Value-based care pilot explores solution for improving access to health finance for low-income women and households

May 27th, 2024

Universal health coverage is core to Kenya’s Vision 2030 and the current administration’s Bottom-up Economic Transformation Agenda (BETA). Envisioned is the need to provide the highest quality of care to all Kenyans.

FSD Kenya’s health finance work is designed with the aim of facilitating and advocating for value adding finance that enables improved health and financial resilience to health shocks for women and households.

Typically, health financing assumes a fee-for-service approach where providers are paid for the services they provide rather than for health outcomes. FSD Kenya has partnered with Britam Holdings Limited and the FSD Network Gender Collaborative Programme to design and pilot a maternal and neonatal healthcare value-based care programme.

To Britam, a value-based care approach could help improve the viability of their products for the lower-income market segment by reducing the claims ratio. An earlier analysis of their AfyaTele product’s maternal and neonatal healthcare  claims data implied that most of those covered were not attending the required four antenatal care visits.

In 2023, a maternal and neonatal healthcare  user journeys study among the AfyaTele product customers was undertaken to inform the design of the programme. Based on the study findings, all those interviewed had attended the minimum four recommended antenatal care visits. However, these visits did not necessarily take place at the healthcare facilities in their health insurance cover panel. This is because factors such as proximity to their residences or workplaces matter much more than the cost of the visits. Consequently, some mothers end up paying out of pocket.

The findings and insights from the study have been applied in the design of the antenatal care value-based care pilot programme whose implementation will start early 2024. Crucial in the design was defining a package of care which caters to most of the needs presented during the journey and pricing it at a level that is affordable to the women and sustainable to the healthcare providers.

Besides investing in a system that can aptly monitor the quality of care, the pilot will entail orientating the healthcare providers to this new approach and providing the right nudges and incentives to drive the desired behaviour.

The method is relatively new in emerging economies like Kenya. While this is not the first value-based care pilot in the country, Britam’s is the only known private sector oriented one and will thus make a significant contribution to the discourse on this approach. The pilot will be undertaken in Nairobi and its environs.

The value-based care approach could potentially enhance the quality of healthcare delivered to patients if adopted. It could also improve the sustainability of health insurance solutions which is normally hampered by moral hazards out of provision of services which are not necessarily required under the cover.

This blog is one of the articles in FSD Kenya’s 2023 annual report. To read the full report, click here. 



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