Dr. Kirengo, co-founder and CEO of <a href="https://imaramed.org/">Imara Mediplus Hospital</a>, wasn’t your typical <a href="https://centerforfinancialinclusion.org/board-leadership-for-impact-program-overview/" target="_blank" rel="noopener noreferrer">Board Leadership for Impact Program</a> (BLI) participant. Rather than a financial inclusion organization, the social enterprise he leads is a multi-specialty healthcare facility focused on providing quality medical services to low- and middle-income earners living in smaller cities and towns in Kenya. Last fall, a time that feels so long ago now, Dr. Kirengo was interested in strengthening board leadership at Imara, so he and two colleagues attended BLI. In this Q and A, Dr. Kirengo discusses the state of health insurance in Kenya, the economic impact of the virus, and even homemade hand sanitizer production and locally sourced masks. He also provides invaluable advice to the financial inclusion community and general public on how to make workplaces safer.
<h3>Q: What are you seeing on the frontlines of the COVID-19 response in Kenya?</h3>
<strong>Dr. K:</strong> Over the past two weeks, we have seen an increase of 10 to 20 patients per day because people are scared. Patients come in with a sore throat or with symptoms the news is telling them is coronavirus. This has been difficult because we are trying to tell people to maintain social distancing. We’ve had to increase security to prevent people from coming in with visitors. We want people to come so we can treat them, but we need to limit our risk especially since we have limited protective equipment.

Because of the lack of supplies in Kenya, we’ve also had to experiment and build our own face shields and masks. Just recently, one of our suppliers increased prices by 5 times, so we are looking for alternative ways to buy or make our protective equipment. We’re also making hand sanitizer for the public and organizations to use. Another concern is with delays to insurance payments as the insurance companies see an insurgence in demand for payouts.
<h3>Q: What’s been the response to making and distributing hand sanitizer? Who have you distributed it to?</h3>
<strong>Dr. K:</strong> We experienced a price hike for sanitizers immediately when the first case of COVID-19 hit Nairobi. For example, one of our suppliers tried to sell us, for $100, a quantity we normally buy for $20. We realized quickly that this would be an unsustainable cost, so we talked to our pharmacist and nurses, ordered supplies and started making our own. Businesses around Embu, where we operate, told us they were facing similar challenges and risked receiving and using substandard hand cleaning material or none. So, we started making in surplus and selling to them. We have provided sanitizer to banks, hotels, restaurants and even individuals.

[caption id="attachment_38108" align="alignleft" width="500"]<a href="https://content.centerforfinancialinclusion.org/wp-content/uploads/sites/2/2020/04/Sanitizer-and-Mask-e1587576109170.png"><img class="wp-image-38108 size-full" src="https://content.centerforfinancialinclusion.org/wp-content/uploads/sites/2/2020/04/Sanitizer-and-Mask-e1587576109170.png" alt="hand sanitizer and homemade masks" width="500" height="324" /></a> <em>Hand sanitizer and a face mask created by Imara Mediplus Hospital in Kenya.</em>[/caption]
<h3>Q: Economically, how will the pandemic affect your patients and their communities? What might be the repercussions of this on Kenyan society?</h3>
<strong>Dr. K:</strong> There is less cash flowing through the economy. Everyone is saving money. Businesses are shut down due to lock down and curfew, as well as reduced footfall and increased cost of running businesses. We have seen a change in the spending habits of most of our patients. Currently, patient numbers for regular clinics have declined. We are largely attending only to urgent and emergent care cases.

