Panel Topic: "Solidarity, responsibility and care: ethnographic explorations of health insurance"
Co-convenors: Jacinta Victoria Muinde and Ruth Jane Prince
Jacinta Victoria Muinde, Ruth Jane Prince, and Edwin Ameso will be giving paper presentations based on their ethnographic work on health insurance in Kenya.
Conference: The Association of Social Anthropologists of the UK 2021 virtual Conference (29 March – 02 April).
See more information about the event on ASA2021 homepage.
Panel Abstract:
The "Universal Health Coverage" agenda is redefining global health, as it foregrounds a language of universality, the right to health care and demands for equity, solidarity, and social justice. Under the umbrella of financial protection and increasing access to quality health care, attempts to expand health insurance have become a cornerstone of UHC policies. In much of the Global South, existing national health insurance schemes are parastatal and have historically been limited to people in formal employment. Attempts to extend insurance coverage means including people in the informal economy whose incomes are precarious. As digital, mobile and financial technologies crowd into this field, insurance is emerging as a field of experimentation, often combining a language of solidarity and a language of market innovation. This panel seeks to explore, ethnographically, these experiments with forms of solidarity: How are they positioned between the state and the market? How do they interact with existing socioeconomic landscape and inequalities (such as class), with informal solidarity networks, including kinship, neighborhood and religious groups, as well as formal social protection schemes? Which economic subjectivities, and forms of responsibility for health and care are being pursued or fostered in this process? Which possibilities do they foster, and which vulnerabilities do they exploit?
Presentation of Jacinta Victoria Muinde's paper "Care Solidarities: Navigating Kenya’s national health insurance"
Abstract:
Over the last decade, the Kenya government has continued to expand the country’s national health insurance (National Hospital Insurance Fund) to include those in the informal sector as well as providing free maternal health care and health insurance subsidies for the vulnerable populations such as the beneficiaries of cash transfer schemes and elderly persons. Although the national health insurance is framed within the language of financial protection and state responsibility to care, the health insurance does not offer reliable access to healthcare. In many cases, patients and health workers navigate both mundane and persistent complexities, disappointments, frustrations and failure of the national health insurance through different solidarities: ethnic and kinship based, and patronage networks. The increasing digitization of Kenya’s economy through mobile money technology over the last decade has transformed these forms of solidarities/networks of care in different ways. Based on ethnographic fieldwork in Kenya, this paper explores the new forms of solidarity and care that are forged, maintained and reinforced at the intersection of the country’s national health insurance, formal and non-formal social protection mechanisms, and mobile/digital technology.
Ruth Jane Prince's paper "Health insurance, medical markets, and the vulnerable middle class in Kenya"
Abstract:
In Kenya, an emerging biopolitical landscape of healthcare is taking shape (or was, before the corona pandemic) at the intersection between expanding insurance and medical markets, a middle class with access to credit, the globalization of medical travel, and the continued evisceration of public healthcare. This paper follows middle-class cancer patients and their families as they navigate these landscapes, as shifting yet precarious geographies of health insurance and medical technologies open up horizons of care just within or beyond reach. I explore trajectories of diagnosis and care that are made possible and foreclosed by Kenya’s national health insurance fund, and how these openings and closures force families into double binds, as the (overwhelming) economic burden of illness ultimately rests on family, kin and their social networks.