AMPATH Promotes Population Health with Universal Health Coverage

Last month AMPATH took a big step toward a vision of making access to quality health care available for all. AMPATH teams started a pilot project going door-to-door in Turbo Sub-County, immediately northwest of Eldoret, to facilitate enrollment in an affordable national health insurance product to families, especially those with informal or no employment. For just $5 per month, a family can purchase comprehensive health coverage from the Ministry of Health that pays for free primary and sub-specialty care and free hospital-based inpatient care including dialysis, chemotherapy, and other services that had previously been unaffordable or inaccessible.

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This is the next step down the path toward Population Health with Universal Health Coverage. Ensuring universal health insurance is the third pillar of Population Health, building upon Pillar One: Economic Empowerment of Communities and Pillar Two: Building a Seamless Care System.

The initial response to this household sweep to increase enrollment into the national health insurance product has been extremely positive. Of the 1,330 homes that AMPATH has visited in the first four weeks, 91 percent of families that did not have existing insurance wished to enroll. In some cases, families had previous coverage that had lapsed, and 21 percent of these families paid penalties and re-enrolled and ten percent were securing the necessary funds to do so.

There remains 12 percent of families who cannot afford this insurance. A means test is used that includes factors such as: What type of roof do you have? What type of flooring? How many pots and pans? Depending on these variables, families can qualify for a subsidy of half of the premium or get the essential package from the Ministry of Health for outpatient care only. This essential package can be a stepping stone to a subsidy, which can then be a stepping stone to privately paying for insurance. A dedicated behavioral health specialist is working to keep the default rate low and a system will be created to assist those at risk of default without creating financial dependence.

Once established with health insurance, family members are referred to join a community group (AMPATH’s GISHE model) which provides access to microfinance (savings and loan) opportunities and income-generating education and support. They are also referred to a clinic to get an integrated health screening for HIV, cervical and breast cancer, hypertension, diabetes and mental health disorders. While at the clinic, they can be linked into the care system depending on the level of care needed for their severity of illness. This could include primary care services, referral to a specialist at the chronic disease center or referral to Moi Teaching and Referral Hospital. After referral, our goal is to get patients returning back to their primary care home.

The pilot project will continue in Turbo (population: approximately 200,000), then scaled to the rest of Uasin Gishu county (population: 1,000,000), and then replicated to other counties based on their interest and cooperation. This project will provide a model for other countries and programs in sub-Saharan Africa to achieve Universal Health Coverage with a financially stable health system. Capitation funds paid by the national health insurance entity go into the county Ministry of Health account, which can then be used by clinics to improve care provided, staffing levels, or address any other need. Our pilot will help demonstrate health utilization rates and secure financial pathways.

The goals of the Turbo pilot include:

• reaching 20,000 homes ( approximately 100,000 people) in the next year

• demonstrating that capitation funds paid improve the health system

• providing families with financial protection and improving their wealth because of national health insurance and income generation support

• and most importantly, showing improved health outcomes (blood pressure controlled, heart attacks and strokes prevented, etc.)

A successful population health program ensures access to quality care and health equity so the poorest are receiving the same quality health services as the rest of the population. AMPATH is turning this vision into reality for thousands of Kenyan families.

Laura Ruhl, MD, MPH is the Field Director of Population Health for the AMPATH Consortium.