GDC Research

TITLE OF PROPOSAL
FOCUS COUNTRIES OF THE RESEARCH

ABSTRACT (350 words)
RESEARCH QUESTION (100 words)
RATIONALE FOR THE COMPARATIVE CROSS-COUNTRY APPROACH (300 words)
DATA AND METHODOLOGY (400 words)
CHALLENGES AND RISK MITIGATION (200 words)
STRATEGIC RELEVANCE FOR THE INSTITUTION (200 words)
COMPOSITION OF THE TEAM (200 words)
DISSEMINATION STRATEGY (200 words)
TITLE OF PROPOSAL
The Road to Universal Health Coverage: A Comparative Study of Kenya and Ghana health
insurance on the poor households.
FOCUS COUNTRIES OF THE RESEARCH

Kenya and Ghana
ABSTRACT (350 words)
The attainment of Universal Health Coverage is anchored under the overall Sustainable
Development Goal on health. Efforts by governments to implement Universal Health Coverage
has been faced with numerous controversies due to allegations of corruption and financial
sustainability. Despite this allegations developing countries continue to make strides in order
provide everyone with affordable access to health services. However, these efforts are usually
made difficult by the fact that the poor and the vulnerable are often excluded or limited in their
ability to access to health services. Furthermore, governments are also faced with inefficient
funds to extend free coverage to these groups. Other challenges include lack of training and
organization, insufficient standards and quality monitoring, and high out-of-pocket expenditures.
To tackle these problems, various donor organizations have funded various governments through
various programs. To tackle the problem high out-of-pocket expenditures among the poor and the
vulnerable, donor organization have introduced various health subsidy programs with an aim of
promoting the attainment of Universal Health Coverage (UHC) for all.
In Kenya this attempt is attained through; the Health Insurance Subsidy Programme (HISP)
funded by World Bank Group and the Rockefeller Foundation and through the Africa Health
Markets for Equity (AHME) consortium funded by Bill and Melinda Gates Foundation and the
UK Department for International Development. These programmes primarily targets
beneficiaries of Cash Transfer Programmes and is based on the correct assumption that these
beneficiaries are already selected due to their poverty and vulnerability status, and are therefore
ideal candidates. In Ghana, a similar arrangement is in place whereby beneficiaries of the
Livelihood Empowerment Against Poverty beneficiaries are able to access free health insurance
in addition, the Africa Health Markets for Equity (AHME) consortium is also running in the
country.
With many studies focusing on measures of aid effectiveness, little literature focuses on the
channels, instruments, modalities work and which dont, or why, across a growing range of
donors. This research will seek to fill this gap by examining health insurance subsidy programs
and its impact on the poor households in Kenya and Ghana.
RESEARCH QUESTION (100 words)
The main question is the following What is the impact of health insurance on the marginalized
poor households health care in Kenya and Ghana?
The specific questions will be the following.
Do the way donors implement aid make a difference, and how?

How do recipient countries organize the administration of aid coming from different
donors, for the same sector?
What is the administrative burden of managing aid in a specific sector, across countries
and donors?
How does donor aid influence the success of health insurance subsidies for the poor and
vulnerable?
RATIONALE FOR THE COMPARATIVE CROSS-COUNTRY APPROACH (300 words)

The provision of health insurance in Kenya is primarily through the National Health Insurance
Fund (NHIF) which was established in 1966 under the Ministry of Health. Over the years, it has
morphed into a state corporation with the mandate of providing accessible, affordable,
sustainable and quality social health insurance. It has coverage of 18% of the population, as
opposed to the 2% coverage by private insurance providers. As such, it is best suited to deliver
UHC in Kenya. However, the corporation faces a big challenge in that the only source of revenue
comes from members contributions. This inadvertently limits the participation of the countrys
majority poor. In a bid to tackle this, the Health Insurance Subsidy Programme (HISP) for the
poor was initiated as a pilot in 2014 among beneficiaries of the Orphans and Vulnerable Children
Cash Transfers (CT-OVC).
In Ghana, the free healthcare model was initially adopted, but was unsustainable. As such, user
fees were introduced but with vulnerable groups being exempted. However, this too had limited
success due to various reasons, among them, inadequate funding. This then gave rise to the
National Health Insurance Scheme (NHIS), a health insurance scheme targeting the most
vulnerable. The NHIS receives funding from a budgetary allocation from the Ministry of Finance
and the Ministry of Finance resources for exempted persons. All the beneficiaries of the
Livelihood Empowerment Against Poverty (LEAP) have access to free health insurance unlike in
Kenya. The country is also a beneficiary of the AHME consortium which is also running in
Kenya.
These two countries have been selected for comparative studies due to their similarities in terms
of; the challenge, so far, to attain universal health coverage and subsequent targeting
beneficiaries of cash transfer programs as recipients of the health insurance subsidies in addition,
both countries run AHME consortium.
METHODOLOGY AND DATA (400)
The study will use mixed methods for evaluations and will involve both qualitative and
qualitative data collections. The qualitative information will focus on the design and
implementation of the program for each country which is will provide vital context. This method
is important for robust findings especially when we have quantitative methods. Field experience
is, not only meetings with donors, ministries and project officials and the beneficiaries involved.
It is very desirable to get such exposure very early on in the study so it can help inform the
evaluation design. Return trips are also advisable to help elucidate the findings. The research
team respected a set of ethical codes in conducting the fieldwork. This involved a transparent
explanation of the project and the purpose of collecting the data. The research team wills ensure
that the data is kept confidential. This will be followed by qualitative data collection based on
sampling methods which will be used to determine the impact of the health insurance program
on the poor households in the Ghana and Kenya. In order to be able to do this the study will use
econometrics. A properly designed impact evaluation can answer the question of whether the
program is working or not, and hence assist in decisions. Impact evaluation can also answer
questions about program design: which bits work and which bits dont, and so provide policyrelevant information for redesign and the design of future programs. We want to know why and
how a program works, not just if it does. To do this the study will get a treatment and comparison
groups are drawn from the same population then a single difference estimate is in principle valid.
Evaluation findings are strengthened when several pieces of evidence point in the same direction.
Often a single data set will allow a variety of impact assessments to be made. Better still if
different data sets and approaches can be used and come to broadly the same conclusion.
Qualitative information can also reinforce findings and add depth to them. Where a rigorous
approach has not been possible then triangulation is all the more necessary to build a case based
on plausible association.
CHALLENGES AND RISK MITIGATION
Risks expected during the study include:
Stakeholders do not buy-into the health subsidy programs.

