With the help of its implementing partners in the PharmAccess Group and local partners in Africa, the Health Insurance Fund has been supporting health insurance since 2006.
Affordable access to quality healthcare for currently uninsured people through financial inclusion in an affordable health plan is still a very rare phenomenon in sub-Saharan Africa. Only 4% of healthcare expenditure in Africa is covered by health insurance. The fact that health insurance remains out of reach for most people means that, when they are injured or become ill, they can become trapped in a downward spiral of lost income paired with high and unexpected healthcare costs.
The Health Insurance Fund, through its implementing partner the PharmAccess Group:
- develops partnerships with insurers, governments, insurance distributors and mobile network and money operators in order to strengthen healthcare systems;
- provides risk sharing mechanisms to reduce the hurdles for the management of financial risks by local partners in order to kick start sustainable market development and growth.
The health plan activities within the PharmAccess Group focus on previously uninsured, low- and middle-income groups with a strong social structure and cohesion, such as women’s associations, farmer organizations and small-scale traders. Different models are designed and implemented in optimal alliance with the local context so as to evaluate different private health delivery models based on a results-oriented approach.
As the target groups are involved in the development of the insurance package, the marketing and the selection of the clinics, there is a high degree of ownership among the insured people. Programs are run in-country by local private insurance companies, third-party administrators and healthcare providers. Contracts with these companies are competitive and performance-based. The pre-payment in the form of health insurance premiums guarantee clinics a steady income. By subsidizing part of the premium, Health Insurance Fund lowers the risk for both the insurers and their clients.
Supply and demand
This approach is directed at creating local ownership and building trust among all parties involved: governments, patients, healthcare providers and insurance companies. It addresses the healthcare system as a whole. On the demand side, it offers low-income groups subsidized insurance premiums according to their means. As a result, demand for healthcare grows and healthcare providers must be able to deliver quality healthcare services, which they work towards with the internationally recognized SafeCare standards. On the supply side, key elements of the approach include a focus on capacity building and performance-based loans for healthcare providers through the Medical Credit Fund. These loans help the healthcare providers to meet the higher demand for healthcare.
The health plans are operational in Nigeria, Kenya, Tanzania, Namibia and Mozambique. In 2014, the Health Insurance Fund achieved an important milestone when the Kwara State Government in Nigeria committed to taking over the Community Health Insurance Program and scaling it up to 600,000 people across the state.