Health Insurance Fund Annual Report 2011

HealthInsurance Fund

Annual Report 2011

Preface

Thanks to excellent cooperation with Hygeia Community Health Care and the Kwara State Government, we achieved a record enrollment of 95,000 people in Nigeria, representing a growth of over 50% compared to 2010. Within a period of five years, this has grown to become the biggest private community health insurance program in Africa. In 2011, together with AAR, we launched the first health insurance plan in Kenya, where based on the lessons learned in Nigeria, the contributions of beneficiaries cover 75% of the medical expenses.

We are proud to say that SafeCare and Medical Credit Fund serve healthcare providers beyond the Health Insurance Fund’s Program. Nearly 300 public and private clinics and hospitals have benefited from our quality improvement program. We remain committed to the communities and partners with whom we work through our continuous efforts to support them in capacity building.

We have implemented standards that have contributed to increasing trust in the healthcare system and reducing investment risk and transaction costs in Africa. We have been able to mobilize additional resources – almost eight times the amount that has been invested until now by Health Insurance Fund – from third party donors, local governments, investors, local banks, private clients and member contributions for the premium. This is more than the amount that the International Finance Corporation has invested in health care in Africa over a period of 10 years (1997-2007).

In 2011, as in the previous years, we have shown how development cooperation within public-private partnerships can be very effective. We would like to sincerely thank the staff, local partners and our committed partner the Dutch Ministry of Foreign Affairs for their dedication and outstanding efforts towards achieving these results.

K.J. Storm ChairmanDecember 2012

The Health Insurance Fund, PharmAccess and partners have been working together to improve access to good quality basic health care for uninsured people in Africa. A new approach to development cooperation has been established in the form of public-private partner ships. The health insurance program, established with the support of the Dutch Ministry of Foreign Affairs, has made considerable progress. 2011 has been a year of continued momentum for our organization and partners.

Introducing Health Insurance Fund

Health Insurance Fund 3

4 Health Insurance Fund

“Introducing health insurance is a revolutionary concept. You basically tell the people: we will help you save money. That will create a critical mass that will increase demand as well as the quality of health care.”

Bert Koenders, former Dutch Minister for Development Cooperation


Our mission and approach

The mission of the Health Insurance Fund is to improve the wealth of low- and middle-income families by protecting them from health-related risks. It aims to achieve this by providing access to affordable and good quality health care through voluntary private health insurance.

Together with our main implementation partner, PharmAccess, we have implemented insurance programs in Nigeria, Kenya, Tanzania, Namibia and Mozambique. To this end, we make use of local insurers, administrative offices and care providers and we enter into competitive contracts with these private parties, based on achievements such as numbers of people insured, services provided and the quality of the services.

People who are yet to be insured also play an active role in our approach. Our programs focus on groups with a strong social structure whom we involve, amongst other, in the development of the insurance package, the marketing and the selection of clinics.

Our approach creates an environment of trust between those insured, insurers and care providers in a particular region. It is therefore important that our programs do actually have the intended impact: this is something we monitor and evaluate through independent research.

No insurance means less health care and more poverty

Health insurance as we know it is almost

non-existent in Africa. Health insurance

covers a mere 4% of the total healthcare

expenditure in Africa. This means that

the vast majority of people have to pay

out-of-pocket for all their healthcare costs.

This is particularly a major problem for

low-income groups as they have no

money for doctor visits or medication.

Unexpected and high healthcare costs

often lead to even greater structural

poverty for these people.

How we create our programs

Package Each health plan provides a fully developed and tested package of basic healthcare services. The package is designed to cover most of the healthcare events for which people seek professional medical assistance. For each country, the package is actuarially costed separately for rural and urban settings.

Marketing Health plans are accompanied by marketing plans and marketing tools. Marketing plans will describe marketing objectives, branding, marketing-mix, channel approach and marketing activities. The plans will also specify the blend of marketing tools to be implemented. Innovative marketing tools have been developed and tested in many countries.

