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Enrollees in Nigeria, Kenya and Tanzania


Total disbursed loan amount in USD


Number of patient visits to SafeCare facilities per month


Number of active clinics in the SafeCare program


During her stay in Tanzania for the World Economic Forum on Africa, Her Royal Highness Princess Mabel of the Netherlands visited the Shree Hindu Mandal hospital in Dar es Salaam. On May 6th, the Princess was shown round the nearly constructed two stories high HIV/AIDS wing of the hospital which will officially open its doors on May 22nd. PharmAccess has monitored the whole construction of the building. Princess Mabel found the visit inspiring and she Twittered that you could tell that the doctors and patients are very keen to move to this new part of the hospital.

The new wing is much needed to answer adequately to the growing demand. The Shree Hindu Mandal non-profit hospital, which started in 1953 as a small clinic, has grown into a 24-hour in-and-outpatient hospital for about 300 patients a day. Almost 60 percent of these patients have HIV-related health problems. A special HIV/AIDS-wing can provide more and better care for them and therefore relieve other wards. Her spontaneous visit was a great boost for everyone who has worked so hard in realising this new building. 

The wing is funded by a donation from the AmsterdamDiner. Once a year this AIDS fundraiser organises a charity dinner for the Dutch business society to raise money for a cause in the fight against HIV/AIDS. The past three years the profits have been donated to the programs of the Health Insurance Fund. In 2007 the targeted project was the realization of this new HIV/AIDS wing for the Shree Hindu Mandal Hopital, which will operate in the recently launched Health Insurance Fund program in Tanzania.

Click here to read about her visit in the Dutch newspaper De Telelgraaf

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Did you know that...access to credit facilities for low income earners is crucial to their social and economic development. Without access to fundamental banking and financial service millions of people throughout Africa are denied entrepreneurship and are thus denied to productively contribute to their countries’ economic development. Furthermore access to financial services greatly contributes to achieving the Millennium Development Goals.

“There is a correlation between access to credit and MDGs. This being the age of making the impossible possible; citizens are getting engaged and have become very creative.” said Prof Yunus to the East African. Yunus, who was speaking at an annual microcredit summit in Kenya, won a Nobel Prize in 2006 for championing Microcredit for the poor in Bangladesh. "People are ready in Africa there is no problem with the people it's a question of institutional and conceptual arrangement and microcredit could be wonderful social business," he said to Reuters.

Actively promoting best practices and policies that will increase access to finance to reduce poverty is the role of UN Secretary General’s Special Advocate for Inclusive Finance for Development Princess Máxima of the Netherlands. Her mission is to advocate access to fundamental financial services, such as loans, saving accounts and insurance for everyone needing them, both individuals and small to medium-sized enterprises.

On April 8th when the Princess launched the Health Insurance Fund program in Tanzania, Princess Máxima recognized the importance of our work. In an interview with the Dutch current affairs program Nova she explains that access to quality care is a fundamental basic. Health insurance is a vital tool to protect people against the disastrous effects of catastrophic health payments and enables them to build an economically steady future.

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On April 8th the Health Insurance Fund program officially kicked off in Tanzania. Her Royal Highness Princess Máxima launched the program by handing out the first health insurance cards to three members of the micro-credit organization PRIDE who had just signed up for the program.

It was a great honor that the Princess in her role as UN Secretary General’s Advocate for Inclusive Finance for Development was there to launch this program. A program she qualified as very important. In an interview with the the prime time Dutch current affairs program Nova, directly after the launch the Princess explained that unexpected health care expenditure is the number one cause for families to go bankrupt. Health insurance is in her eyes a vital tool to protect these people against these dramatic out-of-pocket expenses. The first target group who will receive health insurance are approximately 40,000 small business entrepreneurs and their dependents of the micro-credit organization PRIDE.

But are our clients aware of these costs and about the protection health insurance offers? Yes, the clients who received their insurance cards out of the hands of the Princess were all relieved to have health insurance now. They felt the burden of healthcare costs on their household budget. ‘When one of my children or I would get sick, we could not always afford treatment’, Juma Hamisi Sultan says, he has been a PRIDE member for five years and runs a small clothes shop. ‘I would have to pay cash for the treatment. Costs that were often too high for my low-income.’ He estimated that each month he paid about 15,000 shillings (about €8) for him, his wife and two young children on health care.

