Seite 1 Page 1 Can Private Health Insurance Companies be used as a Tool to Reach the Poor?: Innovations in Increasing Access to Gender Based Violence Services by the Kenyan Urban Poor Rukia Yassin, Snr. Program Officer GBV & Human Rights Component GTZ Health Sector Programme, Kenya International Conference on Urban Health New York Academy of Medicine 27th October, 2010

Seite 2 Page 2 Public Private Partnership (PPP) between a private insurance company and two GBV service providers in Kenya Strategic Relevance To demonstrate that private financing/ management sector can deliver public goods very well and is an important partner when planning and implementing social health protection strategies Strategic Relevance To demonstrate that private financing/ management sector can deliver public goods very well and is an important partner when planning and implementing social health protection strategies Increasing Access to GBV Services

Seite 3 Page 3 Gender Based Violence and Human Rights Component Objective  To ensure that attitude and behaviour in regard to GBV incl. FGM and its treatment and legal sanctions have improved  Works with partners at Central level (GoK) and district level with MoH, CSO and health facilities Gender Based Violence and Human Rights Component Objective  To ensure that attitude and behaviour in regard to GBV incl. FGM and its treatment and legal sanctions have improved  Works with partners at Central level (GoK) and district level with MoH, CSO and health facilities GTZ Health Sector Programme (GTZ HSP)  A technical advisory organization that supports the Kenyan government in implementing the National Health Sector Strategic Plan as well as consecutive planning processes for policy advocacy, reforms and implementation  Works in the areas of sexual reproductive health, health policy, health financing, gender based violence & human rights including FGM with quality assurance as cross-cutting  A technical advisory organization that supports the Kenyan government in implementing the National Health Sector Strategic Plan as well as consecutive planning processes for policy advocacy, reforms and implementation  Works in the areas of sexual reproductive health, health policy, health financing, gender based violence & human rights including FGM with quality assurance as cross-cutting Increasing Access to GBV Services

Seite 4 Page 4 Public Private Partnerships (PPP)  PPP describes development partnerships which are jointly planned, financed and realized with common risks by companies and development aid organizations  The cooperation between business, the state and civil society Both partners reach their objectives faster, cheaper and more efficiently  PPP describes development partnerships which are jointly planned, financed and realized with common risks by companies and development aid organizations  The cooperation between business, the state and civil society Both partners reach their objectives faster, cheaper and more efficiently Increasing Access to GBV Services Public Private Partnerships combine business interests of companies with developmental goals PPP Private Sector Goals Developmental Goals

Seite 5 Page 5 AAR Health Services Limited  A private healthcare company since 1984  Provides preventive & curative health care services incl. care, case management, evacuation services, health promotion & corporate plans  Based in Nairobi with operations in Kenya,Uganda,Tanzania & Rwanda  A private healthcare company since 1984  Provides preventive & curative health care services incl. care, case management, evacuation services, health promotion & corporate plans  Based in Nairobi with operations in Kenya,Uganda,Tanzania & Rwanda Increasing Access to GBV Services Nairobi Women’s Hospital (NWH)/ Gender Violence Recovery Centre (GVRC)  Since 2001, Non-profit making charitable trust of NWH, a private institution specializing in obstetrics & gynaecological services  Mobilizes resources to provide free quality comprehensive medical, psychosocial treatment, clinical management & referral for GBV survivors  Since 2001, Non-profit making charitable trust of NWH, a private institution specializing in obstetrics & gynaecological services  Mobilizes resources to provide free quality comprehensive medical, psychosocial treatment, clinical management & referral for GBV survivors Moi Teaching & Referral Hospital/ Centre for Assault Recovery of Eldoret (CAR-E)  Since 2007, 2nd major GBV service provider after GVRC in Kenya  Provides free quality comprehensive services to GBV survivors including provision of expert witness in court  Since 2007, 2nd major GBV service provider after GVRC in Kenya  Provides free quality comprehensive services to GBV survivors including provision of expert witness in court

Seite 6 Page 6  Quality improvement of services offered to GBV survivors  Increasing access to GBV services by the urban poor  Increased advocacy for available GBV services  Management of funds provided for by GTZ for GBV services by a private health insurance company  Efficiency of utilization of GTZ funding  Quality improvement of services offered to GBV survivors  Increasing access to GBV services by the urban poor  Increased advocacy for available GBV services  Management of funds provided for by GTZ for GBV services by a private health insurance company  Efficiency of utilization of GTZ funding Increasing Access to GBV Services Kenya’s Health Sector is Challenged in Financing for GBV Services ! Purpose of the PPP between a Private Health Insurance Company and 2 Urban GBV Centres in Kenya (since 2009)

Seite 7 Page 7 Services Provided through the PPP  Case managers assess management of individual cases and follow up progress of GBV survivors from admission to discharge Increasing Access to GBV Services Case Management Claims Management Service Provider Management Quality Assurance  Includes claims vetting & ensures funding is spent as per contractual agreements & care provided  Entails contracting, accreditation & supervision of providers incl. documentation of standards of services  Undertaking of quality audits to ensure that care is as per the national standards and protocols for SGBV service delivery

Seite 8 Page 8 Contracts between GTZ and AAR (PPP management agency) + GVRC & CAR-E (provision of quality comprehensive care to survivors) Submission of claims by AAR to GTZ for re-imbursement Funds transfer by GTZ to GBV service providers How does it work…? Increasing Access to GBV Services Submission of invoices to AAR by GVRC & CAR-E for verification as per contracts

Seite 9 Page 9 Provider Management  Market value= Kshs 105, 000/ year  AAR contribution to PPP= Kshs 52, 500/ year  Market value= Kshs 105, 000/ year  AAR contribution to PPP= Kshs 52, 500/ year Increasing Access to GBV Services Case Management  Market value= Kshs 420,000/ year  AAR contribution to PPP= Kshs 210, 000/ year  Market value= Kshs 420,000/ year  AAR contribution to PPP= Kshs 210, 000/ year Claims Management  Market value= Kshs 315, 000/ year  AAR contribution to PPP= Kshs 157,500/ year  Market value= Kshs 315, 000/ year  AAR contribution to PPP= Kshs 157,500/ year Quality Assurance  Market value= Kshs 210,000/ year  AAR contribution to PPP= Kshs 105,000/ year  Market value= Kshs 210,000/ year  AAR contribution to PPP= Kshs 105,000/ year AAR charges clients 15% admin fee (market value of scheme) & 7.5% for the PPP

Seite 10 Page 10 Achievements so Far … Increasing Access to GBV Services  AAR ensures funding is spent as per contractual agreements & care provided Increased financial access (especially by the urban poor) to quality GBV services as a result of proper fund management Ensuring accountability Adherence to national quality standards and protocols Increasing competency of private sector in GBV service provision Involvement of the private sector in increasing healthcare access by the poor GVRC attends to approx 230 clients per month (3000 beneficiaries so far) CAR-E attend to approx 110 clients per month (1600 beneficiaries so far) Highlights the role of private sector in healthcare and sustainable development Replicable model in Kenya and beyond with a significant role for future health financing models Increased financial access (especially by the urban poor) to quality GBV services as a result of proper fund management Ensuring accountability Adherence to national quality standards and protocols Increasing competency of private sector in GBV service provision Involvement of the private sector in increasing healthcare access by the poor GVRC attends to approx 230 clients per month (3000 beneficiaries so far) CAR-E attend to approx 110 clients per month (1600 beneficiaries so far) Highlights the role of private sector in healthcare and sustainable development Replicable model in Kenya and beyond with a significant role for future health financing models

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