Administration and ICTThe proper and efficient administration of a health plan is key to its smooth operation. Our health plan has a model for capturing enrollment data, for processing of claims, for financial administration and for capturing and analyzing utilization data. This model is applied by the administrator involved in the health plan to ensure that all administrative processes meet predefined standards, connect up correctly and provide

The Health Insurance Fund has been providing insurances in Africa since 2006. We develop and test different models that we adapt to the local situation and needs of the target group. Although our programs differ per country, they have a number of elements in common, the most important of which are given below.

Primary and maternal care

The package contains primary and

maternal care in all the programs.

This type of coverage is generally the

most popular among low-income groups,

because it is affordable, has a high

likelihood of being used and usually offers

good quality care near home or work.

The premium

Experience has shown that the poorest

are able and willing to make a token

contribution towards the premium for

the health plan. While middle-income

groups can generally be expected to

pay the full amount of the premium for a

basic healthcare package, lowest-income

groups require some form of premium

subsidization.

Quality improvementIf customers are expected to join and pay into the health plan, the quality of the health care provided by the basic package needs to be warranted. The quality of health care can be ensured by using the SafeCare standards to assess and monitor the progress in quality improvement. Quality improvements require funding that the healthcare providers may not be able to organize by themselves. The Medical Credit Fund provides access to loans for small and medium-sized healthcare providers through local banks.


Our development approachThe process of establishing a health insurance

plan consists of eight steps:

1. Surveying the health care available

2. Surveying the target group

3. Developing a business case for care providers

4. Determining the insurance package

5. Developing the implementation strategy

6. Training healthcare providers

7. Introducing and rolling out the insurance

8. Monitoring and evaluation

accurate and reliable data for operations and management purposes.

MonitoringEach health insurance plan needs to be adapted to local circumstances and modifications based on results. It is therefore necessary to monitor developments closely to be able to respond adequately to flaws in design and operations of the health plan.


Our achievements since 2006

Increased access to good quality basic health care for currently uninsured groups In 2011, through continuous collaboration, local leadership and technical assistance by the Health Insurance Fund, over 105,000 people from four different countries enrolled in our program, in six different plans. The current level of re-enrollment rates in the Nigerian plans varies from 45% to more than 77%. Since the start of the program, more than 650,000 visits by patients from low- and middle-income groups have taken place.

Quality improvement We have achieved tangible results on the supply side in terms of quality upgrades of clinics and hospitals and local capacity building. Approximately 50 private and public providers have upgraded their services to international standards. The Lagoon Hospital Ikeja and Lagoon Hospital Apapa have received a Joint Commission International (JCI) accreditation, the first and only hospitals in sub-Saharan Africa to have shown compliance to such international quality standards.

Learning and EvaluationTo test and evaluate different models and modalities of support, we operate and support multiple plans in Nigeria, Tanzania, Kenya, Mozambique and Namibia. The variety of program designs and geographical locations has taught us valuable lessons and has enabled us to collect invaluable data, including biomedical, financial and market data that have never previously been made available in Africa. We play an important role in transferring the knowledge and experience gained from our program to the national

programs of various organizations all over the world.

Reducing investment risksOne of our key objectives is to reduce the investment risk in Africa by using public funds. A major result of our program has been the founding of the Medical Credit Fund (MCF). The MCF’s technical assistance program enables small and medium-sized enterprises (SMEs) in health care to become bankable and reduces their risk profile. At the same time the MCF works with local banks to increase their knowledge and understanding of lending to small and medium-sized healthcare providers. The SMEs in health care are now able to invest in and grow their business, and provide more and better quality services to their clients. These investments are co-funded with other investors and have resulted in additional funds of tens of millions of euros being committed to health and economic development. Peer-to-peer fundingAnother outcome of our program has been the launch of the MatchFund, a peer-to-peer fund designed to link consumers of private sector companies to beneficiaries of our program. The first contributor to the MatchFund is the Eno insurance company in the Netherlands.

