Pamoja Health

Less than half of Africa’s citizens (50%), some 615 million people only have access to the healthcare they need; the continent’s quality of health services is generally poor and the family planning needs of half the continent’s women and girls are unmet.1 Each year, approximately 97 million Africans, representing 8.2% of the continent’s population, incur “catastrophic healthcare costs” – particularly in Tanzania, Sierra Leone, Egypt and Morocco1. Annually, 15 million people will be pushed into poverty as a result of these out-of-pocket costs.

Beginning in the mid-1990s, Tanzania prior to independence in 1961, user charges were instituted in all public health facilities. After independence, health services became free to the public and were financed through general tax revenue. However, sustaining the level of financing required to ensure adequate quality of care and coverage of health services became problematic thereafter. This made the ministry of health to introduce the user fees system2. User fees, commonly called the ‘cash and carry’ system in Tanzania, undoubtedly has contributed to inequitable health service access and utilization between different socio-economic groups and between poor rural and richer urban dwellers in which people in rural areas especially those in informal sectors are inadequately served3.

witnessed the introduction of health insurance (HI) as a means to redress the ever-increasing expenditures on healthcare costs, and thus to protect the people from catastrophic healthcare expenditures5. Two HI models, the Community Health Fund (CHF) and the National Health Insurance Fund (NHIF), were implemented in 1996 and 2001 respectively. Currently, about 24 % of the Tanzanian population is covered under CHF and 6 % under the NHIF. CHF remains a voluntary insurance targeting the informal and rural population nationwide6. Through the CHF Act of 20017, the government of Tanzania declared CHF a voluntary prepayment scheme and directed district council’s administration to define the benefit package and a flat rate premium per year8. As of today, enrolment in CHF membership covers up to six household members7. Each household obtains a single membership card valid for 12 months that can be used in primary and secondary healthcare facilities within the district of registration. Despite this expansion, however, their coverage remains at only about 1 percent (220,000) of the population. While the average enrolment of CHF varies across districts, the 30 % coverage rate that was expected by the year 2015 has not yet been achieved. This might have been caused by diverse factors such as the voluntary nature of the schemes, a limited benefit package, low income and restricted use at local primary and secondary health facilities.

In Tanzania in order to attain the achievement of universal health coverage (UHC) and reduction of mortality which is one among the major targets of the Sustainable Development Goal (SDG) Three, which seeks to promote health for all at all ages by the year 2030, More interventions are needed. Further efforts are needed to match the needs of people in the country, the growth of digital technology should be seen as an opportunity in addressing similar challenges.

The mobile micro health insurance solution Pamoja Health is being developed through a collaboration between Airtel Money and Community Health In-fund (CHF). The insurance seeks to provide services to low-income families enrolled in the Community Health Insurance Scheme in Tanzania's 19 regions who can access the CHF Family package of Tshs 30,000 for a year at a cost of Tshs 10,000 in a period of four months. Instead of paying the entire sum at once, the insurers will be able to pay the funds over three separate times. Additionally, the micro health will feature a Pamoja wallet that will allow a customer to serve any additional money earned for paying in the following phase.

The Pamoja service will be accessed via USSD system, where by members of CHF will use mobile phone to make payment using the registered number. Pamoja team will enroll eligible individuals using Web application which has been developed by Pamoja technical team, individual will give out their important details including details of other five members of family who will benefit from the service. Pamoja team will provide card with the registered number which will help member of the family to access services in different healthcare facilities.

 Partnership with airtel will help Pamoja solution to scale and reach large number of targeted individual due to the fact that airtel will be sending reminding and advocating text to the targeted group. The Pamoja wallet is the added value of the solution, Pamoja wallet will help beneficiaries to serve amount of money that will help them in the future payment. The Pamoja solution is unique because it helps individual to make payment in three different phases compared to existing interventions that allow only single payment annually. The objectives of the solution are to increase insurance coverage in Tanzania as well as to simplify the availability of health care services among low income rural resident of Tanzania

Patients, Community Health Fund beneficiaries and other local community users of health insurance: Those living in low-income areas will benefit from quality care and good performance from healthcare facilities. They will access healthcare services in affordable price by paying for insurance in different phases, also the payment simplification by means of USSD will favor beneficiaries.

