Nairobi 5th February, 2020: In Kenya, 78% and 22% of outpatient and inpatient household health expenditures respectively are out of pocket, partially because many health facilities within easy access of the population are not contracted by insurers.
For 11 years, PS Kenya has been running the Tunza social franchise- a fractional franchise of small and medium size health clinics. Like any other small and medium sized health clinics, Tunza clinics have missed out on the insurance business. Partly because of their sizes which makes them have very little bargaining powers over the insurance companies. The ripple effect has been inadequate number of low cost health facilities in the insurance panel making it very difficult to develop micro health insurance products.
To respond to these market gaps, and with support from Africa Health Markets for Equity (AHME), PS Kenya decided to try a new model of contracting where privately owned and run health facilities are aggregated into a structured network and presented to the insurance companies as a unit. The idea was to improve efficiency in provider-payers contracting. Overall, the hypothesised net effect was to widen access to health services to insured persons.
A follow on to this project, SHOPS + ,a project of USAID supported PS Kenya to implement this exercise which did not only see PS Kenya sign up an empanelment contract with Insurance for All (IFA) but also influenced a private insurer (IFA) to fuse in family planning in their benefits — a first one in the industry in Kenya.