variety of program designs and geographical locations has enabled us to collect invaluable data, including biomedical, financial and market data. Evaluation of our programs has shown that low-income communities can now protect themselves from high financial risks and have better access to quality health care. Local government and policy The Nigerian government s national strategic health development plan 2010-2015 showcases our Nigerian programs as an exemplary community-based insurance plan. UNAIDS describes our program as an example of insurance innovation to achieve sustainability and self-reliance among low-income Africans. In 2010, the G20 awarded the PharmAccess Group with a prize for our innovative financing model. Trust Health Insurance Fund has created an environment of trust between insurers, care providers and policyholders, thereby reducing investment risks as well as transaction costs. Health care SMEs can now grow their business and provide more and better quality services. 9

Highlight: Kwara State program The Kwara State community health insurance program has generated much international interest. It provides access to health care for rural populations, and is an example of how effective public-private partnerships can be. 10 66,938 Number of people insured 14 Number of health care providers 359,865 Number of visits to health care providers At the moment, Health Insurance Fund and local partner Hygeia Community Health Care have 67,000 farmers and their families enrolled in a Hygeia community health insurance plan. As farmers depend on good health in order to carry out their profession, access Data until 31 December 2012 to health care is crucial for their livelihoods. The program has had a transformative impact on this rural, low-income area. Both the quality of health care has improved and the number of health facilities in the program has increased. Enrollment continues to grow and renewal rates are high. The program has contributed to increased trust in the health care system as well as to the economic development of the region. Link to local government One of the key success factors lies in the support and close involvement of the Kwara State government. The effect of the program in the community has been so profound, that the government has committed EUR 2.4 million over a five-year period for statewide implementation to 600,000 people. In time, the Kwara State government intends to take over the funding of the program. The groundbreaking Community Health Insurance of the Kwara State Government is exactly the kind of innovative partnership that we should replicate here in Nigeria and beyond. Ban Ki-Moon, Secretary-General of the United Nations

Health Insurance Fund Trinity Building C Pietersbergweg 17 1105 BM Amsterdam The Netherlands +31 (0)20 566 71 58 info@hifund.org www.hifund.org Our Group of Organizations