The failure of large-scale utopian projects is often invoked as explanation for the recent fascination with small-scale, miniature and scaled down solutions to world problems. For example, small, mobile, technical devices – along with scaled-down expectations regarding societal change – are promoted as financially and pragmatically feasible instruments of intervention in the field of development, global health and the response to climate change, often as a way of dealing with a lack of public infrastructure. At the same time, we are witnessing the paradox of moves in the other direction, towards ambitious imaginations of societal transformation that explicitly invoke intervention on a ‘global’ and ‘universal’ scale. New forms of welfare and social protection – such as Universal Health Coverage and Universal Basic Income – have societal and global ambitions regarding coverage and scale, involving biometrics and claims about generating ‘big data’, even while what they actually offer in terms of welfare or healthcare is extremely limited. While seemingly different in their imaginaries, scales and visions of social change, these scalar moves are driven by techno-utopia, sharing a faith in the capacity of technological innovation to address the planet’s problems. They also draw upon a language of the collective, the public, the commons, while often promoting market logics and the privatization of formerly public goods.
This paper explores these tensions by looking at the health insurance market in Kenya. Experiments with different forms of health insurance alongside a concern with financial risk protection are at the core of national moves towards Universal Health Coverage, defined by the WHO as “ensuring all people can receive the quality health services they need without being exposed to financial hardship”. Health insurance schemes are meant to pool risk so that the rich subsidize the poor and the healthy the sick. In Kenya, the National Hospital Insurance Fund, previously confined to civil servants and those in formal employment, has been extended to reach those in the informal economy, with mixed results. Meanwhile, “micro-insurance” for-profit companies, partly funded by donors, focus their efforts on creating insurance markets at the bottom of the pyramid. These enterprises tap into a globally dominant model of corporate investment into development, which enmeshes financial profit, moral engagement, private enterprise and the public good.