Beryl Maritim: How we pay for healthcare

My name is Beryl Maritim. I'm a Health Financing Researcher at KEMRI Wellcome Trust within the Health Economics Research Unit. And my area of research is around healthcare financing, health economics within low- and middle-income countries. And really, the problem that my research tries to address is in Kenya for example, nearly four out of ten Kenyans live below the poverty line. And so, these households struggle to meet their basic household needs, and nearly every year 1 million Kenyans are being pushed into poverty as a result of health care payments. So, my research tries to look at how can countries finance healthcare in a way that protects families from healthcare cost, while ensuring access to quality healthcare. So, at the very core it's about how do we achieve universal health coverage in a sustainable and fair way.

A recent research project that we've worked on was focusing on Kenya's programme that pays health insurance premiums for the very poor. On paper that sounds very straightforward, but who actually counts as poor? What we found in our research is that the way we define the poor, or how we identify people to benefit from these programmes, determines who actually gets access or benefits from these programmes. And what we found in this particular programme is that we end up recruiting or including people in these programmes who can pay for their own healthcare, and leave out the people who actually need the protection from financial hardship as a result of healthcare payments. So, when we share these kinds of findings with policy makers, what we hope to achieve is that they can be able to inform reforms that ensure that programmes like this actually benefit the people who they were intended for. 

The big questions in healthcare financing right now are really about fairness and sustainability. And I would sum it up in three broad questions. So how do countries raise adequate revenue or resources to finance health care, especially in light of dwindling or shrinking funding from donors? And the second question is really around, once you've mobilised resources, how do you allocate it in a way that ensures that people are protected from financial hardship, and can access quality healthcare? And lastly, how do you allocate very scarce resources in a way that is fair and efficient? Those are the main questions in healthcare financing right now.

For the patients, my work makes a real difference. For a household, a hospital visit can mean the difference between putting food on the table or not being able to feed your family, pulling a child out of school or selling your property. So, this kind of work that I do goes towards informing reforms that reduce these choices, and reduce the bar for accessing health care for many families. And so having that peace of mind that you can access health care without meaning financial ruin can mean a big difference to many households.

Globally, millions of people are pushed into poverty every year as a result of healthcare payments. And without good evidence, governments struggle to design programmes that can actually provide protection for families against healthcare payments, or the risks of incurring catastrophic expenditure for households. And so, funding this kind of research ensures that we are able to produce the evidence that governments need to design smarter and more equitable financing for healthcare, and moves us closer towards achieving universal health coverage. So, it's not just about health care in itself, it's also about building resilient communities.

This interview was recorded in September 2025.