The Health Insurance Fund is a foundation that provides private health insurance to low and middle income groups in sub-Saharan Africa. The insurance covers quality basic health care, including treatment for HIV/AIDS. Through its innovative approach the Fund strives to contribute to increased access to quality basic health care, which in turn will help achieve the Millennium Development Goals.
The Fund was established in 2005 and is based in the Netherlands. In October 2006, the Dutch Ministry of Foreign Affairs awarded the Fund a €100 million grant for the development and implementation of insurance schemes in sub-Saharan Africa over a period of six years. The first schemes were launched in Nigeria in early 2007, targeting 80,000 market women and farmers and their families. A second program in Tanzania has been launched in May 2011 for the coffee farmers of KNCU and their families. In Kenya, the third country, the Health Insurance Fund has introduced a health insurance scheme for milk farmers of Tanykina and their families.
The Health Insurance Fund is an initiative of Kees Storm, former CEO of AEGON (one of the largest life insurance companies in the world), and PharmAccess Foundation. PharmAccess Foundation is a Dutch not-for-profit organization dedicated to the strengthening of health systems in sub-Saharan Africa ('Africa').
The Fund’s programs target organized groups of previously uninsured, low-paid workers, such as women’s associations, farmer organizations, or people with a micro loan. Guaranteed access to good quality health care enables these beneficiaries to be healthy and therefore sustain and enhance their income and productivity.
Organized and accessible
Target groups must consist of low and middle income workers (and their families) with the capacity to contribute to the health insurance premium. Groups must be organized and accessible through existing structures to facilitate co-payment collection. Groups are selected on the basis of target group studies and in collaboration with respected local organizations, such as unions, associations, traditional and community leaders, NGOs, government organizations, etc.
To realise its mission the Fund is committed to four sub-goals:
Provide access to an affordable and quality private health insurance scheme to reducing health and financial risks for low-income families
Provide sufficient and stable income streams, affordable financing options, and quality technical assistance to healthcare providers and insurance companies to reduce their financial and operational risk
Provide innovative and more effective financing mechanisms for example funding only the marginal cost of services linked to output-based system to reduce the risk of donors of aid ineffectiveness and avoid crowding out other donor or public resources
Work together with governments in an effective partnership to build an alternative to universal health care coverage that strengthens the current public/private national healthcare delivery system
The Health Insurance Fund provides subsidized medical insurance for people in sub-Saharan Africa. The programs are executed by local (African) Health Maintenance Organizations or insurance companies. Each Health Insurance Fund program consists of insurance schemes for one or more specific target groups.
Insurance tailored to the needs
A specific insurance benefit package is developed for each scheme in collaboration with the local executing partner of the program, which is tailored to the needs of the target population. For each target group the Health Insurance Fund and the local executing partner determine the level of premiums as well as the level of contribution to the premium (co-payment). The level of co-payment will be low in the initial phases of the program, but is expected to increase over time to enhance sustainability.
The insurance benefit package provides coverage for the most common medical problems that are found among the target groups and consists of primary care, limited secondary care and medication, including HIV/AIDS treatment.
PharmAccess, in collaboration with the local executing partner, selects local healthcare providers (clinics, hospitals, laboratories, pharmacies) on the basis of a set of pre-defined criteria through a medical due diligence. These providers can be either private or public.
Group Enrollment, family insurance
To ensure that the target population will participate in the schemes, an enrollment strategy is applied. Communities are, amongst other things, mobilized through community leaders, information meetings or radio messages. Special ‘marketing teams’ will undertake ‘on-the-spot’ registration and enrollment in the field. Upon payment of their part of the premium, insurance scheme beneficiaries receive their insurance ID card. Enrollment is done on a yearly basis.
Quality measurement and operational research
To bring the quality of healthcare services up to minimum required level, all clinics are enrolled in a quality improvement program of SafeCare. SafeCare has been established by COHSASA of South Africa, Joint Commission International of the US, and PharmAccess, to introduce standards to improve healthcare delivery in resource–restricted settings. Compliance to these standards can be measured and rewarded. The upgrading program deals with amongst others infrastructure, medical equipment and with medical and administrative training of the staff members.
This research is carried out by the Amsterdam Institute for Global Health and Development (AIGHD), a research institute affiliated to the Academic Medical Center (AMC) of the University of Amsterdam and the Amsterdam Institute for International Development (AIID).
The first schemes were launched in Nigeria in early 2007 targeting market women and farmers and their families. A second program in Tanzania has been launched for the coffee farmers of KNCU, Africa’s oldest cooperative representing small scale coffee farmers in the Marangu area. In April 2011, the Health Insurance Fund launched a program in Kenya for milk farmers and their families of Tanykina Dairy Plant Ltd. in the West of the country. In Tanzania and Kenya, the Health Insurance Fund is identifying other well-organised target groups for the development of new schemes .
Where is Health Insurance Fund