“There is an extensive body of work showing that the design of insurance systems is key to their success in relieving poverty, improving health and improving welfare. Whilst both Nigeria and Kenya are signed up to rolling out universal health insurance, the design of these systems is not yet fully understood and we hope that our research can influence how effective the systems will be for women in the future,” explains Professor Richard Lilford, lead investigator in the study and Professor of Public Health and the University of Birmingham.
“One of the main benefits of health insurance is known to be the day-to-day security that it brings. However, sometimes the introduction of an insurance system can result in ordering more tests that are needed, which ultimately leads to poorer care for patients. We want to understand what is happening on the ground, does it match the intentions of the policies and even when it does, does that lead to the anticipated benefits?” Professor Lilford continues.
Both Nigeria and Kenya have national policies to roll out health insurance across the population. This research will help to provide the evidence base to get these policies embedded effectively. In Nigeria researchers will collaborate with the University of Ibadan and in Kenya there is a partnership the African Population and Health Research Center, as well as economics support from Georgetown University in Washington, US, which will run alongside the University of Birmingham’s clinical and epidemiological expertise.
“In Nigeria we are currently engaging with officials of the National Health Insurance Health Authority and health insurance agencies, and policymakers in the Federal Ministry of Health and Social Welfare to pave the way for the practical implementation of whatever is learnt from this research project by both national and sub-national agencies offering health insurance,” explains Professor Akinyinka Omigbodun, University of Ibadan.
“Our social health insurance scheme in Kenya is in its infancy. We already know there are conflicting views of patients, providers and the social health authority managing the insurance. Many Kenyans are skeptical about the system and how straight forward it will be to receive promised services. While providers raise concerns about challenges in submitting claims and processing payments, the possibility of fraudulent claims, cite a need for greater accountability and transparency. Through this project we want to better understand these challenges in depth from various perspectives,” Dr Gershim Asiki from the African Health Research Center.
The first phase of the research will involve fact finding to derive the right research questions, then the second phase will include both feasibility pilot studies and observational studies. It is hoped that this package of studies will focus on how care differs for women with or without insurance or with different types of insurance, and will provide insights into what could be tested to improve the coverage or design of health insurance to improve the quality of care and/or improve wellbeing and economic security. These outcomes are hoped to support the Gates' Foundation's prior Lives and Livelihoods vision to improve health outcomes for women and children in low- and middle-income countries.
