Leapfrogging universal health coverage through a digitally enabled Health Insurance Scheme

Abstract

Context: The Kenya Constitution 2010 provides the right to the highest attainable standard of health for all, a devolved function. Kisumu  County has an annual per capita health spending of Ksh. 3,507 and high poverty rate (38%). With an uninsured population of 78.5%, the  catastrophic health spending (19.7%) points to a vulnerable majority unable to access healthcare.

Approach: In 2021, the County  Government of Kisumu, PharmAccess Foundation, and National Health Insurance Fund (NHIF) launched Kisumu Solidarity Health Cover  (MARWA) in 49 health facilities to eliminate financial barriers to healthcare access. This involved connecting participants to MARWA using  mobile phones, co-funding health insurance premiums with donors, ringfencing health funds, deploying a quality digital platform  (SafeCare), and enhancing healthcare journeys through digital tools.

Key results: Health insurance penetration increased from 12.5 % to  23%, covering 42,650 households (142,000 lives) in 2022. Patient mobility increased across participating facilities; a legislative framework  that ringfences health funds adopted, and a dedicated ‘county health insurance budget (KES 65m) for the vulnerable established.  

Lessons Learned: Operationalizing a financial protection program requires a responsive policy and legal framework; fiscal constraints or  delays in the disbursement of equitable share revenue restrict the expansion of insurance coverage and enforcement of quality  improvement; poor quality data or its fragmentation inhibits the use of ‘means testing’ as an eligibility criterion and; political interference  in the identification and enrolment into the financial protection program.

Conclusion: Marwa presents a promising  transitional step towards UHC through a scalable public-private partnership approach.