- The Washington Times - Thursday, April 22, 2010

KISAJU, Kenya | Kenyan student Shadrack Silipo had a heart operation five years ago, the sort of surgery that often bankrupts families in Africa.

Mr. Silipo’s parents normally would have paid by selling off land — the same green acres that form the inheritance for their eight children. But Mr. Silipo’s father, a retired principal, had enrolled the family eight years ago in a micro-insurance plan that covered the $5,000 operation in full.

Even as the U.S. debates how best to insure its people against sickness, a type of health care financing is growing more popular in Africa: micro-insurance. Activists say it can help pay for health care for some of the billions of people in the developing world who cannot afford it.

“Poor people need health insurance; they deserve it. and it can be done,” Nobel-prize winning economist Muhammad Yunus told the Associated Press.

His Grameen bank already provides health insurance to around half a million poor Bangladeshis, and Mr. Yunus wants to expand further by using the Internet to connect doctors to patients in remote areas.

Micro-insurance is defined as a product accessible to those earning less than $2 a day, who pay tiny weekly premiums of sometimes less than a cent. The policies usually cover all conditions — including pre-existing illnesses like HIV/AIDS and maternity costs — and are written in language that is easy to understand.

Some 14 million Africans use micro-insurance, and the number of African policyholders has increased by 80 percent in the last five years, according to a recent study by the International Labor Organization. The numbers are still a fraction of the potential market, but are growing rapidly as more organizations offer insurance products to the poor.

Melanne Verveer, the head of women’s issues in the U.S. State Department, said the U.S. government has increased its global commitment to micro-enterprise development — which includes micro-finance — from $193 million in the 2007 fiscal year to $265 million in 2010.

“We’re looking at ways to build on the existing U.S. commitment to micro-finance, expanding it to include things like savings and insurance,” she said. “It’s a highly effective tool to alleviate poverty.”

About half of Kenya’s 40 million people survive on less than $2 a day. When children get sick from the raw sewage that trickles through fetid slums, families must choose between medicine or food. A hospital stay is usually out of the question. Hospitals sometimes detain patients, including new mothers, when they can’t pay their bills.

Dr. Andrew Otieno, who runs a clinic in Nairobi’s biggest slum, said many poor families put off seeking help until it’s too late.

“Sometimes we see them conducting deliveries in the house, and there are complications. Both the mother and the fetus can lose their life,” he said. Other patients, he said, “only go to hospitals when they are gasping or in a coma.”

Those are the tragedies that the continent’s insurance schemes are trying to avoid. Ghana’s government-run health insurance — introduced in 2003 — now covers about half the population. About 90 percent of Rwandans also have access to basic health care, thanks to a government-run plan.

In Kenya, the government offers a plan that covers an adult and all their children for just under $20 a year. It covers up to 180 days of hospital care a year, although there is no provision for outpatient care. But patients may still be required to pay fees for some surgeries, such as a heart operation.

Medical insurance in Africa is generally much cheaper than in the U.S. because doctors earn far less money, medical malpractice lawsuits are almost absent and hospitals often receive some government support.

But still, insurance can be a hard sell. It’s difficult to persuade those struggling to survive to part with precious cash to pay for care that they may never need. For that reason, said World Health Organization specialist Varatharajan Durairaj, micro-insurance could help the middle classes and some of the poor, but not the most desperate.

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