A lot of companies and SMEs have either enforced salary pay cuts or laid off people. The changes will not be reversible in the near term. It will take a while for businesses and the economy to bounce back to where it was. Tourism, one of the major economic activities in the country, is nearly at a standstill. Things may get worse as we haven’t had a full shutdown, and this may still happen.
<h3>Q: Can you speak to insurance coverage? Do your patients have insurance? Is it public or private? And does this insurance adequately cover COVID-19 testing or treatment? How might this affect livelihoods?</h3>
<strong>Dr. K:</strong> Less than <a href="https://www.nation.co.ke/newsplex/Worldhealthday/2718262-4375778-dhdk0ez/index.html">25 percent of the population of Kenya is covered</a> by health insurance. More than 90 percent of this insurance is the government run social insurance (National Health Insurance Fund, or NHIF). NHIF, however, provides very limited coverage and has low reimbursement rates, while private insurance that pays better has limited coverage and number of subscribers. With COVID-19, private health insurances had declined to cover their clients against the condition. This received a lot of negative publicity, so they reverted and accepted covering the condition, but only in government hospitals, where care is cheaper but generally considered to be of lower quality due to poor patient to staff ratios. Therefore, currently, COVID-19 is “exclusively" under government management. Some private hospitals are offering care, but I’m not sure how that is financed.
<blockquote>The challenge I foresee is the inability of the majority of the population to pay for COVID-19 healthcare needs.</blockquote>
The challenge I foresee is the inability of the majority of the population to pay for their healthcare needs when it comes to COVID-19, considering most businesses are shut down, experiencing tough financial times or have to cut salaries. For example, the cost of a single COVID-19 test in a private lab is $130. If positive, two more tests are needed that come out negative before a patient is released. On top of this, patients are placed in quarantine for two or three weeks. How does a common Kenyan afford this?
<h3>Q: What advice would you give leaders of financial service providers who are feeling the impact of the coronavirus on their employees, business operations, and clients?</h3>
<strong>Dr. K:</strong> For businesses that are lucky enough to work online or remote, just do it.  For any organization, it is important to reiterate the basics:
<ul>
 	<li><strong>Wash your hands</strong> for at least 20 seconds or use hand sanitizer.</li>
 	<li><strong>Avoid touching your face</strong>, especially if you haven’t washed or sanitized your hands.</li>
 	<li><strong>Wear masks</strong> as appropriate. First and foremost, what people often forget about masks is that they are disposable. I’ve seen a lot of companies buy just one mask per staff member; however, staff should not be wearing the same masks day in and day out.
<ul>
 	<li>If it is an N95 mask, and you are using it day to day, you should dispose of it after two days and get a different one.</li>
 	<li>Surgical masks should be disposed after a few hours of use, maybe a day maximum.</li>
 	<li>Wash your hands before and after touching the mask.</li>
</ul>
</li>
 	<li><strong>Eye protection</strong> is key. Do your employees have glasses or something to protect the eyes from droplets? This could be an eye shield as well.</li>
 	<li><strong>Social distancing</strong> must be enforced. How are you ensuring distancing? If it is a bank, how are you training your employees to ensure a safe distance is kept? You can put stickers on the floor to highlight the appropriate distance and where people should stand. Remember a safe distance is 1 to 1.5 meters. This goes for security guards and staff as well.</li>
 	<li>Anyone with <strong>symptoms</strong> may cause anxiety for fellow employees and clients, so you need to have a way to subtly and respectfully separate them from everybody else. You should know where to refer them to if they feel sick, so they can get the necessary attention. Send people home who are symptomatic.</li>
 	<li>If there are people who can <strong>take leave</strong> now, have them take leave because most places are locked down and a curfew is in place, at least in Kenya.</li>
 	<li>If you have <strong>SMS and message capability</strong>, you should be sharing information and highlighting the importance of social distancing and sanitation through your client channels.</li>
</ul>
&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

"We're Also Making Hand Sanitizer": Kenyan Doctor on COVID-19 Impacts

Kenya

Sub-Saharan Africa

Test of a Lifetime: COVID-19 and Financial Inclusion

Challenges and Crises

Enabling Environment

Health Insurance

Insurance

Blog Post

For the insurance industry, 2008 is more often reminiscent of the bailout of AIG than of new beginnings. However, 2008 also launched an unexpected wave of creative destruction. This essay series not only celebrates the 10-year work of the Center for Financial Inclusion, but also  several pioneers that strive to make insurance inclusive for all: the ILO’s Impact Insurance Facility, the Centre for Financial Regulation and Inclusion and the Microinsurance Network—all of which began a decade  ago.

As a more recent settler on the inclusive insurance planet – although almost three years have flown by – others may keep the flame, but I would like to offer a personal opinion on the past decade of innovation, and my perspectives into what more needs to happen to combine sustainable business and social impact for those who need insurance most.

Back in 2008, microfinance institutions predominantly distributed what was then called microinsurance. MFIs provided insurers with a readily available pool of clients for credit life insurance, which reimburses the outstanding loan amount in case of death or disability of the borrower.

This was the first era of inclusive insurance.

