From left to right: Hon. Nassor Ahmed Mazrui, Abdallah Masoud, Kwasi Boahene, Dr Heri Marwa, Dr. Salim Slim, Aafke de Graaff
“I’ve seen firsthand how a hospital bill can derail a family’s future. By shifting the burden away from out-of-pocket payments and embedding innovation in public systems, we can build a future where access to care is based on need, not wealth.”
Dr. Heri Marwa, Country Director, PharmAccess Tanzania
An estimated 40–60% of sub-Saharan Africa’s total healthcare expenses are out-of-pocket, which leads to large inequities and can push people into poverty.
We believe that no one should face poverty because they fall ill. That is why we invest in innovative (private) models and leverage them within public social health insurance systems that are designed to be inclusive, equitable, and sustainable.
Our contributions have supported the development and passage of social health insurance legislation, including dedicated budget allocations for vulnerable populations. These gains are meaningful, but not yet enough. Economic pressures and slow implementation continue to delay the goal of universal health coverage (UHC) by 2030.
Still, there is reason for hope. In all countries, UHC and social health insurance are political priorities.
Bringing innovation to public insurance systems
We are co-developing low-cost health insurance platforms to reduce out-of-pockets and move to pre-payments, and we are supporting the pooling of different financing streams into a combined pool. We are doing this by collaborating with the public and private sector, and by increasing transparency through data and technology.
Tanzania and Zanzibar: Fiscal innovation meets digital transformation
A major development in 2024 was the operationalization of the Zanzibar Health Services Fund (ZHSF), now covering 18% of the population. This public financing mechanism has embedded non-communicable diseases (NCDs) within its benefits package, reflecting a commitment to tackle chronic illnesses as core public health priorities. The full enrollment of all civil servants and their dependents into the ZHSF signals strong government buy-in and long-term commitment.
Complementing this is the Health Equity Fund (HEF), created to ensure care access for the most vulnerable, including NCD patients. The consolidation of the NCD Fund – which was set up in collaboration with Norad – into the HEF illustrates the growing need for government financing and enhanced strategic purchasing. Interministerial alignment around the HEF required extensive dialogue and delayed operationalization in 2024.
Electronic Medical Records (EMRs) were integrated with openIMIS® and deployed across Zanzibar’s public hospitals. The Matibabu system now registers 91% of the population, unifying patient identification through the Matibabu Card, linked to national IDs and birth records. This digital transformation facilitates real-time data use, accelerates claims processing, and lays the groundwork for interoperable, government-owned digital health infrastructure, and has enabled the tracking of more than 3 million healthcare visits in Zanzibar.
The private sector was not left behind. Zanzibar Private Hospitals Owners Association (ZAPHOA)’s member facilities were trained in NCD protocols and digital workflows, aligning private provider services with public health financing models.
On the mainland, following the 2023 enactment of the Universal Health Insurance (UHI) Act, a leadership transition in the Ministry of Health disrupted early momentum for UHI rollout. PharmAccess provided technical input to shape a low-cost health insurance model tailored to the informal sector. The consolidation of the health insurance pools into UHI saw the decline of enrollment into ICHF, which stood at 1.6 million at the end of 2024.
Ghana: Pioneering value-based care and digital financing models
Ghana’s National Health Insurance Scheme (NHIS), covering over 18 million people (55% of the population), remains a model of African social health insurance. In 2024, PharmAccess helped reshape the NHIS towards greater efficiency, sustainability, and patient-centered care.
High inflation undermined NHIA tariff adequacy, prompting some providers to introduce co-payments, thereby also undermining scheme equity. Political uncertainty ahead of elections also delayed policy adoption. To address this, PharmAccess emphasized stakeholder-targeted data communication and continued dialogue with NHIA leadership.
A major breakthrough came through data analytics. PharmAccess’ partnership with the NHIA revealed that individuals aged 60 and above accounted for 43.8% of total healthcare costs, prompting a strategic shift toward value-based care (VBC). Subsequently, 22 Christian Health Association of Ghana (CHAG) facilities began piloting performance-based reimbursement, linking payments to health outcomes rather than service volume.
This change signals a crucial policy inflection point, curbing rising healthcare costs while incentivizing better care. Additionally, PharmAccess supported NHIA in piloting digital care pathways for NCDs, yielding cost reductions of 15%. These innovations were underpinned by NHIA’s decision to explore formal reimbursement frameworks for digital health—an unprecedented policy move in Ghana.
Nigeria: Scaling state-level innovations amid cost pressures
In Nigeria, PharmAccess focused on deepening its impact through state-level innovation—particularly in Lagos and Kwara States. Amid steep inflation and cost increases in health commodities, PharmAccess-supported agencies took decisive steps to preserve affordability and access.
In Kwara State, the Health Insurance Agency increased premiums by 150% – a politically sensitive but necessary adjustment to preserve the scheme’s solvency. Importantly, the scheme remains among Nigeria’s most affordable and inclusive health plans. Civil servant resistance to payroll deductions impeded full scheme enrollment, and PharmAccess engaged in sustained advocacy and facilitated platforms for trust-building among workers and unions. Kwara State has enrolled almost 64,000 people, funded fully through local domestic financing.
In Lagos, health insurance schemes reached 3.1 million insured individuals – 12% of the population. Among these, 61% are enrolled via private plans, and 39% under the Lagos State Health Scheme (Lashma). PharmAccess provided technical assistance to Lashma and developed the digital portal that Lagos State used to monitor the activities of private health insurers, which now capture data from 43 licensed HMOs.
As of December 2024, the National Health Insurance Authority (NHIA) of Nigeria reported that approximately 19.2 million Nigerians were enrolled in health insurance schemes, marking a 14% growth within a year. PharmAccess supported NHIA to develop digital platform for monitoring state health insurance and technical assistance to enhance healthcare quality and accreditation.
Kenya: strategic support during transition
Kenya faced a pivotal policy transition in 2024 as the government replaced the National Hospital Insurance Fund (NHIF) with a new Social Health Authority (SHA). The reform, while visionary in design and partly modeled on lessons from Kisumu’s Marwa program, encountered delays in implementation due to unclear benefit packages, underfunding, and full re-registration requirements.
PharmAccess maintained strategic readiness in Kisumu by collaborating with the Ministry of Health to improve delivery systems of healthcare facilities and support capacity building on digital health infrastructure for healthcare facilities.
Building on insights from an initial pilot in Kisumu – conducted with PharmAccess – CarePay identified the importance of embedding health coverage into existing financial and operational flows, rather than relying on separate, retail-based purchases. This learning shaped a model that now integrates health insurance into riders’ daily transactions and employment frameworks. As a result, CarePay successfully enrolled over 4,100 informal taxi drivers and motor riders (boa boda riders) in Kenya.
In 2024, CarePay doubled the number of people actively managed on its platform through deeper partnerships with leading private insurers in Kenya—bringing its total impact to over 5 million lives. CarePay is the growth partner for health insurers looking to unlock new customer segments and enter new markets. Its next-generation platform connects payers, providers, and members in real time, enabling a more transparent, efficient, and outcomes-driven health insurance ecosystem.
Working with private insurers like AAR Insurance and Jubilee Health, CarePay not only reduces administrative and claims costs but also drives better health outcomes through faster claims processing, timely access to care, and actionable data. The platform powers insurance products that are up to 85% more affordable than traditional offerings. Building on its strong presence in Kenya—where it partners with 8 of the top 10 health insurers—CarePay is planning roll out to Uganda and expanding into the Middle East through their strategic partnership with Reinsurance Group of America (RGA).