Stre@mline: Revitalising rural health insurance

There are an estimated 600 million people in Africa who live in rural areas representing 50% of the continent’s population. Their daily average wage is 2 dollars which excludes them from most of the insurance programs. 98% have no health insurance.

As a result, most of the healthcare is paid out of the pocket. According to the WHO Universal Health Coverage report 2019, 97 million Africans incur catastrophic healthcare costs which push 15 million people into extreme poverty every year. About 30% of households borrow money or sell assets to pay for healthcare.

Lack of technology infrastructure and robust data management makes the insurance schemes that do exist inefficient and ineffective, driving up costs and limiting uptake. False or inflated claims further undermine insurance schemes’ sustainability.

Stre@mline uses a simple model that leverages community involvement, trusted health care providers and technology to revitalise rural health insurance.

Around 95% of people in Uganda (and Africa) belong to one or more savings, funeral, church, or similar groups to facilitate saving, borrowing and insurance transactions. Stre@mline mobile application enables these groups to save for their healthcare and pay premiums in flexible weekly instalments using mobile money payments on their phones. Existing groups pool resources, spread risk and enable more affordable health coverage through a trusted local health care provider.

Health care providers use Stre@mline platform for scheme administration; managing scheme members, premiums, co-payments, claims processing and reporting, making tracking of the schemes’ surpluses or deficits quick, easy, and accurate.

Stre@mline business intelligence platform enables scheme pattern analysis, uncovering useful epidemiology trends to target health promotion and minimise costs forecasting usage of resources eg. medicines, staff; key for planning and identifying potential cost savings opportunities, fraud detection, etc.

By the end of 2020, Stre@mline had acquired 20 hospital clients and digitised 475 000 patient records. By the end 2021, Stre@mline was serving 34 hospitals and managing the records of 850 000 patients, including 52 000 patients covered by community-based insurance schemes at 3 of the hospitals.

Stre@mline plans to use 80% of the award grant to support the establishment and expansion of community-based health insurance schemes across its 15 target hospitals and reach a total of 200,000 beneficiaries. The remaining 20% will go toward further developing its technology and infrastructure; building a business intelligence module to provide robust insurance scheme monitoring and inform hospitals' decision-making.

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