AMPATH’s population health approach
Pretonila visited Busia County Referral Hospital in a border town in western Kenya to be treated for a minor ailment. On this particular day, she would not be paying for any health services at the hospital. This is because Pretonila has National Hospital Insurance Fund (NHIF) insurance allowing her to access free outpatient care. As she waited to see a clinician, we asked how health insurance has helped her and her family. Pretonila said, “Since we received health insurance, I have peace of mind because I can go to the hospital anytime like I have today and receive services. Before we had insurance, there were times I would not go to hospital when I was sick because I did not have the money to pay for medicines and hospital fees.” Like many others, Petronila’s husband learned about the NHIF health insurance from an AMPATH liaison officer.
AMPATH’s long history of improving HIV care while supporting Kenya’s Ministry of Health (MOH) system has uniquely positioned us, the MOH, and NHIF to partner to provide a comprehensive care package. This insurance extends beyond HIV to growing public health concerns in Kenya like chronic and non-communicable diseases. By integrating disease-specific programs, developing a robust electronic medical records system, working to build a referral system, ensuring adequate drug supplies and improving access to specialty care such as cancer treatment, the population health model will improve efficiency and quality of the health system. This revolutionary model is a comprehensive, integrated, community-centered, and financially sustainable health care delivery system responsive to the needs of the entire population. Three priorities form the pillars of Population Health: 1) a seamless care system from primary to tertiary facilities; 2) community groups to improve health and wealth; and 3) universal health insurance.
AMPATH is partnering with the Busia County Government to enroll more NHIF insurance beneficiaries, especially self-employed and low-income Kenyans. AMPATH liaison officers make home visits and talk to clients like Petronila, alerting them to the importance of health insurance, and assisting them to enroll. Poor Kenyans are more likely to be financially devastated by hospital expenses when they or their loved ones fall sick and need care. Health insurance safeguards families’ wealth and ensures health by improving access to care.
Central to the Population Health model’s success is our community-centered approach guaranteeing all services be informed and driven by the needs of the population we serve. Through Group Integrated Savings for Health and Empowerment (GISHE) groups, members gain skills and knowledge to empower them economically, take loans, save and begin to generate income, access NHIF insurance and receive preventive, acute and chronic health care. As these groups become more successful, they will have the power to form agricultural and livestock cooperatives bringing increased economic opportunities and wealth to their communities. In leveraging the power of community groups, we aim to disrupt the cyclic relationship of poverty and poor health by creating a cycle of wealth and health.