Successful health insurance programmes in Nigeria, Kenya, Ghana and Tanzania

Foreign trade and development minister Lilianne Ploumen is extending Dutch funding to the Health Insurance Fund (HIF) for a programme that offers affordable health insurance to hundreds of thousands of people in Africa. The programme also improves healthcare infrastructure. ‘This approach is bringing good health insurance within reach for countless Africans,’ the minister commented. ‘It goes to show, yet again, that when public and private partners team up and use modern strategies, they can achieve great things together.’

For the next seven years, Ms Ploumen has earmarked 10 million euros a year for further expanding a system that gives poor people access to good health care by being properly insured. Since 2007 the Netherlands has contributed 100 million euros. Dutch companies – notably Achmea, AEGON, Heineken, Shell, SNS REAAL and Unilever – were instrumental in launching the programme, which has since generated international investment capital to the tune of almost 180 million euros. Besides money, the companies also contribute their expertise.

Access to good-quality health care

The Health Insurance Fund offers low wage-earners insurance for basic health care and also ensures that sufficient good-quality care is available. Ms Ploumen added, ‘With this programme we’re creating a public-private infrastructure from scratch. Unless people had savings, they could not afford health care when the need arose. So they often had to sell their property and livestock. Having insurance rules this out. Once the system is established, it starts to grow automatically. The greater the take-up, the more solid the insurance system.’

Investing in the quality of health care is an integral part of the programme. For example, Nigeria now has proper health centres in rural areas, whereas in the past people had to travel many hours to obtain primary care. Mobile phones are another source of innovation. It is now possible to save up, arrange medical insurance and pay for treatment through a ‘digital wallet’ linked to a mobile phone account.

Giving one million people access to health care

The programme is being implemented by the Dutch PharmAccess Group, which arranges for local insurers to market the insurance policies in African countries. With seven more years of Dutch funding, healthcare-system change in Africa can be further developed and expanded. The aim is for at least one million people in low-income categories to have access to high-quality health care by the end of this period.

Kwara State, Nigeria – a good example

Boosting the client base is often done through rural communities and farming cooperatives, in which the support of traditional leaders is crucial. So for example in Kwara State, Nigeria, the emir of Shonga played a decisive role in the local people’s acceptance of the health insurance system.

The insurance package here provides cover for basic health services, and HIV/AIDS, tuberculosis and malaria. In the initial phase, 112,000 people were able to take out basic insurance at the equivalent of 27 dollars per person per year, and the numbers are expected to rise sharply in the years ahead. The programme’s 35 clinics and hospitals currently deliver the best care in the area. The system also benefits people who are not yet insured.

Research has shown that expanding health care has led to a 90% increase in the take-up of available care and a 52% drop in patient costs. In addition, there has been a sharp increase in the number of women giving birth safely in clinics and in the number of doctor’s visits by children under five. In terms of health care, Kwara is now one of the four best-performing states in Nigeria, whereas ten years ago it was one of the worst. Local authorities in Nigeria are gradually assuming responsibility for funding the programme. The Kwara State programme now serves as a model for Nigeria’s other 35 states.