Ten Years Gone, Ten Years to Go: Taking Inclusive Insurance from Adolescence to Adulthood

Getting Inclusion Right

Crop Insurance

Inclusive insurance

Life Insurance

<em>&gt; Posted by Center Staff</em>

<a href="https://www.flickr.com/photos/55267733@N04/8378728848/"><img class="aligncenter size-full wp-image-16718" src="https://centerforfinancialinclusionblog.files.wordpress.com/2014/11/8378728848_b5044892c0_b.jpg" alt="A mother and child stand outside a health clinic where they both received check-ups and necessary vitamins and vaccines. Great Rift Valley Region, Kenya" width="490" height="367" /></a>

In Kenya, where public health insurance has been available since 1965 and access to health care is a constitutional right, only <a href="http://www.worldbank.org/en/news/feature/2014/10/28/improving-healthcare-for-kenyas-poor">20 percent</a> of the country actually has access to some sort of medical coverage, according to the World Bank. With a population of 44 million, this means that 35 million are excluded from coverage and millions are unable to afford services at private or public health facilities. In terms of the money spent, about one quarter of health care services spending in Kenya comes out of pocket. Each year, about one million Kenyans fall below the poverty line because of health care related expenses. Recent investments in the industry indicate that this grim reality could be changing, however, and soon.

A few days ago fund manager LeapFrog Investments <a href="http://www.ventures-africa.com/2014/11/leapfrog-set-to-acquire-east-african-health-insurance-firm-for-18m/">bought a majority stake</a> in Resolution Insurance, Kenya’s fourth largest insurance provider, for $18.7 million. The new funds will go towards realizing Resolution’s growth strategy of diversifying product offerings and extending services access to more Kenyans and other East Africans. The investment comes at an exciting time for both investors and providers. Though coverage remains low overall, the industry is growing rapidly. The non-life insurance market in Kenya is expanding at 20 percent annually, with health insurance at 38 percent annually. The deal is currently undergoing final regulatory processes.

Beyond Resolution Insurance, LeapFrog recently raised $400 million which it says will go toward investments in financial services across Africa and Asia, with a quarter of funds reserved for East Africa.



A few months ago, the Kenyan government, in partnership with the IFC, UKAid, the Gates Foundation, and others launched a collaborative <a href="http://www.worldbank.org/en/news/feature/2014/10/28/improving-healthcare-for-kenyas-poor">Health Insurance Subsidy Program</a> (HISP). The program offers Kenyans health insurance subsidies for coverage of care at public and private facilities. Administered through Kenya’s National Hospital Insurance Fund under its Ministry of Health, the first phase of the program covers 125,000 Kenyans and 23,500 families. These lower-income individuals were selected by the Ministry of Labor, Social Protection and Services to ensure that the program was addressing those in need.

Of the program, Cheikh Oumar Seydi, IFC’s regional director for East and Southern Africa said, “HISP is part of the World Bank Group’s Health in Africa Initiative’s support to the Kenyan Government’s priority agenda of achieving universal health coverage by expanding medical cover to the poorest and vulnerable.”

If successful, HISP will scale up to include nine million Kenyans.

<em>Photo credit: <a href="https://www.flickr.com/photos/55267733@N04/8378728848/">Julia D/Flickr.</a></em>

<strong>Have you read?</strong>

<a href="http://cfi-blog.org/2014/10/06/bundling-mhealth-info-and-microinsurance-to-improve-health-outcomes-in-kenya/">Bundling mHealth Info and Microinsurance to Improve Health Outcomes in Kenya</a>

<a href="http://cfi-blog.org/2014/08/15/300-households-for-one-year-results-of-the-kenya-financial-diaries/">300 Households for One Year – Results of the Kenya Financial Diaries</a>

<a href="http://cfi-blog.org/2014/03/05/balancing-client-value-and-the-business-case-in-kenyan-health-microinsurance/">Balancing Client Value and the Business Case in Kenyan Health Microinsurance</a>

Kenya Edges Closer to Universal Health Coverage

Elizabeth Winters

Kathleen Yaworsky

India

South Asia

Zambia

Advisory Services

Alternative Data

Data Analytics

Delivery Channels

Digital Financial Services

Financial Health

Financial Service Providers

Financial Technology

Fintechs

Insurance Companies

Insurtech

Resilience

Underwriting

Underserved Groups

Article

India is a global leader in financial inclusion. For over a decade, Accion has worked with and learned from India’s innovators, investors, and policymakers to expand economic opportunity for its people and businesses.

