Providing Private Health Insurance in Africa

During my extensive travels throughout Africa, one of the greatest problems I see for many Africans is having access to health care. There are several organizations working make health care accessible, but one organization is worth mentioning: the Amsterdam-based Health Insurance Fund (http://www.hifund.org). The Fund, established in 2005, is creating an innovative method to accessing quality health care including HIV/AIDS treatment through an innovative approach: building accountable and reliable demand-driven, output-based private health insurance schemes for low-income groups. (Photo courtesy of the Health Insurance Fund)

According to the Fund's website, "The Health Insurance Fund has been established to set up private health insurance programs for low-income communities in different countries in sub-Saharan Africa. PharmAccess has been contracted by the Fund to develop, manage and control the insurance programs. PharmAccess contracts local implementing partners to provide the insurance to the selected communities. Independent operational research organizations measure the impact of the insurance program. The Health Insurance Fund is responsible and accountable for the overall program in the context described above."

I had the pleasure of meeting Mr. Onno Schellekens, Managing Director of the PharmAccess Foundation and Mr. Chris van der Vorm, Health Insurance Fund's Executive Director during their visit to Seattle in September 2008. I learned that the Health Insurance Fund will carry out programs in at least four African countries, which will be implemented by local (African) Health Maintenance Organizations or insurance companies. PharmAccess, in collaboration with the local partner, selects local healthcare providers (clinics, hospitals, laboratories, pharmacies) on the basis of a pre-defined criteria and these providers may be either publicly or privately operated.

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 four countries over a period of six years. The first scheme was launched in Nigeria in January 2007 targeting 115,000 women in Lagos and farmers in Kwara State. A second program is currently being developed in Tanzania.

The Fund's website explains the implementation strategy, "To ensure that the target population will participate in the schemes, an enrollment strategy is applied. Communities are mobilized through community leaders, information meetings or radio messages, among other things. 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 immediately receive their insurance ID card. Enrollment is done on a yearly basis. To limit adverse selection, family enrollment is encouraged." (Photo courtesy of the Health Insurance Fund)

The Fund's objectives include:

• To build local financial-administrative and medical capacity in the health sector;
• To lower the threshold for investments in health infrastructure: to increase investments and leverage public money by attracting private funds;
• To demonstrate that demand-based health schemes applying an output-based approach are transparent and efficient and reinforce quality standards; and
• To evaluate different healthcare delivery models based on a demand-driven and results- oriented approach.

On October 23, 2008, the first Health Insurance Fund Conference was held in Amsterdam titled "Africa Healthcare Systems in Africa: Time for a New Paradigm – Mobilizing the Private Sector to Develop a Sustainable Healthcare Economy in Africa." While I was unable to attend the conference, I have read about its success. The Health Insurance Fund is developing an excellent model of effectively engaging the government, civil society, and private sector by implementing an innovative strategy to increase the accessibility of quality health care including HIV/AIDS treatment to potentially millions of individuals throughout Africa.