Links with local government The Kwara State Government in Nigeria has committed EUR 2.4 million for five years to gradually take over the funding of the program in Kwara State. This collaboration is crucial in ensuring the sustainability of our program in Kwara State. It is unique that a


local government in Africa is partnering with a development agency to promote private health insurance for its citizens.

Policy influencing Our Nigerian programs have been mentioned in the Nigerian Government’s national strategic health development plan 2010–2015 as an exemplary community-based insurance plan. During a visit to Nigeria in May 2011, the UN Secretary-General Ban Ki-moon spoke about the unique character and importance of the Community Health Insurance Plan of the Kwara State Government. UNAIDS describes our program as an example of insurance innovation to achieve sustainability and self-reliance among low-income Africans.

Lessons learned

It is essential in our innovative approach that we learn from our experiences and integrate the lessons learned into the structure and implementation of our programs. A few of the lessons learned:

1. Ensure availability of medical and actuarial data Due to the innovative character of our program, there was initially a lack of medical data on the target population and actuarial data on healthcare utilization and costs, which made it difficult to accurately determine the size and cost of the healthcare package and to calculate premiums. These challenges are being addressed by a stronger focus on acquiring medical and actuarial data before and during the implementation of the program.

2. Build local capacityLocal capacity building of the private sector is required to deliver viable health insurance products and services (insurance companies, health maintenance organizations, and administrators). This is needed for the implementation of the program, but also to ensure smooth operations in the future.

3. Provide intensive and continuous consumer education/marketingContinuous marketing and education is crucial for enrollment and re-enrollment, especially prior to increasing co-payments and for a young and urban population that is likely to migrate.

4. Introduce and monitor standardsThe introduction and monitoring of standards is required for the efficiency, transparency and quality of services. Initially quality standards were monitored using an internal protocol, but this is now carried out in accordance with the internationally recognized SafeCare standards.

5. Define eligibility rulesEligibility rules for enrollment must be clearly defined. Focusing on families helps avoid adverse selection and improve risk pooling.

6. Ensure high involvement of community leadership and government Local leaders and governments should participate and take ownership of the program in order to ensure the program is accepted and financially sustainable. This has resulted in advocacy becoming a more important aspect of our work.

“Our plans are for this program to extend to 60 percent of the state.”

Abdulsalam Abdulrasaq, the Kwara State Government

2011: our program results

Nigeria The Health Insurance Fund has been active in Nigeria since January 2007. We have launched four insurance programs in Lagos and Kwara State, all being carried out by Hygeia Community Health Care. In 2011, preparations were started for the expansion of the insurance program in Kwara.

Market women in LagosStart January 2007Target group 10,000 market woman and their families (approximately 40,000 people in total). The women are organized into market associations and work at different markets, of which 8 participate in the program. They trade a wide variety of products and services: food, music, soap, clothes, cell phones and haircuts. Highlights 2011 68 % of the market women visit a doctor regularly. This has resulted in more than 330,000 visits since the start of the program, including almost 10,000 hospital deliveries. As the clinics have been in the program since 2007, substantial quality improvements have taken place over the years. Two clinics have even been officially accredited in accordance with the international standards of the Joint Commission International. End 2011

number of people insured

number of care providers

number of visits to doctors or clinics

24,915 12 333,991


Small ICT entrepreneurs in LagosStart July 2009Target group 20,000 members of the Computer and Allied Products Dealers Association of Nigeria (CAPDAN) in Lagos, and their families. These members are employers, their employees and their respective household members. CAPDAN is an umbrella organization for small and medium-sized IT enterprises, located in the village of Ikeja IT in Lagos. The IT village is the central place for ICT-related business activities in Lagos. The program is funded by the World Bank, through the Global Partnership for Output-Based Aid (GPOBA). Highlights 2011 Throughout 2011, 2 medical outreaches were organized per month, with approximately 150 attendees per outreach. These outreaches consisted of screening for hypertension and diabetes, and health education on relevant public health concerns such as sanitation, immunization, breast feeding and antenatal care.End 2011

