Universal health coverage: Social enterprises crucial for health cover success
Kenya is making commendable progress in the push to attain universal health coverage (UHC). UHC is about financial protection and equity in access to quality health services that address the most significant causes of disease and death.
A pointer to the progress Kenya is making in UHC is increased National Hospital Insurance Fund (NHIF) enrollment. In 2018, for example, NHIF membership rose by 23 per cent to 7.7 million, with most of the new members coming from the informal sector.
Kenya National Bureau of Statistics data further shows that payouts by the national insurer increased by an impressive 41.4 per cent to Sh37.2 billion last year.
What this means is that there is a Jua Kali operator or mama mboga somewhere who would have previously been forced to sell household items to get treatment but is now able to access the treatment without financial strain.
To sustain this momentum, the government is setting aside Sh47.8 billion for UHC in the 2018/19 budget — more than half of the approximately Sh90 billion allocated to healthcare. Although UHC accounts for more than 50 per cent of the entire national healthcare budget, there is still a huge gap in terms of funding.
It is key to reiterate that UHC is not only about boosting insurance cover, but also ensuring access to quality services. Access, quality and financing of healthcare — the three key pillars of UHC — collectively require tremendous investment and expertise, which the public sector cannot provide alone.
Historically, this funding and technical skills gap has been bridged by donors. However, this is coming to an end.
Today, due to demands for accountability as well as creeping nationalism in donor countries, donors are only willing to invest in programmes that can sustain themselves. In other words, there is a shift from aid-led to enterprise-led development .
This has set the stage for the growth of social enterprises. These are basically organisations that combine their primary goal of driving positive social change with the efficiencies and profit-orientation of private sector.
However, unlike fully-fledged capitalist businesses, profits generated in a social enterprise are not distributed to directors or shareholders but re-invested in scaling up solutions in order to achieve greater impact.
In Kenya, social enterprises can play a unique role in accelerating the attainment of UHC.
First, the increased public funding for UHC provides a powerful form of risk underwriting for private sector players keen on providing healthcare solutions. This is critical as very often private investors are unwilling to spend in areas where government support in the form of funding, policy and regulation is doubtful or lacking.
Second, Kenya has made considerable steps in advancing the ICT sector. In fact, ICT is currently the fastest growing sector of the economy, having grown 11.4 per cent last year.
ICT is important when talking about private investment in healthcare because new technologies allow healthcare providers to scale solutions at a fraction of the cost while not compromising quality.
Third, more Kenyans are embracing entrepreneurship. Entrepreneurship is not about avoiding problems, but confronting them and getting rewarded for solving them.
Fewer bigger problems exist in Kenya, and indeed Africa, than lack of access to quality and affordable healthcare. In fact, Ministry of Health data indicates that the leading reason why Kenyans slide into poverty is medical bills.
Entrepreneurship lends itself well to solving the challenges in healthcare. The good news is that social enterprises provide room for entrepreneurs to solve problems, get rewarded, but still drive social impact.
Scottish economist, Adam Smith, famously said, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest”.
When people are motivated to make money, they find a solution. When people are motivated to make money and transform lives, they find a lasting solution. The latter is what social enterprising is all about and why it is key in accelerating attainment of UHC in Kenya. — The writer is the venture development Mmnager at Amref Health Africa in Kenya —[email protected]