The introduction of a National Health Insurance Scheme in Zambia is a timely, purposeful and strategic initiative aimed at addressing certain resource deficiencies in the health system, financially protecting and advancing the health of citizens and legal residents of Zambia as well as securing the sustainability of the health system. For Zambia, it addresses concerns over the financial burden and equity in access experienced by a large segment of the population, particularly the vulnerable and indigent in seeking adequate health care services for themselves and thier dependents given that approximately 99%of the population has no private health insurance coverage. Current unpublished data from the Zambia National Health Insurance Authority (ZNHIA) show that from the targeted population that is eligible (and mandated) to contribute towards the national health insurance scheme, there are no records, systems or mechanism to identify, enroll and collect premiums from 60% of the targeted contributing population. This is primarily because of the fact the majority of people in actual employment in Zambia are “self-employed” in what is categorized as the informal sector with no traceable income tax records or social security numbers. In the last five years, there has been an exponential growth of Digital Financial Services (DF), particularly Mobile Money Services (MMS) which are used by over 70% of the working age population (15-60 age; both in the informal and formal employment categories). How can this extensively used service be harnessed to identify and possibly be a preferred platform to process enrollment, premium payment, policy administration, and communication of the “unregistered” informally employed” category of contributors to the NHI?
On the other hand, Kenya has the National Hospital Insurance Fund (NHIF), a State Parastatal that was established in 1966 as a department under the Ministry of Health. Over the years, reforms have been undertaken to accommodate the changing healthcare needs of the Kenyan population, employment and restructuring in the health sector. Currently an NHIF Act No 9 of 1998 governs the Fund which transformed the NHIF from a department of the Ministry of Health to a state corporation which aims at improving effectiveness and efficiency with a core mandate of providing medical insurance cover to all its members and their declared dependents (spouse and children). More recently, the Kenyan government has made a commitment to achieve Universal Health Coverage (UHC) by 2030. A key part of its UHC strategy is to expand coverage of the NHIF, which currently covers approximately 15% of the population. In 2015, the NHIF introduced significant reforms aimed at enrolling more people and expanding the range of services that enrolled members have access to.
The “Achieving UHC through DFS” assessment has a specific aim of gathering and providing detailed information and possible options of how the ZNHIA could collaborate and/or partner with Mobile Network Operators (MNOs) to achieve the NHI goals by increasing the member-contributor base population amongst the informally employed persons who are not captured and processed by the Zambia Revenue Authority (ZRA) for NHI monthly contributions. The assessment will identify the most practical and cost effect solutions of the client-facing interaction processes (enrollment, premium payment, policy administration, and communication) through the use of mobile money services. Furthermore, a country comparison research methodology will be applied to undertake a case study of the how the Kenya NHIF is undertaking its reforms and if some of these interventions can be applied to the nascent ZNHIA plans to increase the coverage of contributors. Our research will be informed by the WHO health financing evaluation framework that considers the feasibility, equity, efficiency, and sustainability of health financing mechanisms.
Institute for Health Measurement is an African-led and owned for profit organization working primarily to strengthen health systems for public health programs across Africa and has offices in South Africa, Zambia, Swaziland and Lesotho. Since its establishment in 2011, our staff compliment has grown from 5 to a team of over 50, managing development assistance funds from the US Government, the World Bank and the UN Family (including UNFPA, UNICEF and WHO). Our operating budget has increased from approximately $400,000 per annum to approximately to $4,000,000 per annum in 2019. We have implemented health systems and health management information systems projects and undertaken large scale qualitative and quantitative research assignments and program evaluations across East and Southern Africa. IHM has a proven track record of providing high-quality cost-effective program research and evaluations for various health sector clients; health informatics technical assistance; grant funded Strategic Information (SI) and Health Management Information Systems (HMIS) program implementation. IHM comprises a team of experienced and recognized public health experts in health informatics, program monitoring and evaluation, data analytics, quantitative and qualitative researchers and epidemiologist from across the Southern Africa region who have built strong long-term working relationships and networks with key organisations and institutions in the East and Southern Africa region. Through a CDC funded sub-contract, IHM in Zambia is responsible for the deployment of a nationwide roll out of the Electronic Health Records (EHR), which will underpin NHI Information Systems functionality for user (patient) interaction and transactions with the public health providers.