Farmers in the Kwara regionStart January 2007. Expansion of program in 2009, new expansion plans for 2012.Target group More than 150,000 farmers and their families in the Kwara Central region, and the Kwara North region. The community is led by local leaders who actively assist in the organization and mobilization of the community. The main livelihood in Kwara is farming, but most households are also involved in other activities such as trading and fishing.Highlights 2011 In 2011, more than 66 % of the participants renewed their insurance. This indicates that people really appreciated the care provided and are willing to pay for it. The success of the program is partly due to the fact that the Kwara State Government has made a financial commitment to the Health Insurance Fund, and plans to gradually take over the entire premium subsidy.End 2011

“The money we would have spent on hospital bills can now be spent on our children’s education and our business.”

“It is about bringing good quality health care to the doorsteps of people.”

Rufiat Balogun, market shop owner, Lagos

Olapeju Adenusi, managing director

Hygeia Community Health Care







13,473 56,83012 1449,960 258,476


KNCU coffee farmers Start April 2011Target group Coffee farmers and their families of the Kilimanjaro Native Cooperation Union (KNCU) in Tanzania. KNCU is Africa’s oldest cooperative and represents over 150,000 small-scale coffee farmers organized into 92 Primary Societies. The KNCU Health Plan was started for five Primary Societies, targeting around 25,000 people.Highlights 2011 In 2011, an intensive marketing campaign was launched, with contributions by STOP AIDS NOW and HIVOS as well as the Health Insurance Fund. The aim of the campaign was to encourage enrollment in the KNCU Health Plan, by using existing community structures. The final event was a legally binding referendum. An overwhelming majority voted in favor of the health plan, marking the start of the Health Plan.End 2011

Dairy farmers in Tanykina Start April 2011Target group The 4,000 dairy farmers who are members of the Tanykina Dairy Plant, and their families (approximately 20,000 people). Dairy farmers are encouraged to sell their milk to cooperatives, as the large dairy companies pay more per liter when the milk is delivered in large quantities.Highlights 2011 The Tanykina Community Health care Plan is owned by the members of Tanykina Dairy Plant Ltd. In 2011, 10% of the group had signed up for the TCHP. This was the result of a comprehensive ongoing marketing strategy with extensive involve ment by Tanykina members. Tanykina marketeers were recruited and trained to inform, educate and enthuse the members about the TCHP plan.End 2011

TanzaniaIn 2011, the KNCU Health Plan was launched and preparations were made for a new insurance program in Dar es Salaam. Our local partner in Tanzania is the insurance intermediary MicroEnsure.

KenyaThe Health Insurance Fund became active in Kenya with the start of the Tanykina Community Healthcare Plan in April 2011. In Kenya we cooperate with the local insurance company AAR, one of the largest health insurance companies in East Africa. Preparations for another program are already well underway. This program, for the partners and employees of the tea factory in Koisagat, as well as their families (ca. 25,000 people), will be officially launched in 2012.

“ Those who haven’t joined the KNCU Health Plan haven’t understood the benefits of health insurance. I will convince them to understand.”

Scolastica, KNCU coffee farmer







3,911

1,259

10

7

2,663

1,505


Mister Sister, mobile health solution Start Juni 2011Target group People living and working on farms and other remote populations in the area of Windhoek, who would otherwise not have easy access to health services. On average, these people have to travel 68 kilometers to visit a clinic and 100 kilometers to go to a hospital. Research showed that employers were prepared to pay for better health care if the distance between the workplace and the medical facilities were to be reduced to 20 kilometers.Highlights 2011 In 2011, the Mister Sister program was launched: mobile clinics bring basic health care closer to the people. Four trucks currently follow a fixed route schedule in the region surrounding Windhoek. The trucks provide primary health care. End 2011

Eduardo Mondlane University Health Plan Start 2010Target group 22,000 students and staff of the UEM in Maputo and another 2,600 students from various other UEM faculties at other sites throughout Mozambique (in phase 2).Highlights 2011 In 2011, the foundation for the new hospital was laid.

NamibiaThe Health Insurance Fund participates in the Mister Sister program that was launched in Namibia in 2011. It is an innovative program for mobile health care in the Windhoek region. Many national and international partners, from the public as well as the private sector, participate in the program.

MozambiqueThe Health Insurance Fund continues to support an initiative by the University Eduardo Mondlane (UEM) in Mozambique to establish a healthcare delivery system supported by a prepaid health insurance plan for their students and staff.

“One of my workers was diagnosed with high blood pressure and a referral letter for a doctor was issued. This worker now receives chronic blood pressure medication.”

“Before I joined Tanykina Community Health Care, I had to pay for my hospital visits. Without money they would not treat you. Now, TCHP will take care of my hospital bills.”

participating employer in Mister Sister

Wilson Kirwa, Tanykina member


number ofenrollees

number of patients visits

1 4,750 4,127


“The groundbreaking Community Health Insurance Plan of the Kwara State Government is exactly the kind of innovative partnership that we should replicate – here in Nigeria and beyond.”

Ban Ki-moon, Secretary-General of the United Nations

“If you look around, you see that the people are very energetic. They are now healthy. When you are healthy, you have the strength to farm more. As a result the farming practice in the area has increased.”

Aliyu Abdullahi, Local Leader in Kwara State


Programs and Results

Tanzania Moshi

Namibia Windhoek Mozambique Maputo

Nigeria Lagos

Nigeria Kwara State

Kenya Nandi North District

2011 KNCU coffee farmers

3,911Number of enrollees

2011 Mister Sister, mobile health solution


2011 Eduardo Mondlane University Health Plan

2007 Market women in Lagos


2011 Small ICT entrepreneurs in Lagos


2007 Farmers in the Kwara region


2011 Eduardo Mondlane University Health Plan


Data until 31 Augustus 2012

Visits (in 2011) average

Malaria-related visits with lab test

Antenatal care visits per pregnancy

Number of staff trained (in 2011)

Number of trainings given to clinics

Number of staff members trained

Enrollment

Financials

Patients & Care

Medical Quality

105,138

43%

33

25,657

e 33,-13%87%

42,299 37,182

7

54,593 22,74415

3054.6

28

Enrollees in program

Average percentage of enrollees using care (in 2011)

Total number of clinics

Referral hospitals

Number of assessments with SafeCare standards (in 2011)

650,072Number of visits since start of program

Malaria check since start program

Number of pregnancies since start of program

Clinic Quality

= 13 Public

7 Faith based

13 Private

Donors

Dutch Ministry of Foreign Affairs

World Bank

STOP AIDS NOW!

Kwara State Government Nigeria

International Labour Organization

Eno

Benefit package

Primary Health Care

Minor Surgeries

HIV / AIDS

Maternal & Child Care

Chronic Care

Top 5 Reasons for visits (in 2011)

1. Malaria

2. Hypertension

3. Pregnancy

4. Upper Respiratory Tract Infections

5. Myalgia

Method cash/direct debet

Frequency monthly/yearly

Premium

Average yearly premium

Average premium co-payment

Average subsidy

Payment

26%

Safecare certificates

V 0IV 1III 1II 0I 3Entry level 0


“Before the health plan was introduced we saw 150 patients per month, now we serve 500 to 800 patients per month.”

Dr. Sufian H. Mmari, Tanzania

The impact of our programsWhat is the impact of the Health Insurance Fund programs? Does it really improve the health of those insured? Does it improve their socio-economic position? What are the effects on common health problems such as cardiovascular diseases? And of course: how can we improve our approach?

Impact evaluationAn impact evaluation is performed for each of our programs. The study is carried out in three phases (surveys): 1. baseline measurement (baseline survey)2. the first follow-up study after 2 years

(follow-up survey) 3. possibly a second follow-up survey. For each survey, a random sample from the target group and the control group was interviewed extensively.

