Financial & Health Diaries Evaluation Study

Enhancing UHC in Kenya through digital innovations


Under the Sustainable Development Goals, there has been renewed international commitment to Universal Health Coverage (UHC), the goal of ensuring that all people have access to the quality health services they need without suffering financial hardship in paying for them. However, currently in many countries there are significant resource shortages and service delivery gaps. As a result, the poor lack access to care or may be pushed further into poverty from high healthcare costs. In Kenya, PharmAccess and Amref are developing and implementing a range of innovative digital products and services to enhance the movement towards UHC.

The research project will support PharmAccess and Amref in their endeavor through a high-frequency, high-detail Financial and Health Diaries study. The research has three core objectives:

1. Provide under-the-skin insights in the financial lives and health-seeking behavior of the target population.

2. Rigorously evaluate the impact of PharmAccess and Amref’s i-Push program on health care utilization, financial protection and women’s empowerment.

3. To compare the financial and health consequences of two risk-pooling systems (subsidized health insurance in Kakamega vs. free public care in Kisumu).


The key focus of the research in Kakamega county will be on the i-Push program which aims to enrol low-income women of reproductive age and their family members on health insurance using several digital tools. Capitalizing on the mobile money revolution in Kenya, PharmAccess has, amongst other, developed a health wallet on a mobile technology platform (M-TIBA) which links patients, providers and payers; and Amref has developed a mobile phone-based training for community health volunteers. Using the gradual, randomized expansion of the program allows for a rigorous evaluation of program impact. In Kisumu county, the research will investigate the effect of the free public care pilot as recently rolled out by the Kenyan government, which is also supported by PharmAccess’ MTIBA platform.

The study will be based on weekly Financial and Health Diaries interviews, to be collected among a sample of 350 families in the counties of Kakamega and Kisumu over a period of one year. Diaries data provide deep insights into a population’s key characteristics and health behavior along with their health financing strategies. This improved understanding will enable the program to target those most in need in a tailored manner. Also, the diaries allow introducing shorter research cycles and reporting results on a more frequent basis, enabling program managers to learn and take action for continuous improvements. In addition to the diaries data, the research will utilize qualitative methods, household surveys and behavioral experiments.


PharmAcess International
Amref Kenya

Contact info

Wiesje Zikkenheiner (


Joep Lange Institute
PharmAcess (through the iPush program)
Health Insurance Fund




Project website –