Many workers in India earn a daily wage for their labor and rely on that income to survive. But what happens when a person can’t work due to illness or injury? Or loses their job in a global pandemic? Without a safety net for protection, a financial shock like job loss, illness, or theft is devastating, especially to lower-income families.

<a href="https://toffeeinsurance.com/" target="_blank" rel="noopener noreferrer">Toffee Insurance</a>, part of Accion Venture Lab’s portfolio, is a startup that connects uninsured people in India to accessible, affordable insurance products for the specific risks that threaten their health and livelihoods. Instead of expensive and complicated policies that cover a broad range of needs, Toffee offers very specific, simple policies that cover the risks that are most relevant to their consumers, like dengue, malaria, hospital cash, bicycle damage, and theft. Now, they are introducing new products to help underinsured people build financial resilience to the impact of COVID-19.
<h2>Putting safety nets within reach for the uninsured</h2>
Toffee Insurance is changing the way that people buy and sell insurance in order to reach the huge population of at-risk, uninsured people in India. Toffee acts as the bridge between these consumers and large, traditional insurance companies. “We were frustrated with the complexity of insurance for the longest time, we figured there was an easier way to make insurance a safety net for most people, easier to consume. Making insurance a lot more accessible, affordable, and relevant to the masses,” Rohan Kumar, CEO and co-founder, explains Toffee Insurance’s origins.

Customers can purchase policies on Toffee’s website or mobile app in under two minutes and submit claims just as quickly. Toffee handles the claims process with major insurance companies, making the process simpler and faster for the end consumers. In addition to direct online sales, Toffee Insurance works with a network of retailers who offer inexpensive insurance policies for their customers. For example, cycling shops offer Toffee’s commuter accident policies to their bicycle customers who rely on their bicycles to commute to work.

Because these microinsurance policies cover very specific needs, Toffee is able to offer low monthly premiums to their customers. For middle and lower-income people in India who are not familiar with insurance, the affordability and simplicity of these products are key. “This is a model which can actually help bring more people into the net of insurance and can address very, very specific needs of the people,” explains Gourav Agarwal, Chief Distribution Officer.
<h2>Product innovation for those impacted by COVID-19</h2>
Lower-income families and individuals have always been especially vulnerable to unexpected financial shocks from job loss, injury, and illness. Now, the COVID-19 pandemic has created new, unprecedented threats to lives and livelihoods. Across India, Rohan believes, “the biggest risk outside of personal health and wellbeing is the financial uncertainty for most individuals and families.” That’s where Toffee Insurance hopes to provide some relief. “Our mission has always been to curate affordable, accessible, and relevant products for the large, uninsured masses. This pandemic helps, in some ways, create more awareness for having safety nets in place,” notes Rohan.

As people become more interested in health and life insurance categories in reaction to the pandemic, Toffee is introducing new products that cover for COVID-19-specific losses at a low monthly premium, covering essential needs like telemedicine, mental health services, and job loss. Toffee Insurance is relying on their existing tech capabilities to continue issuing policies remotely during India’s lockdown in order to help the uninsured to build financial resilience to the pandemic. In addition to new product offerings, Toffee and the start-up community in India are helping the severely impacted in other ways, like contributing to charities on the frontlines, leveraging call centers to assist hospital information networks, and reassuring customers and businesses that they will be flexible on payments.

While Toffee focuses on taking care of their team and their community, they are staying committed to their mission to extend insurance to those who are most susceptible to financial shocks and least likely to have a safety net in place. “Inclusion of more people under the net of insurance is what is making us proud,” says Gourav.

A start-up innovates to give the uninsured a safety net

Toffee Insurance

Impact Investor

Institutional Funder

Social Good

Accion Venture Lab

COVID-19: Economic response and resilience

When a family member falls ill, especially a breadwinner, the unexpected costs can tip the family finances from coping to crisis. Insurance can help families manage and recover from shocks — a key indicator of <a href="https://www.centerforfinancialinclusion.org/beyond-financial-inclusion-financial-health-as-a-global-framework">financial health</a>. However, according to the <a href="https://www.fsdzambia.org/publication/finscope-2015/">2015 Finscope</a>, only 2.8 percent of adults in Zambia are insured.