A second follow-up survey was conducted in Kwara (Nigeria) in 2011 and showed that those insured did in fact make more use of health-care services than those who were uninsured, but actually had to pay less for healthcare.

In-depth studiesIn Nigeria, we conduct in-depth studies for the insured population on important disease areas. To this end, AIGHD developed a study proposal related to the feasibility of cardio-vascular disease prevention in Kwara State, which was started in 2010. The Quality Improvement Cardiovascular care Kwara (QUICK) project aims to evaluate the

feasibility of cardiovascular disease (CVD) prevention care in accordance with international guidelines in the context of the HCHP program.

In addition to cardiovascular diseases, mother and child health was shown to contribute substantially to healthcare utilization. To measure the impact of our program on the health status of the under-five population and their mothers, the Mother and Child Health study (MACHS) was initiated in 2011 and implemented in Kwara, Nigeria.

The United States Agency for International Development (USAID) supports studies on the regional impact of our programs. The first study carried out in 2011 provided insights into some of the main issues surrounding health-care utilization and health insurance in different contexts in 4 African countries. The objective of the second study conducted in 2011 was to provide valuable knowledge relating to the design and implementation of the Health Insurance Fund programs in Tanzania and Kenya. Particular attention was paid to the burden of chronic diseases on households.

In-clinic researchWe obtain large amounts of data from care providers on the most common health problems and the use of healthcare services. Together with the results of the household surveys conducted, the data shows that infectious diseases, non-transmissible diseases such as cardiovascular diseases and reproductive health are responsible for the main health problems of the population of Kwara, Nigeria.

Independent research

The socio-economic and biomedical effects of our programs

are monitored and evaluated. The results are measured

by two independent institutions: the Amsterdam Institute

for Global Health and Development (biomedical research)

and the Amsterdam Institute for International Development

(socio-economic research)


Our ambitionsOur ambition is to introduce health insurance for low-income groups and to strengthen health care in Africa through public-private partnerships. In 2006, the launch of the Health Insurance Fund was considered to be an innovative approach that still had to prove itself.

Now, five years on, we have learned many lessons. We have gained extensive knowledge and expertise. And we have found many supporters: from international investors to local insurance companies, from development cooperation organizations to national governments.

The results of our approach are promising. We will therefore continue with our program with full conviction over the coming years. Together with the African people we will build on the opportunities created over the past years. And we will continue to seek new opportunities, in close consultation with PharmAccess and the other partners in our group of organizations.

Our ambitions for the coming years Launching new health insurance programs in Kenya, Tanzania and Nigeria.

Expanding the existing health insurance programs in Kenya, Nigeria,

Namibia and Tanzania.

Officially certifying all healthcare providers in accordance with

the internationally recognized standards of SafeCare.

Ensuring access to finance for healthcare providers through the

Medical Credit Fund.

Expanding advisory projects on health insurance.

Focusing on refinancing existing plans.

Ensuring local funding for the health insurance programs

Building the capacity of and strengthening collaboration between

local insurers and third party administrators.

Focusing on advocacy on health insurance.


“It is a wonderful program, but it caters for a small group of people. I’m looking forward to the same program being expanded so it reaches out to most of our people.”

David Koech, Kenyan Member of Parliament


Financial overviewThe Health Insurance Fund is a non-profit organization. The first donor of the Health Insurance Fund was the Dutch Ministry of Foreign Affairs in 2006, followed by the World Bank (2008), the Government of Kwara State (April 2009), the United States Agency for International Development (USAID) (September 2009) and the Dutch Aids Fonds and STOP AIDS NOW! (July 2010).

Dutch Ministry of Foreign AffairsThe main source of donor funding comes from the Dutch Ministry of Foreign Affairs. The funding from the Ministry of Foreign Affairs has been used for the development, support and roll-out of a wide range of insurance programs across several countries.