Local government: The Pamoja health will help Local government officials and healthcare workers to improve the quality and performance of the facilities by increasing health insurance services and identifying high-priority issues for improvement and necessary action plans

Elected political leaders (Village leaders, Ward leaders): Pamoja Health builds quality services and large community trust in the healthcare system, making them more likely to use the quality services which are available to them and Increasing utilization of services by Community members.

The Ministry of Health (MoH) and donors: Will be able to allocate different health resource in different healthcare facilities

We are situated in the neighborhood where people from informal sectors obtain healthcare services from primary healthcare facilities. The team has collectively worked in insurance field and healthcare performance measurement. Our deep roots in healthcare provide us with comprehensive understanding of the everyday patient's experience, culture, and the community users who accesses healthcare services. All of our team members personally receive their medical care using health insurance and are aware of the struggles faced by families trying to locate high-quality care there without health insurance. This is essential for our healthcare performance service design, Quality improvement, and training for low- and middle-income families.

Most significantly, our work is informed by the viewpoints and experiences of the patients and low-income families who utilize healthcare facilities without health insurance and those who are using current CHF (Community health Fund) service. To gather their perspectives and create solutions that are in line with their direct experience of accessing healthcare service using health insurance service in healthcare facilities, we have conducted focus groups and interviews with Community health fund beneficiaries, users of primary healthcare facilities, and community leaders over the past five months.

The majority of the people we connected with were from low families and underdeveloped regions. Following these interviews, we wish to hold feedback sessions where consumers and providers of health insurance services and healthcare facilities can give their opinions on the methods and solutions we've developed to increase health insurance coverage and to boost quality and performance in light of their initial viewpoints.

Access to mentorship, coaching, and strategic advisory would be invaluable for our team to learn how to scale while maintaining quality and impact and strengthening our internal processes. This will help us in developing and refining the Business model, Financial (e.g., improving accounting practices, pitching to investors) Public Relations (e.g., branding/marketing strategy, social and global media) Product / Service Distribution (e.g., expanding client base) Technology (e.g., software or hardware, web development/design, data analysis, etc.) The Monitoring and evaluation support will strengthen our impact measurement framework.  We wish to develop skills in Data for Action and decision-making that allows us to lead the improvement of performance in healthcare and could benefit from training sessions, software packages, or consultations to support us in leveraging this technology to advance our mission. 

Financial constraints have not allowed us to expand the program in other regions. We are looking for funding so that we can able to finalize the rollout phase of the program that we have created that has been customized to the needs of the TANZANIAN population. The MIT Solve award will also allow us to penetrate the market and allow the product to reach as many people living without health insurance in low and middle income countries

Pamoja Health is the mobile micro health insurance that is being built by partnership between airtel money and Community Health In-fund (CHF). The insurance aims at delivering the healthcare services at a cost of Tshs 10,000 for a period of three months for low income families receiving insurance services served by Community Health Insurance Scheme in the 19 regions of Tanzania, who access the CHF Family package for the cost of Tshs 30,000 for a period of one year. 

The insurers will be able of paying the funds in three divided periods instead of paying the whole amount at once. This will enable people with low income that is not constantly generated to afford paying for the insurance. The micro health will also have a Pamoja wallet that will enable a client to serve any extra amount gained for paying in the next phase

Six Anticipated Achievements or outputs are presented below with the specific indicators that will be used to measure them

• Pamoja health will help to reduce financial barriers to health care for people from the informal sector
• Pamoja health will help to improve financial accessibility to healthcare.
• Pamoja health will help to limit financial burden of ill health.
• Pamoja health will contribute to increase in health seeking behavior and encourage rational use of health services
• By actively enrolling more people from informal sector, will help to increase community participation in the healthcare sector
• Pamoja health will also contribute to improvement of healthcare financing for healthcare providers.

