The study worked with a very particular sector in Kenya, the informal sector, commonly known as the “Jua Kali” (literally meaning “under the hot sun”) sector (Orwa 2007). The artisans, vendors, and mechanics in this sector face extreme vulnerability to illness, economic dislocation, and natural disasters. Yet, employment in Jua Kali increased by 5.1 million in 2002, accounting for 74.2 per cent of total non-farm employment, according to Kenyas Central Bureau of Statistics. The Jua Kali sector encompasses small-scale entrepreneurs and workers who lack access to credit, property rights, training, and good working conditions. JKA workers supply goods to local markets using predominantly manual labor and little capital, often making do with handmade tools. Their workshops and stands frequently lack electricity and running water. These workers are organized into various sheds built out of metal sheets that give little protection from the elements. Given the extreme health hazards that they face, Jua Kali workers can stand to benefit from insurance schemes that provide coverage in the event of workplace accidents.
Subjects receiving insurance enrolled in the CIC Afya Bora plan, a combined inpatient and outpatient family health insurance policy. These treated households received inpatient benefits of up to KSH 250,000 per family that covered the costs of:
• Hospital accommodation charges for a general ward bed in contracted hospitals • Doctor and healthcare professional fees
• Prescribed routine lab tests
• X-ray and ultrasound tests
• ICU, HDU, and theatre charges
• Prescribed medicines, dressings, and internal surgical appliances
• Routing diagnostic lab tests
• Day care surgery
• Maternity including non-elective caesarean section with 6 mo. waiting period
• Chronic and pre-existing conditions up to KSH 75,000
Households also received outpatient benefits of up to KSH 50,000 per family that
• Routine outpatient consultation
• Diagnostic laboratory and radiology services
• Prescribed medicine and dressings
• HIV/AIDS related conditions and prescribed ARVs
• Routine immunizations
• Routine prenatal check ups
• Postnatal care up to six weeks after delivery
• Pre-existing and chronic conditions up to KSH 20,000 • Outpatient oncology
• Psychiatry and psychotherapy
Beneficiaries paid KSH 100 for each outpatient visit. Both covers included chronic and pre-existing conditions, including HIV/AIDS but excluded treatment outside Kenya, cosmetic treatment, treatment by non-qualified persons, infertility, self-inflicted injury, ex- perimental treatment, and dental treatment unless occassioned by accidental injury. Ben- eficiaries could access these benefits through CIC’s network of providers that included 26 mission and faith based hospitals in Nairobi.
The plan provided benefits to principals and spouses under 72 years old and children dependents younger than 25 years with proof of enrollment in school or college. Subjects were enrolled in the Afya Bora plan free of charge for one year, a value of KSH 12,745 for the principal, spouse and up to five dependents. Each additional child dependent increased the annual premium by KSH 2,000 per child. The project fully reimbursed households for the base cost and any added premium.
Unconditional Cash Transfer
Subjects in the second treatment group received an unconditional cash transfer equal to the net value of the annual premium they would have had to pay had they enrolled in the CIC Afya Bora scheme. The transfer was delivered to recipients electronically using the M-Pesa mobile money service. M-Pesa is a mobile money system offered by Safaricom, the largest Kenyan mobile phone operator. Using M-Pesa requires a registered SIM card and a valid Kenyan national ID card. The project transfered the money from Innovations for Poverty Action Kenya’s (IPA-K) M-Pesa account to that of the recipient. To facilitate the transfers, we encouraged recipients to sign up for M-Pesa and helped them obtain, where necessary, all of the requirements for registration. The cash was transferred to the registered SIM card wirelessly and the recipient could withdraw the balance at an M-Pesa agent by putting the SIM card into the agents cell phone or by using their own phone.