World BankThe World Bank signed a grant agreement for 6 million US dollar with the Health Insurance Fund. The grant enabled the implementation of a community-based insurance program for ICT workers in Lagos. This program benefits from the same health provider network as the Ministry’s programs in Lagos. The World Bank acts as administrator for the Global Partnership on Output-Based Aid (GPOBA).

Kwara State The Kwara State Government (KSG) is one of our key local government donors that promotes development. In addition to investing significantly in medical infrastructure, the KSG committed EUR 2.4 million in 2009 to our Kwara insurance programs for a period of five years (ending March 2014). The Government has made these funds available as a first step in gradually taking over the premium subsidy that is now provided by Health Insurance Fund.

Aids Fonds and STOP AIDS NOW!The Dutch Aids Fonds and STOP AIDS NOW! made funding available for an extensive marketing campaign as part of the health insurance program in Tanzania. The aim of the campaign was to closely involve the community in the program and to inform and educate them on the benefits of health insurance.

United States Agency for International Development (USAID)The Health Insurance Fund has had a Leader with Associate Agreement with the United States Agency for International Development (USAID) since 2009. The objective of the agreement is to design, support and disseminate key regional studies on the results of our programs, and to promote policy advocacy and evidence-based policymaking. The studies are carried out by the AIGHD and the AIID.

Donor contributions in 2011 EUR

Dutch Ministry of Foreign Affairs 14,080,506

World Bank 814,447

Kwara State 104,134

Aids Fonds 4,414

STOP AIDS NOW! 133,771

United States Agency for International Development 76,030

Total 15,213,302

Our donors in 2011


Expenses per country in 2011The breakdown of expenses per country clearly shows that Nigeria, Tanzania and Kenya are the countries with the highest expenditure. With four programs having been implemented since 2007, Nigeria accounts for more than 40 percent of the total expenditure. It is envisaged that the percentages will shift over the coming years as the existing programs in Tanzania and Kenya will be expanded and new programs will be implemented. The activities of the Health Insurance Fund in Namibia and Mozambique have been grouped under ‘other’ and account for 25 percent of the total expenses.

More local expensesIn 2011, there was a significant shift from expenditure in Amsterdam to spending locally. This has largely been the result of increased cooperation with local organizations in the areas of health quality, marketing and administration, and with the health management organizations and health insurance companies. In addition, there has been a gradual shift of PharmAccess’ work to

HIF program expenses per country Break down of expenses for the Dutch Ministry of Foreign Affairs programs in 2011

Break down of expenses for the World Bank program in 2011

43%

42%

29%

12%3%

6%

12%

31%

65%

18%

14%

25%

Nigeria

Tanzania

Kenya

Other

General Program Management

Operational Research

PharmAccess operations

Local partners (HMO& Insurance companies)

Other implementing partners

General Program Management

PharmAccess operations

Local partners (HMO& Insurance companies)

local offices. Operational research expenses were to a great extent also made locally as the field work and data collection was executed by local workers.


Board and Management

Board Members

Kees Storm (Chair)Former CEO of AEGON

Sjoerd van KeulenChair of Holland Financial Center,Former Chairman of SNS REAAL

Marcel LeviProfessor of Medicine, Chairman of the Executive Board of the Academic Medical Center, University of Amsterdam

Peter van RooijenChair of the Global Fund Finance & Audit Committee,Executive Director International Civil Society Support

Willem van DuinChairman of Achmea

Pauline MeursProfessor of Healthcare Policy and Management at Erasmus University Rotterdam,Member of the Dutch Senate

Advisors

Joep LangeProfessor of Medicine, Head of the Department of Global Health, Academic Medical Center, University of Amsterdam, Executive Scientific Director of the Amsterdam Institute for Global Health and Development (AIGHD), Chairman Supervisory Board of the PharmAccess Foundation

Jacques van der GaagProfessor of Development Economics, University of Amsterdam, Former Chief Economist for Human Development at the World Bank Senior Fellow of the Brookings Institution, Economic advisor to the board