From health care providers ‘perspective, Pamoja health has the potential to increase the utilization of healthcare services. The Pamoja health beneficiaries will be less likely to escape from the health facility at night to avoid health facility bill. Pamoja health has the potential to encourage a more rational use of healthcare facilities as explained earlier, Pamoja health beneficiaries will generally be encouraged to consult health care providers as soon as they are feeling unwell.

• The number of individual feedback and providing this data to the local government to improve the oversight of health service. We hope to bridge the gap between limited, expensive health insurance by the government, and widespread, cheap and accessible health insurance through USSD, providing a model for more citizen engagement.
• Improvements in health outcomes  and sending total number of actionable feedbacks that help the government to improve decision-making on health services on the use of USSD to increase health insurance coverage especially in informal sectors. Working with citizen-led health management committees and groups, the Pamoja Health team is supporting the introduction of community groups to identify gaps in health services and prioritize healthcare needs.
• Reduction in medication load and increasing total number of community/citizens using a USSD platform to pay for health insurance service
• Reduction in healthcare cost and increasing healthcare facilities' trust and engagement: The Pamoja Health will increase the trust with local communities, and also improved the healthcare facilities' reputation in relation to local governments. Many healthcare facilities will see patients and community users as valuable partners who can access healthcare services using affordable and easily accessible health insurance.
• Improve service/program delivery: The Pamoja Health will strengthen relationships between citizens, governments, and other potential partners, to ensure community members access healthcare service in quality manner 
• Increased citizen engagement: Citizens will have the platform to stay informed and organize themselves to participate in meetings, and send concerns and questions on government about the progress of Pamoja Health.

• Inputs: Insurance Campaigns, Bima concerts, and Outreach activities in rural areas
• Activities: Enrolling clients in Community Health Fund, Marketing Community Health Fund Scheme, Distributing the benefit cards
• Output: Reaching the new and virtually untapped market of health insurance in Tanzania and increased number of people receiving health insurance services
• Intermediate Outcomes: Reducing economic burden of people from informal sector when accessing healthcare services.
• Impact: Increased coverage of insurance among people in informal sector in rural areas of Tanzania.

Pamoja health will provide special tablets for enrollment activities. Each tablet will be connected to the main server which is located at headquarters of Community Health Fund Offices. We will be using community health workers who will be immersed in the community to find new beneficiaries of insurance services and enroll them in Community health insurance fund platform and registering them in Pamoja wallet that allow them to have future savings for their insurance services.

The tablets will be operating in both online and offline. This will make Pamoja health team to be able of operating even in remote or hard to reach areas. The last mile principle will be used that allows the device to operate offline and later on to process the information when there is good internet access.

One of our implementation partner is Airtel [Telecom Company] who will help us sending the reminding messages to the beneficiaries on when they should pay for the services and will help in offering the better way of paying and saving the money in Pamoja wallet that helps the clients in future when accessing insurance services.

The primary health data is collected by the doctors at Public Health Centers, travelling medical staff in remotest areas, nurses in small towns & busy hospitals, and volunteers/ fellows assisting small health centers at grassroot level. 

Primary healthcare data is being collected by the volunteers of the project who gather routine and monthly data from both public and private health care facilities in the project sites. Volunteers get travelling allowance and meal allowance during the period of working.

As an organization that caters to the health and wellbeing of people from all walks of life; diversity, equity and inclusivity (DEI) are second nature to us. Pamoja Health is committed to fostering and maintaining a work environment where DEI is fully integrated into everything we do for the benefit of our employees and the clients that we serve.

