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Price of life

Edger Mulili lies by the radiotherapy machine as doctor looks on

Eighteen-year-old high school student Edger Mulili says he would not be alive today if his father had not contributed $5 (£4) a month to a government health insurance scheme in Kenya.

Mr Mulili has cancer of the oesophagus.

He is currently undergoing a five-week chemotherapy and radiotherapy course at Nairobi Hospital, one of the country’s leading private health facilities, located in the capital.

In recent weeks, Kenya’s decades’ old National Hospital Insurance Fund (NHIF) has begun offering private treamtment to policyholders suffering from chronic conditions.

‘Financial catastrophe’

Mr Mulili is among the first beneficiaries of this new service.

“If we didn’t have the NHIF cover I would have died and I wouldn’t have blamed my parents for failing to pay for treatment because they just cannot afford.

“The full course of treatment costs half a million Kenyan shillings ($5,000).

“Even if we sold everything we could, and asked our family and friends to fund-raise, I don’t think we would have received enough money for treatment.”

The insurance pays a maximum of $3,500 for treatment of chronic conditions such as chemotherapy, radiotherapy and dialysis.

The treatment would have been cheaper within the public health sector, but given the option, he chose not to risk the months-long patient waiting list.

According to the World Health Organization (WHO), about 100 million people are pushed into poverty and 150 million globally suffer “financial catastrophe” by spending their money directly on healthcare.

To help guard against this, there is now a push for governments to provide universal health insurance schemes.

A 2012 study carried out by the UN Children’s Fund (Unicef) in Africa and Asia found that only half of the 52 countries surveyed had any form of health insurance scheme, and only four – Ghana, Rwanda, China and Vietnam – were making any visible progress.

But in many developing countries, the vast majority of contributors to Kenya’s health insurance scheme have jobs in the formal sector, such as the civil service or the private sector.

That still leaves the greater part of the population, who are either “unemployed, or in subsistence farming and the informal sector”, according to the Unicef report, in a vulnerable position.

‘Too ambitious’

In order to reach those people, the NHIF has been out on the road.

I join the campaign team in Timau, a small town 225km (140 miles) north of Nairobi.

A truck which they have parked in the market is blasting out loud music and a crowd of locals gathers to watch a group of dancers perform.

Every so often, the entertainment is paused while one of the staff takes the mic and explains the importance of having health cover.

“The idea is to educate them so that they can voluntarily enrol,” says NHIF chief executive Geoffrey Mwangi.

But some think the ambition to attract 12 million people to sign up for the scheme is unrealistic given the 5$ a month price tag.

The average monthly wage in Kenya is under $100.

Image copyright AFP

“The evidence from around the world is that poor or near-poor people don’t tend to buy health insurance unless it is massively subsidised,” says Robert Yates, an expert in universal health coverage at London’s Chatham House think-tank.

“Furthermore, whilst membership remains voluntary, the people who are most likely to join will be high users of healthcare who are likely to consume a greater value of healthcare than their contributions.”

This can put undue pressure on a scheme’s finances, he adds.

He names Rwanda, Burundi, Liberia, Ethiopia, Lesotho and Gabon as examples of African countries where government efforts to bring affordable healthcare to everyone are gaining momentum.

The extension of the national health insurance scheme to cover cancer treatment in private hospitals means that patients who need urgent treatment, like Edger Mulili, should now be able to get it.

To benefit the general population, much more needs to be done to improve public health systems.

But for Mr Mulili, the overwhelming emotion is one of relief.

“Now I feel like everything will be fine. I feel like I’m going to live,” he says, a broad smile spreading across his face.


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