A prepaid healthcare scheme in rural Africa

Healthcare providers in Africa are having to increasingly rely on the resources of the populations they serve. An 8-year experience with one of the first rural-based health insurance schemes in East Africa is described. Initial difficulties included adverse selection of members with chronic ill health, fraudulent claims and overuse of health services, leading to considerable financial losses. External technical assistance introduced member tracking and regular reports, reduced adverse selection, fraud and overuse of services to a minimum, and achieved financial stability. Local market research and a comprehensive marketing plan is essential for the overall success of an insurance plan. Health insurance in this part of Africa is likely to assist middle income earners rather than the poor.