Primary healthcare in East Africa faces a challenge of early engagement.
Traditionally, people have tended to defer seeking treatment because of the cost involved - no universal primary healthcare is provided by governments, which instead are seeking to persuade citizens to pay for national health insurance.
This diffidence about seeking treatment means that clinics and healthcare professionals tend not to see cases until they have reached a serious stage. Both the expense and the risk to the patient become magnified in the process.
According to the World Health Organization, the strengthening of primary healthcare is the most efficient and cost-effective means to achieve long-term beneficial health impacts.
In Kenya the government delegates the provision of primary healthcare to local county authorities. It is here that the Netherlands business team of FMO has become involved in a public-private partnership project with health organization Amref Health Africa, headquartered in Nairobi, and Royal Philips, involving various kinds of support for three clinics in Makueni County.
The project is initially designed to improve access to healthcare for 20,000 people in the county, but in December 2018 a memorandum of understanding was signed by Amref and FMO envisages preparing to follow the feasibility stage with a scale-up that will widen the scope of the initiative to as many as 1 million people and explores new opportunities for collaboration. Amref combines knowledge of the market and healthcare sector with 60 years on the ground experience in African. FMO in turn, brings extensive expertise in financial development that is crucial for running more financially sustainable programmes.
FMO is providing funding through the Development Accelerator facility, as well as legal and business expertise, and is working closely with the regional government, which is responsible for health policy, regulation and quality management at the clinics. Amref, as the largest African health organization, trains health workers, manages facilities and establishes community health units to improve prevention within communities and provide efficient referral. Philips is supplying medical equipment and health systems infrastructure specially designed for use in the demanding environment of rural Kenya.
The $1.3 million project was launched in July 2018 and will run until August 2019. If it is successful, the next phase will see the project rolled out nationwide to around 200 community health units, 200 dispensaries and 240 health centres, some of them already in place but in need of upgrading, while others need to be set up.
The trial is important because it involves a non-NGO model of sustainable finance designed to help the health system support itself and provide much-needed primary healthcare to Kenyans at an affordable price.
The trial is generating considerable interest among healthcare policymakers in Kenya and other countries in East Africa where Amref also operates. It is part of a much wider strategic initiative to help African countries achieve their universal healthcare goals.
It was important to develop a model that would build on the existing infrastructure, the clinics and personnel already there.
Within Kenya, despite the national government's efforts to date, the most vulnerable have yet to benefit fully from the healthcare insurance system. The model adopted by Amref, FMO and Philips in Makueni County is designed to enable this segment of society to benefit from direct healthcare at a price people can afford.
“If we are able to keep people healthy at home, the overall cost to the system will be less,” says Patricia Vermeulen, CEO of Amref in the Netherlands. “If we want this model to be financially sustainable, people need to be insured. To ensure access to care for everyone, the people who cannot afford the insurance will be subsidised by the Makueni government.”
The critical part of the project is ensuring that affordable healthcare is delivered not just to citizens who could not previously pay for it without incurring considerable debt, but also to the most vulnerable. This means innovation such as additional provision for maternity healthcare.
“It was important to develop a model that would build on the existing infrastructure, the clinics and personnel already there,” Vermeulen adds. “Delivering high quality primary care is and will remain a responsibility of the government. This model gives them the opportunity to outsource the execution. By combining the strengths of the public and private sectors, we can improve quality and efficiency.”
Part of the funding will go toward improving the training of medical personnel and modernising the facilities available in the clinics. FMO is also working closely with all the parties involved to offer vital consulting expertise.
The partnership represents a new venture into healthcare for FMO, one that will help the organisation to develop a more informed strategy for the deployment of capital in frontier markets.
The interview with Patricia Vermeulen, CEO of Amref Netherlands was initially published in FMO's 2018 Annual Report.