How a free health insurance pilot is taking on medical debt in Africa

In the over 15 years that Evaline Kibuchi has been working for the Stop TB Partnership in Kenya, she has come across two types of WhatsApp group fundraisers — either for someone who is battling a disease or someone who died and left a huge medical bill. And this annoys her, that society is being pushed into crowdfunding to foot medical bills in a country that has social health insurance and a public workforce that claims the government is investing heavily in health systems. “Where is the disconnect? We have a social insurance fund, we have governments investing in health, we have donors investing in health, yet it seems it is not reaching the people who need it. That is why we have all these WhatsApp groups for fundraising,” she said. The questions she raises are troubling. Less than 20% of the population in Africa is covered by government and private sector health insurance combined, forcing households to finance about 40% of health services through out-of-pocket expenses, according to Aggrey Aluso, the executive director at the Resilience Action Network Africa, or RANA. Even where government-supported health insurance is available, it often fails to cover the true cost of care, especially for chronic and preexisting conditions, and surgeries, and may be restricted to resource-starved public hospitals that discourage patients due to long waiting lists, Lewin Karua, the chief actuary at Continental Reinsurance, said. While private insurance, on the other hand, is too expensive for the majority of the population, attempts to introduce low-cost microinsurance often exclude patients from top-tier hospitals and are prone to losses and fraud, he said. The gaps are driving families to liquidate assets, forgo crucial spending such as paying school fees, and even skip meals to raise money for medical bills — pushing many into extreme poverty, Aluso said. “This creates a vicious cycle of challenges because you have to trade one right for the other. In ideal situations, people are supposed to have some form of insurance to cushion them from catastrophic health expenditures,” he said. A free emergency health insurance program could help families cover medical costs — but questions remain about the inefficiencies that plague Africa’s health care systems. According to data from Helpster Charity, a health tech nonprofit piloting the emergency health insurance program, families in Africa and Asia are spending a full month’s income to treat preventable diseases such as Malaria, pneumonia, and maternal emergencies, including preeclampsia, hemorrhage, and obstructed labor. On average, it costs $39 to treat malaria and a three-day stay at a hospital, but in Nigeria and Kenya, where the emergency health insurance innovation is piloting, the costs are higher, according to Kate Lysykh, the chief executive of Helpster Charity. Helpster’s data showed that in Nigeria, treating malaria costs patients between $25 and $230, in a country where half the population earns about $41 a month. In Kenya, treating severe malaria costs about $109, with households earning a monthly income of about $150. But earnings are also split to support family dependents, Lysykh said. “The average monthly income is divided averagely by five people in Nigeria, and in Kenya, it is usually divided between three or four people per household,” she said. The high cost of treating preventable diseases has persisted for the last decade but has risen in the past year, amplified by declining health care funding. Free emergency health insurance for the poorest could cushion them from the burden of unaffordable health care, Lysykh added. Helpster, in partnership with a network of public and private hospitals, volunteer health care providers and NGOs connected to donors, is piloting free emergency health insurance for curable, treatable, and life-changing diseases in underprivileged regions. The program, which was officially launched in 2023, provides free insurance from funds raised through blended donations. So far, it has raised about $260,000 for interventions across Africa and Asia and verified 2,400 medical cases covered. The cap for individual cases is $3,000, with exceptions made for more life-threatening or complex conditions requiring specialist attention. In Kenya, Helpster works with CFK Africa, PCEA Kikuyu Hospital, and Bungoma County Referral Hospital, while in Nigeria, partners include Chess in Slums Africa, Yobe State Specialist Hospital, and U.M.D. Medical Clinic. Medical, community, and social media outreach ensure that those who need the service are onboarded to receive free treatment. But hospital partners also engage in medical campaigns to inform the public about the free service. “It means that a patient can come into a health facility and request Helpster help. We will analyze the case through the platform and our offline facilities and if the case passes our admission, it will be funded by Helpster,” Lysykh said. Africa has been lined up for the pilot — which is expected to be scaled up in Guinea-Bissau, Senegal, Somalia, Uganda, and Rwanda — due to cases of extreme poverty, lack of free universal health care systems, and high child mortality rates. But flexible policies allowing NGOs to operate in most countries, including open economic and banking systems, have also made the continent attractive. Funded mainly by private philanthropists from the technology space, Helpster hopes to begin implementing emergency medical insurance in at least three new African countries in the next three years, Lysykh said. “This is a market failure as much as a health issue. We hope that technology can move at the speed of need that our traditional aid is not providing. We will always be there until all the governments have free universal health care for their citizens,” she said. On the downside, the risk of fraud from recipients, hospitals, and volunteers clouds the promise that emergency health insurance offers. But Karua said private health insurers can navigate this hurdle by working together — including blacklisting fraudulent providers and strengthening claims-monitoring systems. Eligibility is determined through a transparent, data-driven verification system based on poverty and urgency scores. Poverty scores of 180 out of 250 signal deprivation, while urgency scores of 22 out of 26 indicate that a patient’s survival is at stake. However, many Africans may not be able to access the service due to its limited reach at the moment. Governments can plug the gap by subsidizing private health care costs while delivering capitated services, or those that have a fixed cost per patient, at subsidized rates, Karua said. “Governments can actively push for lower health care costs through tax subsidies and incentives for private providers. Making private health care more affordable would, in turn, make insurance more accessible,” said Karua, adding that insurers can unite to negotiate better rates with private hospitals.