Community health workers can help increase uptake of health insurance

One of the good things about the Health Act that was enacted in June is that it addresses universal health coverage (UHC), that ensures access to quality and affordable healthcare by all Kenyans.

 The unified health system coordinating the relationship between the national and county governments, is the critical first step in making UHC a reality. Clause 54 singles out UHC as a top priority, stating that the “Ministry of Health shall ensure progressive financial access to universal health coverage” through a slew of measures.

One of the measures outlined includes developing a mechanism for an integrated national health insurance system, including making provisions for social health protection.

The country’s health insurance coverage stands at 20 per cent, which is unacceptably low as many Kenyans lack financial protection in the event of huge medical costs.

Consequently, the World Bank estimates that one million Kenyans fall into poverty annually due to health-related expenses. Granted, NHIF membership has grown in recent years, but there is immense room for more growth.

The informal sector, which constitutes around 80 per cent of the workforce has not taken full advantage of NHIF.

This exposes entire families to impoverishment if one member suffers from a major illness. 

The slow uptake of health insurance is the result of a combination of factors including low awareness on its existence and importance. 

Media and billboard campaigns may not be the most ideal way of creating awareness about health insurance, considering many of the uninsured are in hard-to-reach rural communities and the informal sector.

We need to rethink our strategy and work creatively with community health workers and other health personnel at the grassroots to inform the broader public on the importance of health insurance.

This should be supported with regular reminders to heads of households to pay their due premiums.

Communities place a tremendous amount of trust in community health workers to convey accurate information about healthcare.

FIRST LINE OF DEFENCE

They provide the first line of defence and ensure there is wellness and disease prevention, which lowers disease prevalence and relieves the health system of disease load.

Why don’t we train and support these community health workers to become NHIF agents so that they can not only create awareness but also drive uptake?

The community health workers can earn commissions, since most of them are not paid for the critical role they play in public health.

Ultimately, all health workers who come into contact with patients should join the quest to increase the uptake of medical insurance.

 However, we need to remain realistic; not everyone can afford health insurance, even at heavily subsidised rates. Yet, even those who cannot afford need to be covered because health is a human right.

This means that we need to explore social protection with greater urgency. It is an injustice for a Kenyan to lack access to quality, affordable healthcare.

With the Health Act now in place, there is hope that there will be sustained political support for efforts to make quality healthcare affordable and accessible to all Kenyans.

In countries where UHC has been made a reality like Japan and, closer home, Rwanda, political support has been very instrumental.

Dr Ndirangu is the Country Director of Amref Health Africa