Access to health services has been a major challenge for thousands of Kenyans, especially those living in arid and semi-arid areas due to lack of hospitals, infrastructure and other medical facilities. However in Kajiado county, nomads and pastoralists are benefiting from 'Mbuzi Moja Afya Bora', a Swahili phrase that translates as the 'one goat, good health' initiative.
The scheme is aimed at convincing pastoralists to enroll in the National Health Insurance Fund (NHIF) using a language herders understand -- goats.
“I have benefited a lot. I can say it's a good approach considering it is conducted by our county government,” says Simon Saidemo, a pastoralist and a father of four children, who has been in the program for a year already.
“I can walk to any public health facility with the NHIF card and get good health services. It covers my wife with four children, thus six family members."
Goats for good healthcare
Saidemo outlined the process explaining that a goat is sold at market value. The market value is Ksh 6000 or €46. The estimated monthly cost of the insurance in Kenya is Ksh 500, or roughly €4 per month. Yearly coverage is about Ksh 6000 or €46.
This is the estimated market price of a single goat in Kenya.
The amount the goat is sold for is then channeled into health insurance accounts of pastoralists. The county government of Kajiado continues to encourage pastoralists to join the program and benefit from hospital care.
The program is now common among pastoralists. Thomas Kapei, from Bisil village, couldn't afford KSh 500 per month for his medical insurance cover. However, upon joining the program, he can now walk into any public health facility for treatment.
“My child got sick and we took him to Kajiado hospital but we were referred to Kenyatta National hospital in Nairobi. The child was admitted for one month and there was a huge bill to pay. The NHIF card cleared the bill,” Kapei said.
“If I hadn't been registered, we wouldn't have been able to pay and the hospital would have detained us for several months. I am urging the county government to put up an office around Bisil village to cater for those who want to register,” he added.
Those who qualify for the Mbuzi Moja, Afya Bora initiative include pastoralists with less than 10 goats and five cows, the very poor, people living with HIV/AIDS, children of imprisoned parents, the unemployed, and widows.
Namunyaka Noladi, a mother of six children, did not register for the initiative because her family members have private medical treatment. But she is thinking of joining.
“When my children get sick, I go to a nearby dispensary or clinic and I receive treatment free of charge. As economy is getting tough and the number of my goats has reduced, I will get a chance to register to help me in the future,” said Noladi.
Since its inception in 2018, more than 5000 nomads in Rift Valley counties of Kenya have signed up, according to Kajiado County officials. Kajiado and Narok counties specifically have benefited from the program. The Maasai community are the majority here and their main socio-economic activity is pastoralism.
The initiative provides alternative medical insurance that benefits a community that believes mostly in herbal medicine, said Saigilu, the county director of Health Services.
“When we realized that our community members were losing parcels of land because of medical bills, we thought of a solution to it,” he said.
“I wanted to do away with the numerous fundraisers in our communities where members raise money for medical bills which continue to impoverish our members. The alternative was the Mbuzi Moja, Afya Bora program,” he added.
In the neighboring urban center of Ngong sub-county, Christopher Mureithi, a renowned environmental Champion, and crusader is not a happy man. He says he registered to the Mbuzi Moja, Afya Bora initiative but has never received his insurance card to date despite several visits to the ward administration offices.
Unlike other residents in remote areas, most of those who live in urban centers within Kajiado and Narok counties have not benefited from this initiative. Alamin Kayeiya Tianda, a cardiac patient, who is also a village elder in Ngong sub-county, tells Africa Calling that it is now nine months since he was registered but he has not received his health insurance card.
“I have received text messages from the ward administrator and when I went there were no cards,” he said.
“NHIF offices in Rongai refers people to go to the NHIF headquarters but it lacks printing materials for the card. I think the problem is not at the county level, the problem is at the NHIF headquarters."
Tanzania, which borders Kenya's Kajiado and Narok counties, is also adopting this initiative.
Saigilu explained the program is attractive and the insurance cards are renewed after 12 months of membership. One is free to choose registration of a goat or other payment alternatives like cash.
“People have the options of choosing a goat for the first year or pay cash in the subsequent years. Most people in urban centers who can't actually get a goat, we are telling them to come with Ksh 3000 and deposit it in Mbuzi Moja, Afya Bora bank account. They will just bring a deposit slip, then we enter their names in the system for payment. The county government could top up another Kshs3000,” Saigilu explained.
Diseases that the insurance program cover include diarrhea, pneumonia, hypertension, diabetes, ear infections, skin infections, and respiratory diseases ,which are common in arid and semi-arid areas like Kajiado and its neighboring counties.
Lack of infrastructure is a major challenge while trying to reach out to more people, especially in remote areas. Saigilu says that they had to adjust the program to ensure anybody who qualifies is included.
“We advise community members to pick a facility that is convenient for them because at the end of the day, it is about NHIF which is not a different entity. If you choose a facility for outpatient services, you can visit any health facility,” Saigilu advised.
“One of the key challenges has been the transportation of the goats because you have to get them to a single auctioneering point. The other challenge is some community members gave out sick goats which died hence a loss to the county government,” he said.
As the pastoralists in Kajiado County and its environs continue to benefit from Mbuzi Moja, Afya Bora program, health experts are urging other county governments to move towards universal health coverage (UHC). This is where all people are entitled to access quality and affordable healthcare as per Kenya's Vision 2030 promise.