Amina Hassan has a similar story. With her income she could often not pay for treatment for her, her husband and her three children. Or she could only get have a medicine cure, for example antibiotics, simply because she had no money to pay for the other half. ‘We sometimes had to pay 50,000 shillings (about €27) for a single treatment, and now we pays 55,000 shillings per year for health insurance for my whole family.’

Amina Hassan is glad that she does not have to worry about these costs anymore thanks to health insurance for her and her family. Not only will they receive quality treatment in the clinics in the program, she will be able to use the money she saves on health care to invest in her boutique. She is saving for an electronic sawing machine so she can accept more orders.

The medical and economic benefits are clear to Juma Hamishi Sultan as well: ‘Health insurance means that now we will always get treated: when we are sick we go to the hospital.’ He has to co-pay 47,000 shillings (€26) per year for his whole family.

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Did you know...that HIV drug resistance forms a major threat to the successful treatment of HIV/AIDS. In less than a decade the international commitment to fight HIV/AIDS has lead to the incredible achievement that today more than 3 million people in Africa are on life-saving HIV-treatment. However, this success also involves a realistic risk for development of HIV-drug resistance in Africa.

People become resistant to their lifesaving drugs. Unfortunately, drug resistance is a negative side-effect of widespread medication use. The disastrous effects can be seen in the fight against malaria, tuberculosis and other serious illnesses such as pneumonia, diarrhea. It is therefore not hard to predict that the development of HIV-drug resistance is looming.

There is, however, a knowledge gap on how and at what speed this development will proceed. Hardly any research or data collection on HIV-drug resistance in Africa has been performed. For this reason the PharmAccess African Studies to Evaluate Resistance (PASER) program, which started in 2006, has set up a network of clinics, laboratories and research centres in Africa with the aim of strengthening systems for the coordinated monitoring of HIV-drug resistance. The first PASER results indicate that up to 7% of the PASER participants initiating highly active antiretroviral therapy (HAART) show signs of baseline resistance and over 24% in with a history of previous antiretroviral use. Which is a worrying percentage and implies that continued vigilance is warranted.

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Images of the working surroundings of market women in Lagos.

There are over a thousand markets in the city of Lagos. The markets really form the economic heart of this huge Nigerian metropolis. Lagos has a population figure of approximately 17,5 million inhabitants, which makes it is the second largest city in Africa, behind Cairo.  People go to the markets for practically everything: food, music, clothes, cell phones, IT products, to get a haircut or their car fixed.  The images provide a view of theses vital economic centres.

Since 2007 the Health Insurance Fund runs a program for market women and there families. About ten thousand market woman are targeted with an estimated family size of four, the total target group for this insurance scheme is 40,000. The women are organized in market organizations and have access to quality health care right around the corner from where they work.



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Did you know that...more than half of the medicines sold in sub-Saharan Africa are counterfeit. Globally the percentage of fake medicines sold is approximately 10 percent. According to PloS Medicine these fake medicines are really dangerous. Because people do not know what medicines they are taking, the fake drugs lead to unnecessary illnesses and even mortality. As a result the public loses confidence in medicines and the overall health systems. The paper calls for combined action by the pharmaceutical industry and the governments to warn and educate the public not to buy these dangerous drugs.

The counterfeit medicines sell well in sub-Saharan Africa because they are sold by street vendors, street markets and small groceries. Often it is the only medicine the people can afford. The prices in the pharmacy are overall much higher.

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Did you know that...over 4 million people in developing countries are now receiving HIV medication. Due to the enormous international effort in less than a decade the number of people receiving lifesaving antiretroviral therapies (ART) in developing countries went up from practically zero to now 4 million. Of which over 2,9 million in sub-Saharan Africa (see image below).

