Business Daily columnist George Bodo’s piece last Friday about a law being crafted in Zimbabwe aimed at supporting the use of livestock as financial collateral was good news.
It highlighted a chronic problem relevant to healthcare in many Kenyan rural households. Here are people with alternative wealth, read livestock, but who are condemned to exclusion from health insurance because vendors do not see them as potential buyers.
Bodo’s article reminded me of a recent discussion on healthcare financing with an economist at a health innovative technology firm. The gist of our discussion was why a man who owns 200 goats isn’t being reached by health insurers nor benefiting from tech innovations around health insurance.
The 2017 Economic Survey and National Hospital Insurance Fund (NHIF) data show that less than six million Kenyans have any form of health insurance.
Across the hospital compound in Iltilal village where I practice, my friend lives in a manyatta (Maasai hut) and owns an intimidating number of cows and goats but still has no basic NHIF cover.
Every time a family member falls sick some are sold to finance hospital charges. Despite being “wealthier” than most Kenyans, no insurer is thinking about him.
The vast majority of those with health insurance are employed, self-employed, are supported by donors or vulnerable family schemes. My six years’ observation in Maasailand shows that vast swathes of such populations have low NHIF membership despite accounting for 70 percent of Kenya’s population.
Strangely though, these neglected folk have high ability to pay for such bills.
All it takes is some enlightenment and novel business model that seamlessly converts livestock into premiums.
A second observation is that the majority here do not have formal financial tools like bank accounts or mobile banking literacy: their currency is livestock. With average homesteads owning 100 goats and wealthier ones over 500 it is a ripe market for selling.
In most of these houses, goats and cows are sold when someone falls ill often to pay for bills tenfold what a decent insurance premium would cost.
For donor and development organisations pushing to get marginalised communities into the universal healthcare coverage vehicle, it is time we started having discussions on how to surmount this “payment modality” chasm which locks such communities out.
Donor sponsored NHIF and development partners could support financial intermediaries to take up livestock in lieu of health premiums as one approach.