In a previous news blog I explicated a theory for improved access to services in countries of moderate income. I argued that services would always be limited in very low-income countries. On the other hand, in high-income countries the tax base is sufficient to support comprehensive public services, including health services. However, I explained that in countries of intermediate wealth, the tax base was often immature and small, relative to the total economy. In such a scenario it is necessary to rely on community contributions in order to improve access to services. I refer to this as the IKEA model.
I found a very nice example of the IKEA model recently. This is a pre-payment service implemented by Safaricom and other companies in Kenya called M-TIBA. These organisations provide an electronic wallet that families can contribute to, which provides ready cash at the point when services are required. Such a service can ensure that money is available for out-of-pocket payments. Electronic pre-payment thus acts as a kind of community insurance or risk-sharing system.
I see great potential in these services, but feel that they should be evaluated. Like microfinance, people may make exaggerated claims of how beneficial they can be. I expect that these services will be most useful when they are all linked to other services. Thus, I imagine that a pre-payment system will be much more effective in securing transport to hospital when it has grown up in parallel with an inexpensive (perhaps partially subsidised) local ambulance service. As part of my work as lead for the Access work package in the NIHR Global Health Research Unit on Global Surgery, I shall be investigating this type of system in improving access to acute surgical and medical care.
— Richard Lilford, CLAHRC WM Director
- Lilford RJ. Towards a Unifying Theory for the Development of Health and Social Services as the Economy Develops in Countries. NIHR CLAHRC West Midlands News Blog. 13 October 2017.
- PharmAccess. “M-TIBA is truly leapfrogging healthcare in Kenya”. 15 December 2015.
- Banerjee A, Karlan D, Zinman J. Six Randomized Evaluations of Microcredit: Introduction and Further Steps. Am Econ J Appl Econ. 2015; 7(1): 1-21.