In the past few years the fight against HIV/AIDS has been recognized as a global health priority by the international community. This lead to the commitment to reach “Universal Access to antiretroviral treatment”, this goal was endorsed by the United Nations General Assembly in 2006.  Although great steps have been taken in providing ART to developing countries, the war is far from won. In sub-Sahara Africa alone two thirds of the world’s 33 million HIV cases live. By far the hardest hit region by the HIV pandemic in the world.

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‘The benefits are tremendous’, says His Royal Highness the Emir of Shonga. He was interviewed briefly at a health conference in Lagos last year on the progress of the program in his Emirate. The success of the Health Insurance Fund program in the Shonga district in the heart of Kwara State is in his eyes expressed by the growing numbers of subscribers: ‘they are attracted to it.’ The very positive effect of this success is that ‘people are healthier and feeling better.’ Click on the film below to view the brief interview.

The Emir has greatly contributed to this success. With his status in society he was able to promote and ensure community involvement in the program. In an earlier held interview in the Netherlands in 2008 he made clear that he understood his role: ‘Politicians are there for the short term. I, on the other hand contribute to making the program work in the long term; that is my commitment. ‘

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Did you know that... global healthcare fraud costs €180 billion a year. Each year, this huge amount of money, which is 5.59 percent of total global health spending, is wasted through fraud and errors in health care. These numbers are published in a study by the European Healthcare Fraud and Corruption Network (EHFCN) and the Center for Counter Fraud Services (CCFS) at Britain’s Portsmouth University. The amount that is lost annually equals four times the combined budget of UNICEF and the World Health Organisation.

‘Every euro lost to fraud or corruption means that someone, somewhere is not getting the treatment that they need’, Paul Vincke told Reuters. Paul Vincke is EHFCN’s president an co-author of the study. ‘They are ill for longer, and in some cases they simply die unnecessarily. Make no mistakes: healthcare fraud is a killer.’

Examples of mistakes and corruption vary from over-claims of healthcare providers, to cartel agreements between pharmaceutical companies, to patients lying about their economic status to get free treatment. 

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Did you know that…healthcare spending will consume 15.5% of the GDP in North America in 2010. This puts the US on the number one spot of six regions worldwide when it comes down to healthcare spending. The Economist published an overview last week of the cost of good health for six regions.

In 2008 the Gross Domestic Product of the US was $14,441,425 million dollars (source: IMF). So put in dollars the US will spend approximately $2,238,421 million dollars on health care in 2010, around $7257 per capita (population US is over 308 million). Western Europe is second in the list with an average of 10% of GDP. Last in the list are the Middle East and Africa. These countries spend 6% of their GDP on health care.

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Did you know that… every year over 4 million babies die in the first four weeks of life and more than 3.3 million babies are stillborn every year. Ninety-eight per cent of these deaths take place in the developing world. These sad figures are published in the World Health Organisation (WHO) report on ‘neonatal and perinatal mortality’ from 2006.
The WHO figures for developing countries on maternal mortality are as tragic. Of the estimated total of 536000 maternal deaths worldwide in 2005, developing countries accounted for ninety-nine percent (533000) of these deaths. Slightly more than half of the maternal deaths (270000) occurred in the sub-Sahara African region alone.
The high mortality rates are caused by a shortage of staff and the lack of skills.  In sub-Saharan Africa, only 46% of births are attended by skilled personnel, compared to 96% in Europe (World Health Statistics 2009).

Training in Nigeria
Nigeria, where the Health Insurance Fund program runs, forms no exception. What more, the maternal and neonatal mortality rates are amongst the highest in the world. The Fund tries to contribute in effectively tackling this enormous problem by training the doctors and midwives in the program's clinics how to address maternal and neonatal mortality in the community. The training aims to improve the skills of the doctors and midwives by practicing possible complications. And it tries to force a mind change in the community that these problems can actually be tackled.  Often, these deaths are accepted in the community as part of the risk of giving birth.

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A major problem of the healthcare systems in Africa is that the concept of health insurance hardly exists on the continent. Only 4% of total health expenditure in Africa is financed through health insurance (WHO 2008). Solidarity is very limited and risk pooling is scarce. In other words, most Africans lack protection against medical costs.
When they (or a family member) become ill, they have to pay for the medical costs out of pocket. Often leading to terrible impoverishment. For example, to be able to pay the medical bills they can no longer afford to send their kids to school, not being able to pay the fees. Or, they have to sell their livestock to pay for the bills, the same livestock that guarantees the family income and food.

Based on the above rational the Health Insurance Fund introduced the concept of demand driven health insurance for low-income groups and their families in 2007. Whole communities, young and old, sick and healthy take part take part which enhances solidarity and the concept of risk pooling. Up to now over 50,000 people in Nigeria enroled in the program and a scale up of the program last June has brought the program to a farmer community of potentially another 70,000 Nigerians. Furthermore, in Tanzania, where the program will be launched shortly, three communities of approximately 95,000 people have been targeted.

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‘The first question you have to ask: what do we mean by demand? For it is clear that there is need for medical care in Sub-Saharan Africa.’ According to Emma Coles, Director of the Health Insurance Fund, identifying the type of demand is the important first step in delivering quality health care. She popped the question at a workshop hosted by PharmAccess and the Health Insurance Fund on World Aids Day at the 12th National Congres Soa*Hiv*Aids in Amsterdam. ‘However, would you bring yourself, let alone your child to a hospital with no doctors, no nurses and no medicines?’

Unfortunately, most Sub-Saharan hospitals are in such a poor state. Because of a lack of public funds (not tax revenues), there is hardly any money available for public healthcare systems. Coles: ‘Therefore, at the end of 2006 the Shonga Community Health Centre had less than 20 visits a month; this is less than one per day.’ Clearly, the population of in this case Shonga is demanding better care.

They search for other means to get quality care. Private means, paid for out-of-pocket, leading to tremendous impoverishment. What the Health Insurance Fund does is using a tiny amount of this existing money for private health insurance schemes. Money people were already willing to pay for quality care. This insurance grants the targeted group access to quality health care; generating a steady demand. Simultaneously the Health Insurance Fund improves the supply side, by improving the standards of the clinics. Coles: ‘And where are we now since the Health Insurance Fund started the scheme at the beginning of 2007: over a two thousand visits per month.’

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‘The concept of the working of the Health Insurance Fund is new and interesting.’ The Tanzanian B.A. Mwambene, who works for the Van Hall Larenstein University from Wageningen in the Netherlands, was intrigued by Emma Coles’ presentation on World Aids Day at the 12th National Congres Soa*Hiv*Aids in Amsterdam. Coles, senior project manager of the Health Insurance Fund, partly presented the workshop hosted by PharmAccess on how to reverse the severe underfunding in health care in Sub-Saharan Africa. She demonstrated how a subsidized health insurance can trigger demand.

Mwambene: ‘Health insurance is not very common in Tanzania. But I believe it can work, because the Health Insurance Fund tries to create a functioning healthcare system for just a targeted group.’ The Fund uses a bottom-up strategy as a way of granting access to quality medical care for, to start with, selected groups within the population.
However, Mwambene had some doubts about the project as well: ‘Since insurance is new. How do you make people aware, I mean, how do they know they can get insurance?’ Coles acknowledged that this requires a lot of effort. New ways are deployed to reach more people. Coles: ‘What the Health Insurance Fund is trying in the rural areas in Nigeria is house to house enrolment, so literally knocking on every door. And in Lagos we use GPS to pinpoint where everyone, who works on the market, lives. This will enable us to reach them in the future.’

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Fact of the week content tekst.

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The Health Insurance Fund is a foundation that provides private health insurance to low-income groups in Sub-Saharan Africa. The insurance covers quality basic health care, including treatment for HIV/AIDS. read more..

The Fund strives to contribute to increased access to quality basic health care, and through this to the achievement of the Millennium Development Goals.

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On 12 September 2016, OPIC, Calvert Foundation and two private investors announce expansion
PharmAccess and its German consultancy partner GFA have won a 27.3 million Euros tender from the German development bank KfW to improve access to healthcare for low-income pregnant women in 5 regions of Tanzania.
President Felipe Nyuse of Mozambique officially opened the University Clinic


A population-based study
Date: September, 2015

Research findings on Health Insurance Fund supported programs

Date: February, 2015