Dr Rosemary Obara (MBChB, MPH)- Consultant
Ms Annemarie Ojunga- National FSP Manager , SOS CV KE
 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
 Promote civic driven change by empowering communities to
take responsibility of their own development.
 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.
 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
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;
 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
 The CBHI coverage in East Africa was estimated as
5-10% in Uganda (Basaza, Criel and Van der Stuyft,
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.
 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
 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
Household characteristics
Demographic Characteristics
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
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
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
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
 the major exclusions were Caesarean Section, Dental
and optical cover, chronic diseases and drug
 Most of the schemes had a waiting period of 1-3
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.
For the design of successful CBHI schemes/
 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
SOS Strengthening National Advocacy
November 2010 Chris Stalker
 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 ,
 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

Based Health Insurance Schemes In Western And Nyanza Region