IHM intends to undertake the “Achieving UHC through DFS” assessment in collaboration with the nascent Zambia National Health Insurance Authority (ZNHIA) and Zambia Information Communication Authority (ZICTA) which is the government statutory body responsible for regulation Mobile Network Operators (MNOs) including Mobile Money Services (MMS) providers. While it would be most desirable to include MMS providers as part of the research partners, given the competitive and proprietary nature of the services to assessed, IHM proposes ZICTA as the assessment partner as it is an independent entity that provides the legislative engagement channel through its regulatory mandate that provides for periodic reviews of its Value Addition Services licensing1 to MNOs and also allows for a neutral and transparent interactive platform with MNOs that will foster access to sensitive information such as MNO client databases.
The research team will be led by Dr Mpuma Kamanga, a well-rounded public health clinician and health economist with over 18 years’ experience and lead policy designer of the National Health Insurance Act. Dr Kamanga has extensive experience in developing and implementing health systems projects across Africa with a strong track record in Health Financing. He has led and supported various national and international research projects in health systems strengthening initiatives. He holds a Bachelor of Medicine and Surgery (University of Zambia) and a master’s in public health economics University of Cape Town and is currently Director of Special Duties (Health Economics) at the Ministry of Health. The assessment will be co-led by Dr Kamanga and Mr Kunda
Mr William Kunda is an accomplished IT project Manager and Senior Software Engineer. Mr Kunda has extensive hands-on experience in designing and leading Software development projects and has strong competencies in interoperability and integration of software systems. He is the lead architect and Project manager for the recently launching National Health Data Ware House, a first of its kind project that stores multiple data sets from various disparate patient- and aggregate-level systems across the different sub-sectors of the health system. Prior to joining, Mr Kunda was the Software Engineering Manager for Barclays group Africa (ABSA Bank) where he oversaw the design and execution of various new and innovative Digital Financial Services. Contractually, the assessment will be overseen by the CEO of IHM, Mr Kelvin Sikwibele, a public health expert with over 20 years’ experience in Health Systems program design and implementation
Comments
Achieving Universal Health Coverage through DiFS
The “Achieving UHC through DFS” assessment has a specific aim of gathering and providing detailed information and possible options of how the NHI Authority should collaborate and/or partner with Mobile Network Operators (MNOs) to achieve the NHI goals by increasing the member-contributor base population amongst the informally employed persons who are not captured and processed by ZRA for NHI monthly contributions. The assessment will identify the most practical and cost effect solutions of the client-facing interaction processes (enrollment, premium payment, policy administration, and communication) through the use of mobile money services.
Technical feedback
While there is a strong focus on financial protection and equity, and the comparison made with Kenya is interesting, the purpose of this proposal seems possibly somewhat misaligned with the RFA goals. The goal of the RFA is to demonstrate to what extent digital financial services in low-resource health systems have contributed to financial protection, increased demand and use, and strengthened health systems performance. The research proposed here focuses on financial protection but not on health systems strengthening, and further, the research appears to actually support the development of an app.
Thanks for the comments. we
Thanks for the comments. we have tried to address the this in the final response and our application was aimed at demonstrating the future impact of the NHIA on the Health System which has only commenced recently . we intend to create a baseline of the current status (of specific elements of the health system) and how addtional insurance contirbutions will have a net positive impact of the Health System over time as we are in the process of setting up parallel reasearch activities (using the baseline) that will measure the current system and future investments
Feedback on Application
How will findings benefit the entire sector? How will you genericize findings beyond Zambia context?
Thanks Amanda,
Thanks Amanda,
A lot of African countries are going towards the route of National Health Insurance and we hope our findings will outline the steps and pitfalls of identifying the contirubutor base and harnessing technology to have more citizen participation without over burdening a select few as this defeats the whole prupose of financial protection. through the health financing desk at MoH, we would publish the results at various international fora