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Kaundu Community-Based Health Insurance (CBHI)

A community initiated and owned health insurance scheme that reduces out of pocket expenditure associated with seeking health services.

CONTINENT
AFRICA

malawi-continent-image

Country
MALAWI

Location

Dedza-East

Founding year

2015

Website

Organizational structure

Partnership

Health focus

Primary Care

Actors Involved

Health workers, Community, Traditional leaders, Faith-based organisation

Programme Focus

Health financing

Health System Function

Universal Health Coverage

CHALLENGE

Communities living in hard to reach rural areas with only fee-for-service health facilities have limited access to health services.
Distances to the health facility can be up to 20km. Out of pocket health costs have a significant effect on the 50.7% of Malawians who live below the USD 1.25/ day poverty line.

 

Approximately, 29% of health services in Malawi are provided by the Christian Health Association of Malawi (CHAM), mostly in rural remote areas. Although health services are provided free of charge by government health facilities, these facilities are not always accessible to rural communities and they are dependent on CHAM health facilities, offering services at a fee. The cost for diagnostic services and treatment for under five children averages at USD 4.34.

“What motivated us to start the CBHI was that we were not seeing many clients at the health centre or those who were coming, were very sickly. But when we would do community visits, we would find people who are sick or hear stories of women giving birth in the community. And we used to ask ourselves, why is this the case? The next government hospital is far away, about one hour or two hours on a bicycle. And people would often not find drugs there. We learned that people could not come because they were not able to pay when ill”

 

– Mr. Simbi, Senior Health Surveillance Assistant, Lead Project Implementer

INTERVENTION

Kaundu CBHI is facilitated by Kaundu Health Centre, a Christian Health Association of Malawi affiliate. The health centre is collaborating with community members and traditional leaders to administer the CBHI.

 

The scheme provides financial protection against the unforeseen cost of illness for community members. Community members contribute a set amount each month (MK300.00 [$ 0.42] pregnant women; MK150.00 [$ 0.21] for children under five and MK200.00 [$0.28] for those above 6 years.). These contributions are then saved towards reducing the out of pocket costs associated with seeking health care services at the health centre.

 

Community health workers associated with Kuandu Health Centre are responsible for the day to day running of the insurance scheme. Every participating village has a Health Insurance Committee (HIC) made up of community members, traditional leaders with support from community health workers. The committee is responsible for sensitising the community, registering new beneficiaries, collecting monthly premiums and remitting them at the health centre. Committee representatives meet each month with Kaundu Health Centre staff to review progress of the insurance scheme. Community leaders act as advisors to the CBHI, on a monthly basis review financial record to ensure all payments and disbursements are accounted for.

 

This is a bottom-up community-driven approach to expand access to health services, to enhance the quality of services provided and to empower the community to take ownership of their health.

“Don’t I look more healthy and vibrant to you? Before the insurance was introduced, we used to worry when one of us gets sick and sell some of our possessions to pay for health services. The price would be so big that you would just stay at home but since the insurance came, I am happy and also I am grateful as even our grandchildren are benefiting, they are healthier now. This initiative is benefitting us enabling people to go to the hospital”

 

– Traditional Leader, Group Village Headwoman

IMPACT

Since initiation in 2015, Kaundu CBHI has achieved an increase in service utilisation by the local community.

 

From the period 2014-15 to 2016-17, facility-based deliveries increased 10-fold and utilisation of health services by under-5 children and adult outpatient services has nearly doubled. The CBHI has reduced the out-of-pocket payment to 20% of total service cost. Kaundu Health Centre has been able to employ and retain two nurses and procure essential drugs due to the CBHI

CASE INSIGHTS

1. Existing local leadership, governance structures and volunteers are effective resources that can be tapped for increased ownership, accountability and sustainability of programs with communities.

 

2. Constant outreach to and sensitisation of the community ensures that they take up the intervention and sustains it, even in communities that are hard to reach or where people have low-literacy levels.

 

3. Continued and constant feedback to the community on facility operations ensures that communities are up to date and more engaged in their local health facility.

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