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>
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"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

Dr. Thomas Kirengo

Garance Wattez-Richard

Garrett Jaso

The majority of Kenyans have mobile money accounts; their activity demonstrates digital financial services’ potential. Accion helps Kenyan innovators harness emerging technologies to create new financial services.

Health Insurance

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

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

Kenya Edges Closer to Universal Health Coverage