Strong economic growth in recent years in Sub Saharan African has helped reduce poverty to 43 percent of the population. Yet, as Africa’s population expands – it is estimated to reach 2.5 billion by 2050 – the region faces a critical challenge of creating the foundations for long-term inclusive growth. Many countries still contend with high levels of child and maternal mortality, malnutrition is far too common, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic diseases, such as diabetes. These challenges call for renewed commitments and accelerated progress towards Universal Health Coverage (UHC).
Financial protection is generally low in Africa, requiring most patients to pay for health services from their own household income, so-called out-of-pocket (OOP) payments. Patients in low-income and lower middle-income countries are less protected against high OOP than those in higher middle-income countries. OOP payments have increased in nearly all countries, and the regional average has increased from US$15 per capita in 1995 to US$38 in 2014. As a result, 11 million Africans are falling into poverty every year due to high OOP. Protecting people against the impoverishing effect of health payments is a cornerstone of UHC and will help reduce poverty in Africa.
Community Health Workers (CHWs) in Kenya have played a key role in bridging the gap between communities and the formal health system, in community engagement, referral, health promotion and in prevention at community level. Current high attrition rates for CHWs pose a serious threat for people accessing health services. Lack of remuneration is the key factor leading to attrition of CHWs. At AEL, we see this as an opportunity to expand CHW roles, particularly in promoting insurance enrolment and participating as part of care management teams. Ultimately this initiative will increase coverage of the health insurance scheme as well as reduce attrition of CHWs by enabling an income generating mechanism for CHWs where each CHW will be paid a commission for the premiums paid by the community members.
AEL in partnership with the National Hospital Insurance Fund (NHIF) in Kenya has entered an agreement to accelerate the achievement of UHC through mechanisms for providing financial protection to under-privileged communities by reducing out of pocket expenditures. A member registration and update module for NHIF has been built into the M-Jali platform and integrated with the NHIF to enable CHWs to link community members to health insurance by conducting home-based registration and on boarding families to the scheme. The core mission of the interventions by AEL, however, is to strengthen the primary health care provided by the CHWs at the community level.
AEL through its innovative technology platform will manage over 70,000 CHWs on the Leap platform centrally ensuring seamless enrolment of community members into NHIF, ensuring premium payments are made and remitted to NHIF as well as paying-out commission to the CHWs in line with agreed terms. The CHWs will use the M-JALi platform with an automated NHIF enrolment form.
AEL is also the incubation hub for the following:
i-PUSH is an innovative five year programme being implemented by AEL focusing on health financing for women of reproductive age in Kenya. Through a health wallet the programme aims to empower members of poor communities in Kenya to save for their health expenditure. I-Push aims to reach 1 million women of reproductive age.
To promote learning, knowledge-sharing and evidence-creation for UHC, AEL will host different initiatives in health financing and access. This will result in the generation of tools and materials that will form a revenue stream for AEL. This will serve as a resource and knowledge management hub.
In partnership with the National Health Insurance Fund (NHIF), community based insurance as well as private health insurance schemes, AEL will work with Community Health Workers and technology innovations to increase insurance coverage earning revenue in the form of commission or service delivery.
AEL aspires to develop and roll out insurance products that address health challenges at the community level to reduce OOP expenditures focusing on the underprivileged members of the community.