Our leadership team is composed of both male (6) and female (4) staff members from different ethnic and religious backgrounds. We make every effort to provide our employees with equitable distribution of opportunities and resources as a way of promoting aspirational growth which ultimately begets organizational growth.

It is the policy of Pamoja Health to ensure equal employment opportunity without discrimination or harassment on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, age, disability, marital status, citizenship, national origin, genetic information, or any other characteristic. We believe that people should be treated as individuals, respected for their unique attributes and not excluded, harassed or bullied in any way, through unconscious bias, stereotypes or unlawful actions that may form the basis of discrimination, harassment, vilification or victimization.

In an effort to become more inclusive, we are exploring additional ways in which we can partner and employ staff that are differently abled within the Pamoja Health community. Currently, our facilities in Dar es Salaam, Tanzania are wheelchair accessible and have been fitted with apposite equipment to ensure the differently abled have easy access.

We are also keen on forging international partnerships with organizations and people of other races and religions which will broaden our scope of collaboration, sharing of information and professional cultural practices.

Designed by: PAMOJA HEALTH

Designed for: Pamoja Health

The Business Model Canvas

Key Partners

Ministry of Health

Airtel

Community Health Fund

National Health Insurance Fund

Muhimbili University of Health and Allied Science

Key Activities

Advertisements in local radio stations and social Medias

Registration of Pamoja Beneficiaries

Awareness Campaigns on the importance of Insurance

Engagement with stakeholders

Value Proposition

Pamoja Wallet

Affordable

Accessible

Payment Simplification

Customer Relationships

Regular meetings with the Pamoja beneficiaries

Feedback from health care providers on the use of Pamoja Micro health insurance in health care facilities

Establishing suggestion boxes in the healthcare facilities where, Pamoja beneficiaries can address their views

Having a forum where various stakeholders can meet and discuss about Pamoja Micro health insurance

Having Customers desk at Pamoja Office, where beneficiaries can make a call or send message at any time when they are encountered with difficulties in accessing health care services with Pamoja Microhealth insurance.

Customer Segments

For whom are we creating value?

Who are our most important customers?

Our main target customers include people who are informal sector especially peasants

Key Resources

Physical Space

Human resources

Financial resources

Transport

Channels

Pamoja health will adapt the available ways which are being used by the Community Health Insurance fund and National Health Insurance in reaching the clients

 Also Pamoja Microhealth insurance will consult the financial institutions on how better they can reach and sustain financial model to people in rural areas especially hard to reach areas

Cost Structure

Registration cost

Transport cost

Management and operations cost

Advertisement cost

Physical Space cost

Revenue Streams

            Sales

             partnership

             Commission

1. SALES

2. PARTNERSHIP

3. COMMISION

For the past six months, we were developing the solution through various experiments with potential partners, listening to the potential community and the government, improving the customer journey, establishing the business/financial model and operation, designing strategies for business development and marketing and expanding the network to find growth opportunities. Following our pilot, has cultivated a diverse funding stream to support the Pamoja Health in rural communities, including (1) Muhimbili University of Health and Allied Science support, (2) UNCDF and individual donors, (3) awards. Furthermore, financial sustainability has been the result of in-kind support from government partners, Pledged support of operational expenditures.

Our direct key customers are individuals from low- and middle-income countries with challenge in accessing health insurance service, Moreover Pamoja Health is the solution that want to operate using actionable insight from patients, expertise, and experience to improve the quality and performance of healthcare services. We as Afya Lead we donate the time and capital to develop a solution that will increase insurance coverage in low- and middle-income countries while our partner organizations leverage community relationships to encourage involvement in our needs assessments and gather the manpower to measure the performance of Pamoja Health services

We invest in reducing ongoing costs and increasing revenue to become sustainable. In order to build a solution at scale, we must become financially sustainable to encourage replicators to emerge. We believe replicators must be able to be Financially sustainable and viable within a few years in order to see mass replication that would lead to an industry.