SOS CHILDRENS VILLAGES KENYA FEASIBILITY STUDY ON COMMUNITY BASED HEALTH INSURANCE SCHEME IN WESTERN AND NYANZA REGION-KENYA Dr Rosemary Obara (MBChB, MPH)- Consultant Ms Annemarie Ojunga- National FSP Manager , SOS CV KE INTRODUCTION SOS Childrens villages Kenya is a Non profit NGO - a member of SOS Kinderdorf International which has a membership of 133 countries worldwide . SOS CV –Kenya currently supports over 9,000 children who have lost or are at risk of losing parental care. SOS CV supports the programme participants through 2 childcare models ; • • Family- Based Care [FBC] and Family Strengthening programmes [ FSP] in the 7 Counties of Nairobi, Marsabit, Meru, Kisumu, Uasin Gishu , Homabay and Mombasa. Introduction Cont: Besides the direct support provided to children and their families, SOS CV Kenya also facilitates access to basic needs to its target participants through • • 3 medical centres [ Nairobi , Eldoret and Kisumu], 1 technical training Institute, 1 secondary school, 3 primary schools and 5 kindergartens. SOS CV is funded by donor agencies, philanthropists and corporate partners who believe in its cause. Why the interest in Community- Based Health Insurance Scheme [CBHI] ? SOS CV through its FSP continuously seeks opportunities to empower families and communities for child development. One of the main struggles has been to improve household food and income security in a sustainable manner. Healthcare needs have been found to affect the household budget through out of pocket expenditures(OOP), hence reducing funds for basic needs such as food amongst others. SOS CV Childrens’ villages anticipates to support families to manage the out-of pocket health expenses through an affordable community based healthcare management system. Promote civic driven change by empowering communities to take responsibility of their own development. UNIVERSAL HEALTH COVERAGE (UHC) The aims of healthcare delivery system in many countries are to maintain or improve the health status of the population. How? if the system is able to guarantee access to health services for the entire population, regardless of individual ability to pay. Impetus came from the World Health Assembly Resolution WHA58.33 In May 2005, that urged the member states to work toward universal coverage and ensure that their total populations have access to needed health interventions without the risk of financial catastrophe. UHC However, only a few countries have achieved universal coverage namely; Denmark, France, Germany, Portugal, and the United Kingdom. The situation in other countries vary with many countries having health insurance systems that cover only select population groups that are considered easier to reach. Background on CBHI • Four main types of community based financing schemes have been identified in a number of studies: • • community managed user fees where user fees relying on out-of-pocket health care payments are collected at the point of health care utilization; Community prepayment schemes where the community collects payments (in cash or kind) in advance, manages the funds collected, and pays the health care providers on behalf of its subscribers; CBHI Community provider-based health insurance where a provider serving a particular community collects the prepayments himself or herself from the subscribers and provides the needed health care to the subscribers; Linked community health revolving fund - in this case the community acts as the agent of the government or social health insurance in reaching out to rural and excluded communities through contracts or some form of agreement. CBHI The CBHI coverage in East Africa was estimated as • • • • 5-10% in Uganda (Basaza, Criel and Van der Stuyft, 2010), 15% in Tanzania (Humba 2011), 21% in Rwanda (Ndahinyuka and Jovit. 2004). 1% in Kenya 2012 (Kimani et al., 2012). NHIF Coverage is about 20% & was reported to be unaffordable and punitive for the very poor people. CBHI FEASIBILITY STUDY OBJECTIVES To assess the existing community health Insurance schemes and determine the most appropriate scheme to pilot To explore possible collaborations necessary for the successful execution of a Community Health Insurance Scheme. To create an opportunity to learn from best practices on similar health insurance initiatives implemented in the country STUDY POPULATION The Communities being in the western part Kenya are faced with high burden of diseases such as Malaria, HIV, TB, Maternal and Childhood illnesses, Injuries, Respiratory illnesses and others. The absolute poverty levels of the populace have been found to reach as high as 60% in Nyanza and Western regions. Access to treatment and Health Care for all is a Key challenge especially for the very poor. Research Methodology Cross sectional study design Mixed method strategy Sampling – Purposive Sample size – A sample size of 799 households was generated from 84,495 households at a 95% Confidence interval and 3.45 s.d. Scope – 4 counties; • Busia, Kakamega, Kisumu & Homabay Data collection tools: • Household Questionnaires, KII guides, FGD moderators’ guide, Case study, Literature review SOS Strengthening National Advocacy November 2010 Chris Stalker 13 DATA COLLECTED Household characteristics Demographic Characteristics Socio-Economic Morbidity Data Health seeking behaviour, schemes data Health service access Health care payments • The quantitative data was analyzed though descriptive and inferential statistical analysis [ IBM SPSS version 21]. The qualitative data was subjected to content analysis, thematic analysis and categorization. Key findings 1. Majority of the households relied on agriculture and crop sales as the main source of supporting livelihoods. 2. Most households interviewed had an average monthly income of ≤ Kshs. 5000 3. CBHI schemes were found to be higher among the households within the income categories of Kshs. 2001 – 5000 followed by Kshs. ≤ 2000 category for the rural households while the enrolment in urban settings were found to be common among the households earning Kshs. ≤ 20000 SOS Strengthening National Advocacy November 2010 Chris Stalker 15 Key Findings Contd… The households having average monthly incomes below Kshs. 10000 were found to be suffering from catastrophic health spending since the direct costs of healthcare exceeded 50% of their incomes. Lack of awareness and understanding of CBHI Concept was found to be the main cause of non enrolment in CBHI schemes among the poor households. The nature of the CBHI schemes being based on solidarity implied that the Scheme leaders, friends, CHWs and families were the most important sources of influence to SOS Strengthening National Advocacy 16 join or not to join. November 2010 Chris Stalker Key Findings Contd.. The entry points for most of the Nodal Agencies introducing the CBHI concept was through the existing social groups having some on-going activities around some common interests. The benefit packages included; maternity care, skin diseases, diarrhoea, malaria coughs, pneumonia and RTIs the major exclusions were Caesarean Section, Dental and optical cover, chronic diseases and drug addiction. Most of the schemes had a waiting period of 1-3 months. Key Findings Contd.. Households enrolled in the CBHI schemes were found to enjoy better health outcomes and reported their self perception of illnesses to be less serious than their non-enrolled counterparts Possible collaborators for CBHI scheme success included the following; Ministry of Health, Children department, NHIF, County Governments, Health service professionals, NGOs/CBOs/FBOs, private sector and international development partners. Recommendations For the design of successful CBHI schemes/ foundation; Take into consideration the geographical coverage of the schemes and the minimum pool sizes Diversify the Incomes of the Scheme members through IGA support Build capacities of the groups and scheme leadership on CBHI concept, effective cost management and contract management among others SOS Strengthening National Advocacy November 2010 Chris Stalker 19 Recommendations Address equity (social inclusion issues ) for the very poor through subsidization Factor in the provider remuneration and other aggregated costs in setting the premiums and benefit packages Next Steps for SOS Childrens Villages Kenya Strengthen capacity of existing community structures to manage welfare needs, including healthcare in a cost effective manner Eg through community- based health insurance schemes , CHWs Seek like –minded organizations and develop strategic partnerships to adopt and upscale CBHI best practices . Identify and adopt innovative approaches to successfully implement affordable primary heathcare for vulnerable families and communities. Questions and answer THANK YOU !