To combat this problem, we’re supporting a Zambian insurtech startup to develop and pilot a new digitally delivered microinsurance product. This work is part of a multi-year project focused on <a href="https://www.opml.co.uk/projects/deepening-financial-inclusion-in-sub-saharan-africa">Data Management and Analytical Capability</a> (DMAC). One of the primary goals of the DMAC project is to develop financial service providers’ capacity to leverage data strategically so they can develop innovative and inclusive products that respond to the needs of unserved and underserved adults. One such product is a mobile-based hospital cash plan in Zambia.

When this product launches, mobile money subscribers will be able to pick a plan and pay the premiums straight from their mobile money account. If they or a family member falls ill and is admitted to the hospital, they can initiate a claim. They’ll receive a mobile money payout directly to their wallet for each day spent in the hospital. This fast, flexible cash benefit can be used to pay for whatever the family needs to make ends meet. It also saves the family from falling prey to exorbitant rates for small short-term loans from moneylenders or others.

To develop this product, the insurtech startup partnered with a national Mobile Network Operator (MNO) as part of their data strategy to use alternative data — such as mobile KYC and mobile money transaction data — for customer acquisition and underwriting. Following a <a href="https://www.accion.org/are-you-unleashing-the-full-potential-of-your-data">data-driven product development methodology</a>, we helped the insurtech map out the data inflows and outflows that the new hospital cash plan will generate. This exercise informed the operational processes and technical requirements needed to support product delivery. For example, the insurtech pinpointed the minimum set of data fields required in the mobile phone menu that the MNO database would need sent to their backend system through their Application Programming Interface (API) for underwriting. They also identified the critical success metrics to measure and track customer usage and satisfaction with the product experience through <a href="https://www.accion.org/preparing-financial-service-providers-for-digital-transformation-2">customized analytics dashboards</a>. This evaluation process will enable a data-driven feedback loop for continuous product improvements.

This experience has underscored that an organization’s ability to <a href="https://www.accion.org/implementing-big-data-10-tips-fsps">strategically leverage big data</a> and build data-driven products depends on identifying and implementing the appropriate mix of staff skills, tech, and operational systems. Strategic partnerships make it possible to meet these business objectives. In Zambia, for example, the insurtech would not be able to digitally acquire and underwrite new customers without the backend insurance administration and reporting systems they’ve developed, an in-house data analyst supported by a local firm specializing in data collection and management, and a strong partnership with the MNO.

Today, there are very few microinsurance plans available to low-income segments in Zambia.  As we prepare for the pilot launch of this new product, we’re hopeful that it can help make insurance more inclusive. Once the tool is live, the dashboards built will be used to track customer usage and experience and enable refinements. This data-driven product has the potential to insure people in Zambia who’ve never had quality insurance, helping them find new resilience in the face of a health crisis. As the <a href="https://www.economist.com/international/2019/08/22/the-poor-who-most-need-insurance-are-least-likely-to-have-it">Economist</a> recently reported, the poor, who most need insurance, are least likely to have it. But mobile phones and innovative fintech, like the projects we’re working on with DMAC, can make a difference.

___________________________________

<em>Data Management and Analytics Capabilities (DMAC) is a two-year program that uses data-driven evidence to help Financial Service Providers (FSPs) in sub-Saharan Africa to designing inclusive and affordable financial products and services that respond to the needs of unserved and underserved adults, with a particular focus on women and youth. </em>

<em>Initiated by </em><a href="https://www.fsdafrica.org/"><em>Financial Sector Deepening Africa</em></a><em> (FSD Africa) and </em><a href="https://www.idrc.ca/"><em>International Development Research Centre</em></a><em> (IDRC) in partnership with </em><a href="http://www.fsdt.or.tz/"><em>FSDT</em></a><em> and </em><a href="https://www.fsdzambia.org/"><em>FSDZ</em></a><em>, it’s being implemented by </em><a href="https://www.opml.co.uk/"><em>Oxford Policy Management</em></a><em> (OPM), in collaboration with Accion’s </em><a href="https://www.accion.org/how-we-work/advise/accion-global-advisory-solutions"><em>Global Advisory Solutions</em></a><em> and </em><a href="https://www.masterdata.co.za/"><em>Master Data Management</em></a><em> (MDM).</em>

<em>The program is operating across three different markets of varying digital maturity — Sierra Leone, Zambia, and Tanzania — and with three different types of FSPs: insurers, fintechs, and commercial banks.</em>

Helping families in Zambia cope with a health crisis

Financial Inclusion Practitioner

Financial Service Provider

Accion Global Advisory Solutions