Social Health Insurance

Every year, more than 150 million people face health-care expenditures that are so high in relation to available income that they have a catastrophic effect on the household’s financial well-being. In the context of the 2030 Sustainable Development Agenda, important emphasis is placed on achieving Universal Health Coverage. In particular, many low and middle income countries are working to implement health insurance schemes that offer greater financial protection for their populations.

Given the enormous heterogeneity of countries and health systems, it is difficult to develop insurance solutions that cater for all. Mandatory insurance systems often fail to have a substantive impact in countries with large informal sectors, while people may lack understanding or be otherwise unwilling to join voluntary schemes.  Health insurance models can be national or decentralised, community-based or mutual models and depend on both economic and political considerations, as well as socio-cultural settings.

Comprehensive Health Insurance Solutions

Swiss TPH designs and implements tailor-made health insurance solutions specifically for the informal sector and redesigns existing ones to meet contextual needs and create sustainable impact. In close collaboration with health authorities and decision-makers, we support the implementation of insurance structures and processes, operating procedures, marketing strategies, provider management and payment mechanisms, product pricing, risk pooling arrangements, and performance monitoring.  An essential element of our work is to develop social health insurance mechanisms that improve the access that poor people have to health care at the time of need.

Dr. Helen Prytherch

“We develop social health insurance mechanisms to improve the access to health care.”

Dr. Helen Prytherch
Head Health Systems Support

Our Partners

We work with international, national and local partners to implement health insurance solutions including P4H the Social Health Protection Network, the Swiss Agency for Development and Cooperation (SDC), the German Gesellschaft für Internationale Zusammenarbeit (GIZ) and the World Bank.

In Tanzania, for example, we are working with regional and district health authorities to implement a comprehensive reorganisation of Community Health Funds for rural populations.

The intervention is part of the SDC-funded Health Promotion and System Strengthening Project (HPSS). The aim is to strengthen the health system to improve access to quality health services. The new Community Health Fund, health promotion and capacity-building in financial, pharmaceutical and health technology management are part of this 8 year project. The project is accompanied by operational research to optimise project efficacy and guide decision-making. HPSS is funded by the Swiss Agency for Development and Cooperation (SDC).

The Reform of the Community Health Funds in the Dodoma Region in Tanzania. A SDC-funded project.

Swiss TPH has also designed and developed an innovative Insurance Management Information System (IMIS). Through the use of mobile phones, enrolment, claims, renewal and feedback processes are being optimised.  The solution has proven to be cost-effective, while also being sufficiently flexible to meet different insurance needs including a centralised model in Nepal, a district-based model in Tanzania and a church-based scheme in Cameroon.

Health Promotion and Systems Strengthening in Tanzania

The aim of the Health Promotion and Systems Strengthening Project (HPSS) in Tanzania is to improve community health by strengthening both the demand and the supply sides of the health system.

The project implements interventions in the area of health financing, including building viable social health insurance schemes, conducting health promotion, building capacity of the health workforce, and strengthening of financial, pharmaceutical and health technology management.

The project is accompanied by operational research to optimise project efficacy and guide decision-making. HPSS is funded by the Swiss Agency for Development and Cooperation (SDC). 

HPSS Project

Insurance Management Information System

Swiss TPH designed and implemented an Insurance Management Information System (IMIS) as part of the Health Promotion and System Strengthening project in Tanzania to make management of insurance schemes more efficient.

The mobile phone-based system supports enrolment, renewal, claims and feedback management and reporting of insurance schemes. IMIS specifically addresses the insurance challenges in the informal sector and is flexible to meet different user needs and technical requirements.

The open source system also allows for scaling up across multiple sites and insurance models.   The system was also implemented in Cameroon and Nepal. The initial development was funded by the Swiss Agency for Development and Cooperation.

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Selected projects at this location: