Low health insurance uptake in Kenya leaves women and low-income households vulnerable to health shocks; health finance solution offers hope

May 26th, 2023

Health shocks have debilitating impacts on low-income households and specifically women who lack effective mechanisms for mitigation. The situation has been aggravated by Covid-19 in terms of both the burden on the healthcare sector and the long-lasting economic impacts.

The Constitution of Kenya (2010) and Kenya Vision 2030 (Kenya’s long-term development blueprint) articulate the need to provide the highest attainable standard of health care to all Kenyans, with Universal Health Care (UHC) entrenched in both. The National Health Insurance Fund (NHIF) is envisaged to be a key driver of UHC.

The pursuit of UHC is a priority for both the current national administration and the county governments. According to the 2021 FinAccess national survey and the Kenya Demographic and Health Survey (KDHS 2022), only one out of every four Kenyans has access to health insurance, a 16% drop compared to 2019. This means that about one in every five Kenyans who previously had health cover opted out of insurance due to reduced household incomes at the onset of the Covid-19 pandemic.

Eight out of ten Kenyans (83%) who reported having health insurance, were using NHIF. However, NHIF reports a very low retention rate, with about six out of every ten Kenyans (57%) not renewing their subscriptions in subsequent years. The situation is worse for those in the informal sector where only 14% are renewed.

FSD Kenya aims to facilitate and advocate for value-adding finance that enables improved health and financial resilience to health shocks for women and households. While FSD is exploring and will support opportunities in other forms of financial services, most of the work will be in health insurance which would deliver more value for money to women and households given its pooling effect.

Most Kenyans (71%) cite lack of affordability as the reason for low health insurance uptake, followed by lack of knowledge and awareness (about 20%)1. These should be important considerations in designing health insurance solutions. Appropriate health financial solutions need to be tailored to the needs and financial realities of women and households.

While the AfyaPoa solution has shown potential for impact and sustainability, it was designed and targeted at the rider gig-workers market segment which is male dominant. However, the lessons can be applied in design of solutions targeted at women demographics. In the past two years FSD Kenya supported Insurance For All (IFA) to research, design and test a health insurance solution dubbed AfyaPoa targeted at gig workers. The solution, which is currently underwritten by APA Insurance Limited was initially piloted with Sendy riders. The upfront insurance premium payment regulatory requirement necessitated insurance premium financing.

The insurance premium would then be checked off from the riders’ weekly incomes and remitted to IFA. The solution was later rolled out to other gig work platforms and informal sector workers. A total of 2,774 policies had been sold by end of 2022 covering about 12,000 lives, a third of these to women. A total of 9,800 people had used the solution to deal with health events.



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