Health plans in Kenya
On behalf of our implementing partner the PharmAccess Group, Health Insurance Fund currently supports three health plans in Kenya: The Community Health Plan (TCHP) and the DL Koisagat Medical Scheme, which are both community-based, and the provider-driven Bima Poa health plan.
The Community Healthcare Plan
The Community Healthcare Plan (TCHP) was set up in 2011, after Tanykina Dairy Plant Ltd asked PharmAccess, Health Insurance Funds implementing partner, for advice on how to address the health challenges in the communities of their affiliated dairy farmers.
Together with AAR, the largest and most successful private healthcare company in the region, Tanykina and PharmAccess developed a health plan for this target group. In 2013, the program was extended to the general population and expanded into new neighboring areas of Nandi North. AAR handles the marketing, sales and administration aspects of the program.
Click here to watch a film on TCHP.
DL Koisagat Medical Scheme
The Koisagat Tea Estate aims to revolutionize the business of tea farming in Nandi County: through close collaboration with its green leaf farmers, it supports rural livelihoods and improves the incomes, health and food security of the participating farmers.
The DL Koisagat Medical Scheme (DLKMS), set up in 2012, provides primary and maternal care services to the families of employees and green leaf suppliers of the Koisagat Tea Estate. The health plan is run by the DL Group of Companies, which owns the tea estate, and Africa Medilink Ltd. The PharmAccess Group provides technical assistance such as actuarial services, administration and marketing.
Bima Poa is a provider-based health plan initiated by the Kisumu Medical and Education Trust or KMET (as the representative of the providers and the communities) in collaboration with the following partners: AAR insurance (the underwriter), Africa Medilink (the third-party administrator), PharmAccess Foundation (technical assistance) and Safaricom (the mobile technology partner).
The health plan was designed to be affordable to currently underserved markets and is based on actuarial analysis from other health plans (such as TCHP). It was developed in collaboration with the selected healthcare providers and community members. The benefits package covers most of the healthcare events for which people seek professional medical assistance. Finally, reimbursements were designed to be attractive to healthcare providers, while at the same time limiting financial risks to the health plan (e.g. unsubstantiated claims, selective procedures).
Click here to watch a film on the launch of Bima Poa.
As part of the African Health Markets for Equity (AHME) partnership, PharmAccess supports the National Hospital Insurance Fund (NHIF) with the development and testing of the Health Insurance Subsidy for the Poor (HISP) program for the indigent population of Kenya. PharmAccess will also assist the NHIF to expand its coverage of the informal sector with voluntary inpatient coverage.
|Models||The Community Healthcare Plan||DL Koisagat Medical Scheme||Bima Poa|
|Design||Community-based voluntary||Community-based voluntary||Provider-based voluntary|
|Coverage||North Nandi (rural)||DL Koisagat Tea Estate in Rift Valley (rural)||KMET network Kisumu, Siaya (urban & rural)|
|Implementing partners||Private Health Insurance Company AAR & Tanykina & Kabiyet Dairies||Private Third-party administrator AML||Partnership of AAR, AML, KMET and Safaricom|
|Benefits||Basic Package: OP, Chronic & MaternityComprehensive package: Basic package + IP||Basic package: OP + maternity||Basic package: OP + maternity|
|Provider network||Mix of public & faith-based providers||Mix of public, private & faith-based providers||Private providers of Huduma Poa franchise|