Qualifying employees do not register for the subsidy as members in a timely manner.
Incomplete member details are captured.

Non-existent members (i.e. not supported through approved forms) are added to the
members master data
Insurance subsidy cards are generated for non-qualifying or invalid members
Member master data is not up-to date, is impertinent and is inaccurate
Inaccurate information about the Fund, its business, products and services is publicized
thus denting its image and reputation
Fake documents such as IDs, birth certificates and NHIF receipts may be used to support
claims and such claims may be paid out by Health subsidy program
Risk Mitigation Measures

In order to ensure accurate collection data, the research team will cross check the data retrieved
with data from OVC AND program documents to ensure accurate data is collected and analyzed.
Before publication, a draft version of the report will be sent to different stakeholders to check
whether there are any issues mentioned that they do not agree with, or feel uncomfortable with.
STRATEGIC RELEVANCE FOR THE INSTITUTION
The Institute of Research on Economic Development (IRED) is devoted to the advancement of
research on socio economic development. Implementation of The Road to Universal Health
Coverage; A Comparative Study of Kenya and Ghana will enable the institution to pursue its
paths to undertake relevant, innovative and meaningful applied research to solve social and
economic problems by applying state-of-the-art methods and technologies consistent with local
culture and traditions. In addition, implementing the project will enable the organization to
contribute to literature with regard to managing aid effectively and hopefully facilitate change
and practice of management of aid in Sub Saharan Africa.
COMPOSITION OF THE TEAM
The team will consist of Dr. Bethuel Kinyanjui and Dr Wangari Wangombe. The two are
associates in IRED. The team is highly experienced in conducting various research programs
both locally and internationally. The teams diverse experience makes them suitable in
successfully implementing the set project. The team works on projects related to trade and
finance in developing countries. They work on different organizations such as UNCTAD, IFPRI,
AERC, WOTRO, Swiss Development Agency and IOM in different projects. The team is
currently working on impact of trade and labor markets in economic development, Innovations in
developing countries, Diaspora and Economic Development in Kenya, financial inclusion and
inequality in Kenya and Cash transfer programs on Kenya and Ghana. In particular the team is
working on the Breaking the Vicious Circle between Poverty and Ill-Health. Are cash
transfers complementing social health protection policies in Ghana and Kenya? This project
is WOTRO Science and Global Development.
DISSEMINATION STRATEGY
To ensure that the outputs from the research informs policy and practice and thereby maximises
the benefit to OVC beneficiaries and recipient countries, the following dissemination strategy
has been developed using evidence for translating knowledge into practice.
2 interactive workshops in both countries to inform on implementation of good practice

guidelines.
Development of links with key organizations such as Ministry of Health and National
insurance fund to contribute to and capitalize on their networks
Use of electronic media such as websites and blogs to disseminate the projects findings.
Publications including Full, Executive Summary and Plain English summary reports of
the research.
Thus, this proactive dissemination strategy offers the breadth to reach out to multiple audiences
and the depth to conduct more in-depth interactive work with key audiences.

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TITLE OF PROPOSAL

FOCUS COUNTRIES OF THE RESEARCH

FOCUS COUNTRIES OF THE RESEARCH

Do the way donors implement aid make a difference, and how?

RATIONALE FOR THE COMPARATIVE CROSS-COUNTRY APPROACH (300 words)

Stakeholders do not buy-into the health subsidy programs.

Incomplete member details are captured.

Risk Mitigation Measures

2 interactive workshops in both countries to inform on implementation of good practice

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