Sub-Saharan Africa’s healthcare challenges are overwhelming but not insurmountable. The region has 11% of the world’s population, yet 24% of global disease burden, almost 50% of deaths registered among children age five and younger, and more maternal mortality victims than anywhere else in the world. Almost 70% of all people living with HIV are in sub-Saharan Africa, where six to eight thousand people are infected daily. Meanwhile the region hosts 90% of all malaria cases, with 300 million people infected annually.
These epidemics are severely compounded by social determinants of health, and in particular a lack of access to high-quality, comprehensive, and affordable preventative and curative healthcare services, as well as affordable health financing schemes. Only 1% of global health expenditure is spent in sub-Saharan Africa. Chronically low expenditures have yielded limited infrastructure; facilities that are unable to provide consistent and quality care; and an overwhelmed, under-resourced, and inadequately trained healthcare work force, which accounts for only 3% of the world’s trained health workers.
Despite its many development advances, Kenya is in no way immune to these challenges, especially given its high HIV/AIDs, maternal mortality, and infant mortality rates, and its urgent need to strengthen as well as sustainably finance its healthcare system. Business as usual approaches to sub-Saharan Africa’s health challenges will not deliver remedies quickly enough to assist ailing people and insufficient healthcare systems. Recent pilot tests of new approaches show promising results.
Their recommendations include increasing the role of the private sector in providing healthcare; emphasizing quality, standardization, and affordability to increase access; developing innovative health financing initiatives that, while still affordable to consumers, lessen long-term dependency on outside donors and public allocations; creating patient-driven demand; and developing platforms to rapidly increase scale and reach.
EGF is working to address various social determinants of health that widen the gap between ill health and socio-economic growth by combining and adapting tested approaches to provide access to affordable, high-quality, and standardized health services and comprehensive health financing schemes to encourage and sustain the receipt of healthcare throughout one’s life.
EGF has developed an integrated, scalable, and sustainable healthcare delivery model which focuses on prevention and general health as well as addressing leading causes of morbidity and mortality in Kenya, including HIV/AIDS and maternal mortality.
In the next five years, EGF expects to support nearly three million Kenyans, particularly those living in periurban and rural areas, in accessing comprehensive primary healthcare and to leave in its wake a financially solvent healthcare network capable of performing over 10 million patient visits per year. Importantly, EGF also plans to more than double the uptake of private health insurance by providing affordable, comprehensive health insurance schemes to over 1.7 million Kenyans by 2018.
Our approach and programme design have been vetted by Kenya’s Ministry of Health, bilateral donors, and various experts and stakeholders within the healthcare sector in Kenya and globally.
In order to fully institutionalize its integrative health model, EGF is working to implement three sequential phases focused on:
- Provider Reform: The development of a network of 300 health franchises to provide affordable, high quality, and standardized health services across Kenya using a hub-and-spoke model. Hubs to be staffed by medical doctors, satellites by clinical officers, and spokes by nurses. Each unit’s professional provider will be trained and monitored as part of EGF’s commitment to provide consistent, quality care.
- Client Reform: Social marketing campaigns, activities targeting outreach workers, and technology and mobile phone applications will be deployed to increase healthcare and health insurance literacy across Kenya, focusing on low-income communities and families in peri-urban and rural areas in all of Kenya’s 47 counties.
- Insurance Reform: Provider- and patient informed comprehensive health insurance schemes will be developed using capitation payment models for outpatient services and bundled care payment models for inpatient services, instead of the prevailing, unsustainable fee-for-service model. Schemes will be designed based on inputs from the network of health entrepreneurs and data on health-seeking behaviour and health needs, and will leverage underwriting assistance from private sector partners and insurers.
EGF launched the first phase of its healthcare delivery model in 2013 with the generous support of USAID/Kenya through its Strengthening Health Outcomes through the Private Sector (SHOPS) unit. In addition, to date, EGF has attracted the involvement of academic, research, and policy institutions, medical equipment suppliers, pharmaceutical firms, and government actors, all of whom are keen to see the model succeed.