By Joseph Maina
The Laikipia County Government has pioneered a unique healthcare finance model that pools resources from the people, while helping to register them in the National Health Insurance Fund (NHIF). The program, dubbed the Laikipia County Universal Health Coverage model, is a combined effort of Laikipia County with the NHIF and AMREF.
“As a county, we are enrolling people into the NHIF through the use of technology,” said Dr. Donald Mogoi, the Acting Chief Officer for Health, County Government of Laikipia. “We are also using the technology to identify the people that we as a county can subsidize for health insurance. We are working with the national government to ensure that everybody who deserves to be covered is eventually covered. Once everybody is insured, they can access medical care at an affordable cost.”
Under the model, community health volunteers perform house-to house registration and enrolment of people into the NHIF. The health volunteers also collect social economic data, while enrolling people into some economic activity, specifically contract farming, as well as into the county’s enterprise fund. The project makes use of mobile technology.
“AMREF assisted us to develop a mobile phone-based application called Mjali,” Dr. Mogoi told Health Business at his office in Nanyuki town. Through the Mjali application, the health volunteers can do the NHIF enrolment, update the NHIF database, and a payment is done within the homestead. Thanks to the system, more people in the county have been able to take up insurance, Dr. Mogoi said. The system helps to reduce the cost of travel, given that people can now register for the NHIF from their homes.
In addition to assisting its people to access health insurance, the system facilitates the collection of socialeconomics information among households in the county, which helps in determining eligibility for the subsidy program. At the time of the Health Business interview with Dr. Mogoi, the county had covered more than 75,000 households under the program. “We had visited up to 75,000 households in Laikipia. Twenty nine thousand of them had taken up insurance with NHIF. We are dealing with a 38 per cent conversion rate, in terms of picking up health insurance. But our thinking is that we can move it up from that 38 percent to even more than 50 per cent”, said Dr. Mogoi. A human resource deficit is among some of the challenges to the program, along with limited infrastructure. Laikipia currently has two county hospitals – one in Nyahururu and another in Nanyuki, five sub-county hospitals, eight health centres, and 73 dispensaries, serving a population of about 540,000 people in the county.
The county’s health facilities also serve populations from the counties of Nyeri, Baringo, Nakuru, and Meru. In Dr. Mogoi’s estimation, Laikipia’s health facilities serve a total catchment area of close to a million people. “We are looking at the system blocks in our health system,” said Dr. Mogoi.
“First, we must have the facilities closer to the people. Secondly, we are equipping those facilities. So we are getting people into insurance, we are dealing with the financing aspect, but we are also building our facilities to be able to meet the demands that this huge insured group will have.”
Towards this end, Laikipia County has embarked on upgrading and building the capacity of its health institutions. The county doubled the number of dispensaries – from 36 in 2013 to the current 73, as well as equipping them, in order to bring healthcare closer to the people. In addition, the county plans to raise the number of community health volunteers for the program, to help in boosting the numbers of uptake.
“We are currently using 225 community health volunteers, but now we are thinking of increasing to 550. We have 110,000 households in Laikipia. Our thinking is that by the time our model is fully actualised, we will have a community health volunteer taking charge of 200 households”, added Dr. Mogoi. According to Dr. Mogoi, the health volunteers will perform follow up of the 200 households on a monthly basis, checking on their economic activities under the program, and to see the progress of the subsidy program, and also assess possibilities of eventually empowering the people out of the subsidy system.
In its projections, Laikipia County aims to enlist 550-community health volunteers into the program. Each community health volunteer undergoes training, and receives Sh2000 stipend per month to assist in their movement. As part of his or her job kit, each health volunteer receives a mobile phone loaded with airtime.
Under the model, a public health officer supervises ten community health volunteers. Dr. Mogoi said the county hopes to provide quality care to the citizens, as close as possible through a system that will not impoverish them through huge bills