Management and staff

Pieter Walhof, DirectorKwasi Boahene, Senior Program ManagerFleur Henderson, Senior Program ManagerMarthe van Andel, Project ManagerCees Rustenhoven, Financial ManagerLaurens Pels, Corporate CommunicationsAlice Eijpe, Management Assistant



The PharmAccess Group

Unfortunately, Rosa is not an exception. Public health care in Africa faces major problems; the quality of the health care provided is dismal. This is especially a problem for people in the lowest income groups. They often have to turn to private clinics in case of illness at prices they cannot afford and against which they cannot insure themselves. Furthermore, the quality of private health care leaves much to be desired.

Our approachThe PharmAccess Group makes affordable and high-quality health care accessible to people like Rosa, by way of the private health care sector. We strengthen the existing health care system using an integrated approach, in which each of our organizations makes a significant contribution. Our innovative programs give an impetus to the demand for healthcare services (through subsidized health insurance) as well as to the provision of healthcare services (through affordable credits, investments and quality standards).

Improving access to healthcareTogether with local insurance companies, the Health Insurance Fund makes health insurance available for people with low incomes. We negotiate the insurance package together with an organized group in the area: a cooperative of farmers, an organization of market women or company employees, who at the time have no access to health insurance. Those insured pay an insurance premium according to their means, and we subsidize the remainder of the premium. This gives more people access to health care.

Increasing qualityAt the same time we cooperate with smaller scale clinics and hospitals in the region. We help doctors and clinics to attain good standards in their medical services and management. To do this, together with JCI of the US and COHSASA of South Africa, we developed the quality improvement program called SafeCare. This quality mark offers inter nationally recognized quality standards that enable clinics to measure and improve the quality and safety of their services.

Enabling investmentsThe Medical Credit Fund provides affordable loans to doctors and clinics. These care providers have to meet the minimum quality standards set by SafeCare. The quality and the financial stability of care providers improve as a result of the investments that they can make with our loans. This gives banks and investors enough confidence to also provide payable credits.

Our organizations PharmAccess

Health Insurance Fund

Investment Fund for Health in Africa

Medical Credit Fund

Amsterdam Institute for Global Health and Development

SafeCare

4 cows, 24 liters of milk per day. Rosa from Kenya makes a living for her family, which

includes her parents, her husband and their three children, by running her own small

dairy farm. This changes when Rosa’s youngest son gets a severe form of malaria.

This is a downright catastrophe for the family as they have no money for medical

treatment. Rosa needs to go to a hospital with her son. She has to sell her best cow

to pay for doctor visits and medication.


Mobilizing private capitalThrough the Investment Fund for Health in Africa we enable international organizations to invest in the African healthcare chain. This gives successful companies in this sector an even greater opportunity to develop, thereby improving the reliability of the African healthcare system further.

Measuring resultsDo our programs have the expected impact? Do people actually benefit? This is why the impact of all our programs is measured by independent research organizations. The Amsterdam Institute for Global Health and Development measures the biomedical impact while the Amsterdam Institute for International Development measures the socioeconomic impact.

Implementing and encouragingPharmAccess provides the expertise needed to implement our programs, regardless of

whether medics, field workers, project managers, fundraisers or financial controllers are required. In addition, PharmAccess regularly develops new initiatives to strengthen our integrated approach.

It is the effect that countsTogether we are improving healthcare in Africa, by strengthening the private sector. We reduce the risks for companies and investors to an acceptable level so that health insurers will insure low income groups, banks provide credits and care providers have a stable source of income.

We work in publicprivate partnerships enabling us to develop sustainable healthcare systems. The increasing quality of the system results in growing trust which means that every dollar received from our donors generates investments many times greater. And people like Rosa gain access to affordable, reliable and good quality healthcare. Because that is what it is all about.

Trinity Building CPietersbergweg 171105 BM AmsterdamPhone: +31 (0) 20 566 [email protected]

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Documents

Health Insurance Fund Annual Report 2011